|
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 |
$44.23 |
| Max. Negotiated Rate |
$251.86 |
| Rate for Payer: Aetna Commercial |
$226.95
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$186.90
|
| Rate for Payer: Cofinity Commercial |
$229.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$240.30
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.95
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$226.95
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.86
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$201.49
|
| Rate for Payer: Priority Health SBD |
$168.21
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
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 |
$168.21 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Aetna Commercial |
$226.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.55
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$186.90
|
| Rate for Payer: Cofinity Commercial |
$229.62
|
| Rate for Payer: Healthscope Commercial |
$240.30
|
| 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 SBD |
$168.21
|
|
|
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 |
$55.54 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$74.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.30
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Commercial |
$61.71
|
| Rate for Payer: Cofinity Commercial |
$75.82
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| 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 SBD |
$55.54
|
|
|
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 |
$44.23 |
| Max. Negotiated Rate |
$251.86 |
| Rate for Payer: Aetna Commercial |
$74.94
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Commercial |
$61.71
|
| Rate for Payer: Cofinity Commercial |
$75.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.94
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$74.94
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.86
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$201.49
|
| Rate for Payer: Priority Health SBD |
$55.54
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
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 |
$44.23 |
| Max. Negotiated Rate |
$253.51 |
| Rate for Payer: Aetna Commercial |
$239.43
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$225.34
|
| Rate for Payer: Cash Price |
$225.34
|
| Rate for Payer: Cofinity Commercial |
$197.18
|
| Rate for Payer: Cofinity Commercial |
$242.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$253.51
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.43
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$239.43
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.86
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$201.49
|
| Rate for Payer: Priority Health SBD |
$177.46
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
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 |
$177.46 |
| Max. Negotiated Rate |
$253.51 |
| Rate for Payer: Aetna Commercial |
$239.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.09
|
| Rate for Payer: Cash Price |
$225.34
|
| Rate for Payer: Cofinity Commercial |
$197.18
|
| Rate for Payer: Cofinity Commercial |
$242.24
|
| Rate for Payer: Healthscope Commercial |
$253.51
|
| 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 SBD |
$177.46
|
|
|
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 |
$590.44 |
| Max. Negotiated Rate |
$843.48 |
| Rate for Payer: Aetna Commercial |
$796.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.18
|
| Rate for Payer: Cash Price |
$749.76
|
| Rate for Payer: Cofinity Commercial |
$656.04
|
| Rate for Payer: Cofinity Commercial |
$805.99
|
| Rate for Payer: Healthscope Commercial |
$843.48
|
| 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 SBD |
$590.44
|
|
|
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 |
$44.23 |
| Max. Negotiated Rate |
$843.48 |
| Rate for Payer: Aetna Commercial |
$796.62
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$749.76
|
| Rate for Payer: Cash Price |
$749.76
|
| Rate for Payer: Cofinity Commercial |
$656.04
|
| Rate for Payer: Cofinity Commercial |
$805.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$843.48
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$796.62
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$796.62
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.86
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$201.49
|
| Rate for Payer: Priority Health SBD |
$590.44
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
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 |
$496.29 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| 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 SBD |
$496.29
|
|
|
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 |
$200.74 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$669.60
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$496.29
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
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 |
$496.29 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| 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 SBD |
$496.29
|
|
|
HC RADXF UNL NM CNS 78699
|
Facility
|
OP
|
$787.76
|
|
|
Service Code
|
CPT 78699
|
| Hospital Charge Code |
34100043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$669.60
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$496.29
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC RADXF UNL NM ENDOCR 78099
|
Facility
|
OP
|
$787.76
|
|
|
Service Code
|
CPT 78099
|
| Hospital Charge Code |
34100008
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$669.60
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$496.29
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC RADXF UNL NM ENDOCR 78099
|
Facility
|
IP
|
$787.76
|
|
|
Service Code
|
CPT 78099
|
| Hospital Charge Code |
34100008
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$496.29 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| 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 SBD |
$496.29
|
|
|
HC RADXF UNL NM GI PROC 78299
|
Facility
|
OP
|
$787.76
|
|
|
Service Code
|
CPT 78299
|
| Hospital Charge Code |
34100022
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$669.60
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$496.29
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC RADXF UNL NM GI PROC 78299
|
Facility
|
IP
|
$787.76
|
|
|
Service Code
|
CPT 78299
|
| Hospital Charge Code |
34100022
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$496.29 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| 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 SBD |
$496.29
|
|
|
HC RADXF UNL NM GU 78799
|
Facility
|
IP
|
$787.76
|
|
|
Service Code
|
CPT 78799
|
| Hospital Charge Code |
34100051
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$496.29 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| 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 SBD |
$496.29
|
|
|
HC RADXF UNL NM GU 78799
|
Facility
|
OP
|
$787.76
|
|
|
Service Code
|
CPT 78799
|
| Hospital Charge Code |
34100051
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$669.60
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$496.29
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC RADXF UNL NM H R L 78199
|
Facility
|
OP
|
$735.63
|
|
|
Service Code
|
CPT 78199
|
| Hospital Charge Code |
34100013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$662.07 |
| Rate for Payer: Aetna Commercial |
$625.29
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Cofinity Commercial |
$632.64
|
| Rate for Payer: Cofinity Commercial |
$514.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$662.07
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$625.29
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$625.29
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.94
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$463.45
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC RADXF UNL NM H R L 78199
|
Facility
|
IP
|
$735.63
|
|
|
Service Code
|
CPT 78199
|
| Hospital Charge Code |
34100013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$463.45 |
| Max. Negotiated Rate |
$662.07 |
| Rate for Payer: Aetna Commercial |
$625.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.16
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Cofinity Commercial |
$632.64
|
| Rate for Payer: Cofinity Commercial |
$514.94
|
| Rate for Payer: Healthscope Commercial |
$662.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$625.29
|
| Rate for Payer: PHP Commercial |
$625.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.94
|
| Rate for Payer: Priority Health SBD |
$463.45
|
|
|
HC RADXF UNL NM MUSCSKL 78399
|
Facility
|
OP
|
$1,885.39
|
|
|
Service Code
|
CPT 78399
|
| Hospital Charge Code |
34100028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$1,696.85 |
| Rate for Payer: Aetna Commercial |
$1,602.58
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,225.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$1,508.31
|
| Rate for Payer: Cash Price |
$1,508.31
|
| Rate for Payer: Cofinity Commercial |
$1,621.44
|
| Rate for Payer: Cofinity Commercial |
$1,319.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$1,696.85
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,602.58
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$1,602.58
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,319.77
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$1,187.80
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC RADXF UNL NM MUSCSKL 78399
|
Facility
|
IP
|
$1,885.39
|
|
|
Service Code
|
CPT 78399
|
| Hospital Charge Code |
34100028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,187.80 |
| Max. Negotiated Rate |
$1,696.85 |
| Rate for Payer: Aetna Commercial |
$1,602.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,225.50
|
| Rate for Payer: Cash Price |
$1,508.31
|
| Rate for Payer: Cofinity Commercial |
$1,319.77
|
| Rate for Payer: Cofinity Commercial |
$1,621.44
|
| Rate for Payer: Healthscope Commercial |
$1,696.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,602.58
|
| Rate for Payer: PHP Commercial |
$1,602.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,319.77
|
| Rate for Payer: Priority Health SBD |
$1,187.80
|
|
|
HC RADXF UNL NM PROC MISC 78999
|
Facility
|
IP
|
$787.76
|
|
|
Service Code
|
CPT 78999
|
| Hospital Charge Code |
34100061
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$496.29 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| 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 SBD |
$496.29
|
|
|
HC RADXF UNL NM PROC MISC 78999
|
Facility
|
OP
|
$787.76
|
|
|
Service Code
|
CPT 78999
|
| Hospital Charge Code |
34100061
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$669.60
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$496.29
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC RADXF UNL NM RADPHARM THER 799
|
Facility
|
IP
|
$787.76
|
|
|
Service Code
|
CPT 79999
|
| Hospital Charge Code |
34100066
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$496.29 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.04
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Cofinity Commercial |
$551.43
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| 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 SBD |
$496.29
|
|
