|
HC RNP ANTIBODIES, IGG
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.72
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.72
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
IP
|
$219.40
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$138.22 |
| Max. Negotiated Rate |
$197.46 |
| Rate for Payer: Aetna Commercial |
$186.49
|
| Rate for Payer: Aetna Commercial |
$905.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.25
|
| Rate for Payer: Cash Price |
$175.52
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cofinity Commercial |
$915.90
|
| Rate for Payer: Cofinity Commercial |
$188.68
|
| Rate for Payer: Cofinity Commercial |
$153.58
|
| Rate for Payer: Cofinity Commercial |
$745.50
|
| Rate for Payer: Healthscope Commercial |
$197.46
|
| Rate for Payer: Healthscope Commercial |
$958.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$905.25
|
| Rate for Payer: PHP Commercial |
$186.49
|
| Rate for Payer: PHP Commercial |
$905.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.50
|
| Rate for Payer: Priority Health SBD |
$138.22
|
| Rate for Payer: Priority Health SBD |
$670.95
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$118.09 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Aetna Commercial |
$905.25
|
| Rate for Payer: Aetna Commercial |
$186.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.25
|
| Rate for Payer: BCBS Complete |
$87.76
|
| Rate for Payer: BCBS Complete |
$426.00
|
| Rate for Payer: BCBS Trust/PPO |
$118.09
|
| Rate for Payer: BCBS Trust/PPO |
$118.09
|
| Rate for Payer: Cash Price |
$175.52
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cash Price |
$175.52
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cofinity Commercial |
$915.90
|
| Rate for Payer: Cofinity Commercial |
$188.68
|
| Rate for Payer: Cofinity Commercial |
$153.58
|
| Rate for Payer: Cofinity Commercial |
$745.50
|
| Rate for Payer: Healthscope Commercial |
$958.50
|
| Rate for Payer: Healthscope Commercial |
$197.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$905.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.49
|
| Rate for Payer: PHP Commercial |
$905.25
|
| Rate for Payer: PHP Commercial |
$186.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.50
|
| Rate for Payer: Priority Health SBD |
$670.95
|
| Rate for Payer: Priority Health SBD |
$138.22
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
IP
|
$5,296.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,336.48 |
| Max. Negotiated Rate |
$4,766.40 |
| Rate for Payer: Aetna Commercial |
$4,501.60
|
| Rate for Payer: Aetna Commercial |
$2,740.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,442.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,095.29
|
| Rate for Payer: Cash Price |
$4,236.80
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cofinity Commercial |
$4,554.56
|
| Rate for Payer: Cofinity Commercial |
$2,256.47
|
| Rate for Payer: Cofinity Commercial |
$2,772.24
|
| Rate for Payer: Cofinity Commercial |
$3,707.20
|
| Rate for Payer: Healthscope Commercial |
$2,901.18
|
| Rate for Payer: Healthscope Commercial |
$4,766.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,740.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,501.60
|
| Rate for Payer: PHP Commercial |
$2,740.00
|
| Rate for Payer: PHP Commercial |
$4,501.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,707.20
|
| Rate for Payer: Priority Health SBD |
$3,336.48
|
| Rate for Payer: Priority Health SBD |
$2,030.82
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
OP
|
$3,223.53
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$286.51 |
| Max. Negotiated Rate |
$2,901.18 |
| Rate for Payer: Aetna Commercial |
$2,740.00
|
| Rate for Payer: Aetna Commercial |
$4,501.60
|
| Rate for Payer: Aetna Medicare |
$544.74
|
| Rate for Payer: Aetna Medicare |
$544.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,442.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,095.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.74
|
| Rate for Payer: BCBS Complete |
$300.86
|
| Rate for Payer: BCBS Complete |
$300.86
|
| Rate for Payer: BCBS MAPPO |
$523.79
|
| Rate for Payer: BCBS MAPPO |
$523.79
|
| Rate for Payer: BCBS Trust/PPO |
$551.82
|
| Rate for Payer: BCBS Trust/PPO |
$551.82
|
| Rate for Payer: BCN Medicare Advantage |
$523.79
|
| Rate for Payer: BCN Medicare Advantage |
$523.79
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$4,236.80
|
| Rate for Payer: Cash Price |
$4,236.80
|
| Rate for Payer: Cofinity Commercial |
$4,554.56
|
| Rate for Payer: Cofinity Commercial |
$3,707.20
|
| Rate for Payer: Cofinity Commercial |
$2,256.47
|
| Rate for Payer: Cofinity Commercial |
$2,772.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.79
|
| Rate for Payer: Healthscope Commercial |
$4,766.40
|
| Rate for Payer: Healthscope Commercial |
$2,901.18
|
| Rate for Payer: Mclaren Medicaid |
$286.51
|
| Rate for Payer: Mclaren Medicaid |
$286.51
|
| Rate for Payer: Mclaren Medicare |
$523.79
|
| Rate for Payer: Mclaren Medicare |
$523.79
|
| Rate for Payer: Meridian Medicaid |
$300.86
|
| Rate for Payer: Meridian Medicaid |
$300.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,501.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,740.00
|
| Rate for Payer: PACE Medicare |
$497.60
|
| Rate for Payer: PACE Medicare |
$497.60
|
| Rate for Payer: PACE SWMI |
$523.79
|
| Rate for Payer: PACE SWMI |
$523.79
|
| Rate for Payer: PHP Commercial |
$4,501.60
|
| Rate for Payer: PHP Commercial |
$2,740.00
|
| Rate for Payer: PHP Medicare Advantage |
$523.79
|
| Rate for Payer: PHP Medicare Advantage |
$523.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,707.20
|
| Rate for Payer: Priority Health Medicare |
$523.79
|
| Rate for Payer: Priority Health Medicare |
$523.79
|
| Rate for Payer: Priority Health SBD |
$3,336.48
|
| Rate for Payer: Priority Health SBD |
$2,030.82
|
| Rate for Payer: Railroad Medicare Medicare |
$523.79
|
| Rate for Payer: Railroad Medicare Medicare |
$523.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$523.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$523.79
|
| Rate for Payer: UHC Medicare Advantage |
$539.50
|
| Rate for Payer: UHC Medicare Advantage |
$539.50
|
| Rate for Payer: VA VA |
$523.79
|
| Rate for Payer: VA VA |
$523.79
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
OP
|
$3,223.53
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$286.51 |
| Max. Negotiated Rate |
$2,901.18 |
| Rate for Payer: Aetna Commercial |
$2,740.00
|
| Rate for Payer: Aetna Commercial |
$4,331.60
|
| Rate for Payer: Aetna Medicare |
$544.74
|
| Rate for Payer: Aetna Medicare |
$544.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,312.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,095.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.74
|
| Rate for Payer: BCBS Complete |
$300.86
|
| Rate for Payer: BCBS Complete |
$300.86
|
| Rate for Payer: BCBS MAPPO |
$523.79
|
| Rate for Payer: BCBS MAPPO |
$523.79
|
| Rate for Payer: BCBS Trust/PPO |
$551.82
|
| Rate for Payer: BCBS Trust/PPO |
$551.82
|
| Rate for Payer: BCN Medicare Advantage |
$523.79
|
| Rate for Payer: BCN Medicare Advantage |
$523.79
|
| Rate for Payer: Cash Price |
$4,076.80
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$4,076.80
|
| Rate for Payer: Cofinity Commercial |
$3,567.20
|
| Rate for Payer: Cofinity Commercial |
$4,382.56
|
| Rate for Payer: Cofinity Commercial |
$2,256.47
|
| Rate for Payer: Cofinity Commercial |
$2,772.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.79
|
| Rate for Payer: Healthscope Commercial |
$2,901.18
|
| Rate for Payer: Healthscope Commercial |
$4,586.40
|
| Rate for Payer: Mclaren Medicaid |
$286.51
|
| Rate for Payer: Mclaren Medicaid |
$286.51
|
| Rate for Payer: Mclaren Medicare |
$523.79
|
| Rate for Payer: Mclaren Medicare |
$523.79
|
| Rate for Payer: Meridian Medicaid |
$300.86
|
| Rate for Payer: Meridian Medicaid |
$300.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,740.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,331.60
|
| Rate for Payer: PACE Medicare |
$497.60
|
| Rate for Payer: PACE Medicare |
$497.60
|
| Rate for Payer: PACE SWMI |
$523.79
|
| Rate for Payer: PACE SWMI |
$523.79
|
| Rate for Payer: PHP Commercial |
$4,331.60
|
| Rate for Payer: PHP Commercial |
$2,740.00
|
| Rate for Payer: PHP Medicare Advantage |
$523.79
|
| Rate for Payer: PHP Medicare Advantage |
$523.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,567.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.47
|
| Rate for Payer: Priority Health Medicare |
$523.79
|
| Rate for Payer: Priority Health Medicare |
$523.79
|
| Rate for Payer: Priority Health SBD |
$3,210.48
|
| Rate for Payer: Priority Health SBD |
$2,030.82
|
| Rate for Payer: Railroad Medicare Medicare |
$523.79
|
| Rate for Payer: Railroad Medicare Medicare |
$523.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$523.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$523.79
|
| Rate for Payer: UHC Medicare Advantage |
$539.50
|
| Rate for Payer: UHC Medicare Advantage |
$539.50
|
| Rate for Payer: VA VA |
$523.79
|
| Rate for Payer: VA VA |
$523.79
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
IP
|
$5,096.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,210.48 |
| Max. Negotiated Rate |
$4,586.40 |
| Rate for Payer: Aetna Commercial |
$4,331.60
|
| Rate for Payer: Aetna Commercial |
$2,740.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,312.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,095.29
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$4,076.80
|
| Rate for Payer: Cofinity Commercial |
$3,567.20
|
| Rate for Payer: Cofinity Commercial |
$2,256.47
|
| Rate for Payer: Cofinity Commercial |
$2,772.24
|
| Rate for Payer: Cofinity Commercial |
$4,382.56
|
| Rate for Payer: Healthscope Commercial |
$2,901.18
|
| Rate for Payer: Healthscope Commercial |
$4,586.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,331.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,740.00
|
| Rate for Payer: PHP Commercial |
$2,740.00
|
| Rate for Payer: PHP Commercial |
$4,331.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,567.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.47
|
| Rate for Payer: Priority Health SBD |
$2,030.82
|
| Rate for Payer: Priority Health SBD |
$3,210.48
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
OP
|
$325.38
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$425.02 |
| Rate for Payer: Aetna Commercial |
$276.57
|
| Rate for Payer: Aetna Medicare |
$248.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.91
|
| Rate for Payer: BCBS Complete |
$137.36
|
| Rate for Payer: BCBS MAPPO |
$239.13
|
| Rate for Payer: BCBS Trust/PPO |
$214.02
|
| Rate for Payer: BCN Medicare Advantage |
$239.13
|
| Rate for Payer: Cash Price |
$260.30
|
| Rate for Payer: Cash Price |
$260.30
|
| Rate for Payer: Cofinity Commercial |
$227.77
|
| Rate for Payer: Cofinity Commercial |
$279.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.13
|
| Rate for Payer: Healthscope Commercial |
$292.84
|
| Rate for Payer: Mclaren Medicaid |
$130.80
|
| Rate for Payer: Mclaren Medicare |
$239.13
|
| Rate for Payer: Meridian Medicaid |
$137.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$251.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.57
|
| Rate for Payer: PACE Medicare |
$227.17
|
| Rate for Payer: PACE SWMI |
$239.13
|
| Rate for Payer: PHP Commercial |
$276.57
|
| Rate for Payer: PHP Medicare Advantage |
$239.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.77
|
| Rate for Payer: Priority Health Medicare |
$239.13
|
| Rate for Payer: Priority Health SBD |
$204.99
|
| Rate for Payer: Railroad Medicare Medicare |
$239.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.13
|
| Rate for Payer: UHC Exchange |
$386.38
|
| Rate for Payer: UHC Medicare Advantage |
$246.30
|
| Rate for Payer: VA VA |
$239.13
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
IP
|
$325.38
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$204.99 |
| Max. Negotiated Rate |
$292.84 |
| Rate for Payer: Aetna Commercial |
$276.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.50
|
| Rate for Payer: Cash Price |
$260.30
|
| Rate for Payer: Cofinity Commercial |
$227.77
|
| Rate for Payer: Cofinity Commercial |
$279.83
|
| Rate for Payer: Healthscope Commercial |
$292.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.57
|
| Rate for Payer: PHP Commercial |
$276.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.77
|
| Rate for Payer: Priority Health SBD |
$204.99
|
|
|
HC RO INS VAG BRACHTHER DEVICE
|
Facility
|
OP
|
$539.61
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
36100444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$458.67
|
| Rate for Payer: Aetna Medicare |
$296.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.81
|
| Rate for Payer: BCBS Complete |
$163.96
|
| Rate for Payer: BCBS MAPPO |
$285.45
|
| Rate for Payer: BCBS Trust/PPO |
$182.50
|
| Rate for Payer: BCN Medicare Advantage |
$285.45
|
| Rate for Payer: Cash Price |
$431.69
|
| Rate for Payer: Cash Price |
$431.69
|
| Rate for Payer: Cofinity Commercial |
$464.06
|
| Rate for Payer: Cofinity Commercial |
$377.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.45
|
| Rate for Payer: Healthscope Commercial |
$485.65
|
| Rate for Payer: Mclaren Medicaid |
$156.14
|
| Rate for Payer: Mclaren Medicare |
$285.45
|
| Rate for Payer: Meridian Medicaid |
$163.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$458.67
|
| Rate for Payer: PACE Medicare |
$271.18
|
| Rate for Payer: PACE SWMI |
$285.45
|
| Rate for Payer: PHP Commercial |
$458.67
|
| Rate for Payer: PHP Medicare Advantage |
$285.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.73
|
| Rate for Payer: Priority Health Medicare |
$285.45
|
| Rate for Payer: Priority Health SBD |
$339.95
|
| Rate for Payer: Railroad Medicare Medicare |
$285.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.80
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.45
|
| Rate for Payer: UHC Exchange |
$148.00
|
| Rate for Payer: UHC Medicare Advantage |
$294.01
|
| Rate for Payer: VA VA |
$285.45
|
|
|
HC RO INS VAG BRACHTHER DEVICE
|
Facility
|
IP
|
$539.61
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
36100444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$339.95 |
| Max. Negotiated Rate |
$485.65 |
| Rate for Payer: Aetna Commercial |
$458.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.75
|
| Rate for Payer: Cash Price |
$431.69
|
| Rate for Payer: Cofinity Commercial |
$377.73
|
| Rate for Payer: Cofinity Commercial |
$464.06
|
| Rate for Payer: Healthscope Commercial |
$485.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$458.67
|
| Rate for Payer: PHP Commercial |
$458.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.73
|
| Rate for Payer: Priority Health SBD |
$339.95
|
|
|
HC RO INTRSTI RADELEMENT APPL CMPLX
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT 77778
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$348.96 |
| Max. Negotiated Rate |
$1,138.50 |
| Rate for Payer: Aetna Commercial |
$1,075.25
|
| Rate for Payer: Aetna Commercial |
$2,364.31
|
| Rate for Payer: Aetna Medicare |
$663.48
|
| Rate for Payer: Aetna Medicare |
$663.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,808.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.45
|
| Rate for Payer: BCBS Complete |
$366.44
|
| Rate for Payer: BCBS Complete |
$366.44
|
| Rate for Payer: BCBS MAPPO |
$637.96
|
| Rate for Payer: BCBS MAPPO |
$637.96
|
| Rate for Payer: BCBS Trust/PPO |
$748.52
|
| Rate for Payer: BCBS Trust/PPO |
$748.52
|
| Rate for Payer: BCN Medicare Advantage |
$637.96
|
| Rate for Payer: BCN Medicare Advantage |
$637.96
|
| Rate for Payer: Cash Price |
$2,225.23
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$2,225.23
|
| Rate for Payer: Cofinity Commercial |
$1,087.90
|
| Rate for Payer: Cofinity Commercial |
$885.50
|
| Rate for Payer: Cofinity Commercial |
$2,392.12
|
| Rate for Payer: Cofinity Commercial |
$1,947.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.96
|
| Rate for Payer: Healthscope Commercial |
$2,503.39
|
| Rate for Payer: Healthscope Commercial |
$1,138.50
|
| Rate for Payer: Mclaren Medicaid |
$348.96
|
| Rate for Payer: Mclaren Medicaid |
$348.96
|
| Rate for Payer: Mclaren Medicare |
$637.96
|
| Rate for Payer: Mclaren Medicare |
$637.96
|
| Rate for Payer: Meridian Medicaid |
$366.44
|
| Rate for Payer: Meridian Medicaid |
$366.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$669.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$669.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,364.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,075.25
|
| Rate for Payer: PACE Medicare |
$606.06
|
| Rate for Payer: PACE Medicare |
$606.06
|
| Rate for Payer: PACE SWMI |
$637.96
|
| Rate for Payer: PACE SWMI |
$637.96
|
| Rate for Payer: PHP Commercial |
$2,364.31
|
| Rate for Payer: PHP Commercial |
$1,075.25
|
| Rate for Payer: PHP Medicare Advantage |
$637.96
|
| Rate for Payer: PHP Medicare Advantage |
$637.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.08
|
| Rate for Payer: Priority Health Medicare |
$637.96
|
| Rate for Payer: Priority Health Medicare |
$637.96
|
| Rate for Payer: Priority Health SBD |
$1,752.37
|
| Rate for Payer: Priority Health SBD |
$796.95
|
| Rate for Payer: Railroad Medicare Medicare |
$637.96
|
| Rate for Payer: Railroad Medicare Medicare |
$637.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$995.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$995.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.96
|
| Rate for Payer: UHC Exchange |
$904.72
|
| Rate for Payer: UHC Exchange |
$904.72
|
| Rate for Payer: UHC Medicare Advantage |
$657.10
|
| Rate for Payer: UHC Medicare Advantage |
$657.10
|
| Rate for Payer: VA VA |
$637.96
|
| Rate for Payer: VA VA |
$637.96
|
|
|
HC RO INTRSTI RADELEMENT APPL CMPLX
|
Facility
|
IP
|
$2,781.54
|
|
|
Service Code
|
CPT 77778
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,752.37 |
| Max. Negotiated Rate |
$2,503.39 |
| Rate for Payer: Aetna Commercial |
$2,364.31
|
| Rate for Payer: Aetna Commercial |
$1,075.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,808.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$2,225.23
|
| Rate for Payer: Cofinity Commercial |
$1,087.90
|
| Rate for Payer: Cofinity Commercial |
$1,947.08
|
| Rate for Payer: Cofinity Commercial |
$2,392.12
|
| Rate for Payer: Cofinity Commercial |
$885.50
|
| Rate for Payer: Healthscope Commercial |
$1,138.50
|
| Rate for Payer: Healthscope Commercial |
$2,503.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,075.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,364.31
|
| Rate for Payer: PHP Commercial |
$1,075.25
|
| Rate for Payer: PHP Commercial |
$2,364.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.50
|
| Rate for Payer: Priority Health SBD |
$1,752.37
|
| Rate for Payer: Priority Health SBD |
$796.95
|
|
|
HC RO ISODOSE BRACH CALC SIMPLE
|
Facility
|
IP
|
$230.25
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$145.06 |
| Max. Negotiated Rate |
$207.22 |
| Rate for Payer: Aetna Commercial |
$195.71
|
| Rate for Payer: Aetna Commercial |
$846.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.40
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$796.80
|
| Rate for Payer: Cofinity Commercial |
$198.02
|
| Rate for Payer: Cofinity Commercial |
$161.18
|
| Rate for Payer: Cofinity Commercial |
$697.20
|
| Rate for Payer: Cofinity Commercial |
$856.56
|
| Rate for Payer: Healthscope Commercial |
$896.40
|
| Rate for Payer: Healthscope Commercial |
$207.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$846.60
|
| Rate for Payer: PHP Commercial |
$195.71
|
| Rate for Payer: PHP Commercial |
$846.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.18
|
| Rate for Payer: Priority Health SBD |
$145.06
|
| Rate for Payer: Priority Health SBD |
$627.48
|
|
|
HC RO ISODOSE BRACH CALC SIMPLE
|
Facility
|
OP
|
$230.25
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$145.06 |
| Max. Negotiated Rate |
$410.96 |
| Rate for Payer: Aetna Commercial |
$195.71
|
| Rate for Payer: Aetna Commercial |
$846.60
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS Trust/PPO |
$281.87
|
| Rate for Payer: BCBS Trust/PPO |
$281.87
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$796.80
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$796.80
|
| Rate for Payer: Cofinity Commercial |
$198.02
|
| Rate for Payer: Cofinity Commercial |
$856.56
|
| Rate for Payer: Cofinity Commercial |
$697.20
|
| Rate for Payer: Cofinity Commercial |
$161.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Healthscope Commercial |
$896.40
|
| Rate for Payer: Healthscope Commercial |
$207.22
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$846.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.71
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PHP Commercial |
$195.71
|
| Rate for Payer: PHP Commercial |
$846.60
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.18
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health SBD |
$145.06
|
| Rate for Payer: Priority Health SBD |
$627.48
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Exchange |
$241.98
|
| Rate for Payer: UHC Exchange |
$241.98
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: VA VA |
$328.77
|
| Rate for Payer: VA VA |
$328.77
|
|
|
HC RO ISODOSE BRACHY CALC COMPLEX
|
Facility
|
OP
|
$671.51
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$179.84 |
| Max. Negotiated Rate |
$604.36 |
| Rate for Payer: Aetna Commercial |
$570.78
|
| Rate for Payer: Aetna Commercial |
$1,495.15
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,143.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS Trust/PPO |
$502.50
|
| Rate for Payer: BCBS Trust/PPO |
$502.50
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: Cash Price |
$1,407.20
|
| Rate for Payer: Cash Price |
$537.21
|
| Rate for Payer: Cash Price |
$537.21
|
| Rate for Payer: Cash Price |
$1,407.20
|
| Rate for Payer: Cofinity Commercial |
$1,231.30
|
| Rate for Payer: Cofinity Commercial |
$1,512.74
|
| Rate for Payer: Cofinity Commercial |
$577.50
|
| Rate for Payer: Cofinity Commercial |
$470.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Healthscope Commercial |
$604.36
|
| Rate for Payer: Healthscope Commercial |
$1,583.10
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,495.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$570.78
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PHP Commercial |
$1,495.15
|
| Rate for Payer: PHP Commercial |
$570.78
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,231.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.06
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health SBD |
$423.05
|
| Rate for Payer: Priority Health SBD |
$1,108.17
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Exchange |
$451.22
|
| Rate for Payer: UHC Exchange |
$451.22
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: VA VA |
$328.77
|
| Rate for Payer: VA VA |
$328.77
|
|
|
HC RO ISODOSE BRACHY CALC COMPLEX
|
Facility
|
IP
|
$1,759.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,108.17 |
| Max. Negotiated Rate |
$1,583.10 |
| Rate for Payer: Aetna Commercial |
$1,495.15
|
| Rate for Payer: Aetna Commercial |
$570.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,143.35
|
| Rate for Payer: Cash Price |
$1,407.20
|
| Rate for Payer: Cash Price |
$537.21
|
| Rate for Payer: Cofinity Commercial |
$1,231.30
|
| Rate for Payer: Cofinity Commercial |
$577.50
|
| Rate for Payer: Cofinity Commercial |
$470.06
|
| Rate for Payer: Cofinity Commercial |
$1,512.74
|
| Rate for Payer: Healthscope Commercial |
$1,583.10
|
| Rate for Payer: Healthscope Commercial |
$604.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$570.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,495.15
|
| Rate for Payer: PHP Commercial |
$1,495.15
|
| Rate for Payer: PHP Commercial |
$570.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,231.30
|
| Rate for Payer: Priority Health SBD |
$1,108.17
|
| Rate for Payer: Priority Health SBD |
$423.05
|
|
|
HC RO ISODOSE BRACHY CALC INTRM
|
Facility
|
IP
|
$1,283.00
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$808.29 |
| Max. Negotiated Rate |
$1,154.70 |
| Rate for Payer: Aetna Commercial |
$1,090.55
|
| Rate for Payer: Aetna Commercial |
$518.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$833.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.80
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cash Price |
$488.37
|
| Rate for Payer: Cofinity Commercial |
$898.10
|
| Rate for Payer: Cofinity Commercial |
$427.32
|
| Rate for Payer: Cofinity Commercial |
$525.00
|
| Rate for Payer: Cofinity Commercial |
$1,103.38
|
| Rate for Payer: Healthscope Commercial |
$549.41
|
| Rate for Payer: Healthscope Commercial |
$1,154.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,090.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$518.89
|
| Rate for Payer: PHP Commercial |
$518.89
|
| Rate for Payer: PHP Commercial |
$1,090.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$898.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.32
|
| Rate for Payer: Priority Health SBD |
$808.29
|
| Rate for Payer: Priority Health SBD |
$384.59
|
|
|
HC RO ISODOSE BRACHY CALC INTRM
|
Facility
|
OP
|
$610.46
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$179.84 |
| Max. Negotiated Rate |
$549.41 |
| Rate for Payer: Aetna Commercial |
$518.89
|
| Rate for Payer: Aetna Commercial |
$1,090.55
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$833.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS Trust/PPO |
$371.77
|
| Rate for Payer: BCBS Trust/PPO |
$371.77
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: Cash Price |
$488.37
|
| Rate for Payer: Cash Price |
$488.37
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cofinity Commercial |
$898.10
|
| Rate for Payer: Cofinity Commercial |
$427.32
|
| Rate for Payer: Cofinity Commercial |
$525.00
|
| Rate for Payer: Cofinity Commercial |
$1,103.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Healthscope Commercial |
$1,154.70
|
| Rate for Payer: Healthscope Commercial |
$549.41
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$518.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,090.55
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PHP Commercial |
$518.89
|
| Rate for Payer: PHP Commercial |
$1,090.55
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$898.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.32
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health SBD |
$384.59
|
| Rate for Payer: Priority Health SBD |
$808.29
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Exchange |
$318.27
|
| Rate for Payer: UHC Exchange |
$318.27
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: VA VA |
$328.77
|
| Rate for Payer: VA VA |
$328.77
|
|
|
HC RO ISODOSE TELETHRPY COMPLEX
|
Facility
|
OP
|
$1,135.26
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$179.84 |
| Max. Negotiated Rate |
$1,021.73 |
| Rate for Payer: Aetna Commercial |
$964.97
|
| Rate for Payer: Aetna Commercial |
$997.90
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS Trust/PPO |
$221.19
|
| Rate for Payer: BCBS Trust/PPO |
$221.19
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: Cash Price |
$908.21
|
| Rate for Payer: Cash Price |
$908.21
|
| Rate for Payer: Cash Price |
$939.20
|
| Rate for Payer: Cash Price |
$939.20
|
| Rate for Payer: Cofinity Commercial |
$976.32
|
| Rate for Payer: Cofinity Commercial |
$1,009.64
|
| Rate for Payer: Cofinity Commercial |
$821.80
|
| Rate for Payer: Cofinity Commercial |
$794.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Healthscope Commercial |
$1,021.73
|
| Rate for Payer: Healthscope Commercial |
$1,056.60
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$964.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.90
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PHP Commercial |
$964.97
|
| Rate for Payer: PHP Commercial |
$997.90
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$794.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.80
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health SBD |
$739.62
|
| Rate for Payer: Priority Health SBD |
$715.21
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Exchange |
$282.26
|
| Rate for Payer: UHC Exchange |
$282.26
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: VA VA |
$328.77
|
| Rate for Payer: VA VA |
$328.77
|
|
|
HC RO ISODOSE TELETHRPY COMPLEX
|
Facility
|
IP
|
$1,135.26
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$715.21 |
| Max. Negotiated Rate |
$1,021.73 |
| Rate for Payer: Aetna Commercial |
$964.97
|
| Rate for Payer: Aetna Commercial |
$997.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.92
|
| Rate for Payer: Cash Price |
$908.21
|
| Rate for Payer: Cash Price |
$939.20
|
| Rate for Payer: Cofinity Commercial |
$794.68
|
| Rate for Payer: Cofinity Commercial |
$976.32
|
| Rate for Payer: Cofinity Commercial |
$1,009.64
|
| Rate for Payer: Cofinity Commercial |
$821.80
|
| Rate for Payer: Healthscope Commercial |
$1,021.73
|
| Rate for Payer: Healthscope Commercial |
$1,056.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$964.97
|
| Rate for Payer: PHP Commercial |
$997.90
|
| Rate for Payer: PHP Commercial |
$964.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$794.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.80
|
| Rate for Payer: Priority Health SBD |
$715.21
|
| Rate for Payer: Priority Health SBD |
$739.62
|
|
|
HC RO ISODOSE TELETHRPY SIMPLE
|
Facility
|
OP
|
$247.86
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$122.45 |
| Max. Negotiated Rate |
$410.96 |
| Rate for Payer: Aetna Commercial |
$210.68
|
| Rate for Payer: Aetna Commercial |
$544.85
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS Trust/PPO |
$122.45
|
| Rate for Payer: BCBS Trust/PPO |
$122.45
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: Cash Price |
$198.29
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$198.29
|
| Rate for Payer: Cofinity Commercial |
$448.70
|
| Rate for Payer: Cofinity Commercial |
$213.16
|
| Rate for Payer: Cofinity Commercial |
$551.26
|
| Rate for Payer: Cofinity Commercial |
$173.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Healthscope Commercial |
$223.07
|
| Rate for Payer: Healthscope Commercial |
$576.90
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$544.85
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PHP Commercial |
$210.68
|
| Rate for Payer: PHP Commercial |
$544.85
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.50
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health SBD |
$156.15
|
| Rate for Payer: Priority Health SBD |
$403.83
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Exchange |
$145.71
|
| Rate for Payer: UHC Exchange |
$145.71
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: VA VA |
$328.77
|
| Rate for Payer: VA VA |
$328.77
|
|
