|
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: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$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: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
OP
|
$3,999.93
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$3,599.94 |
| Rate for Payer: Aetna Commercial |
$3,399.94
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,599.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$480.45
|
| Rate for Payer: BCN Commercial |
$480.45
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$3,199.94
|
| Rate for Payer: Cash Price |
$3,199.94
|
| Rate for Payer: Cash Price |
$3,199.94
|
| Rate for Payer: Cofinity Advantage |
$2,799.95
|
| Rate for Payer: Cofinity Commercial |
$3,439.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,199.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$3,599.94
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,399.94
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,999.95
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$3,399.94
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$2,519.96
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
IP
|
$3,999.93
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,519.96 |
| Max. Negotiated Rate |
$3,599.94 |
| Rate for Payer: Priority Health SBD |
$2,519.96
|
| Rate for Payer: Aetna Commercial |
$3,399.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,599.95
|
| Rate for Payer: Cash Price |
$3,199.94
|
| Rate for Payer: Cofinity Advantage |
$2,799.95
|
| Rate for Payer: Cofinity Commercial |
$3,439.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,199.94
|
| Rate for Payer: Healthscope Commercial |
$3,599.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,399.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,999.95
|
| Rate for Payer: PHP Commercial |
$3,399.94
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
IP
|
$277.79
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$175.01 |
| Max. Negotiated Rate |
$250.01 |
| Rate for Payer: Aetna Commercial |
$236.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.56
|
| Rate for Payer: Cash Price |
$222.23
|
| Rate for Payer: Cofinity Advantage |
$194.45
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.23
|
| Rate for Payer: Healthscope Commercial |
$250.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.34
|
| Rate for Payer: PHP Commercial |
$236.12
|
| Rate for Payer: Priority Health SBD |
$175.01
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
OP
|
$277.79
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$236.12
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$222.23
|
| Rate for Payer: Cash Price |
$222.23
|
| Rate for Payer: Cofinity Advantage |
$194.45
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$250.01
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.12
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.34
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$236.12
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$175.01
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.56
|
| Rate for Payer: UHC Core |
$144.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$109.17
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
OP
|
$91.72
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$77.96
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$73.38
|
| Rate for Payer: Cash Price |
$73.38
|
| Rate for Payer: Cofinity Advantage |
$64.20
|
| Rate for Payer: Cofinity Commercial |
$78.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$82.55
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.96
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.79
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$77.96
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$57.78
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.62
|
| Rate for Payer: UHC Core |
$47.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$36.05
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
IP
|
$91.72
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.78 |
| Max. Negotiated Rate |
$82.55 |
| Rate for Payer: Aetna Commercial |
$77.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.62
|
| Rate for Payer: Cash Price |
$73.38
|
| Rate for Payer: Cofinity Advantage |
$64.20
|
| Rate for Payer: Cofinity Commercial |
$78.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.38
|
| Rate for Payer: Healthscope Commercial |
$82.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.79
|
| Rate for Payer: PHP Commercial |
$77.96
|
| Rate for Payer: Priority Health SBD |
$57.78
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
IP
|
$293.06
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.63 |
| Max. Negotiated Rate |
$263.75 |
| Rate for Payer: Aetna Commercial |
$249.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.49
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cofinity Advantage |
$205.14
|
| Rate for Payer: Cofinity Commercial |
$252.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.45
|
| Rate for Payer: Healthscope Commercial |
$263.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.79
|
| Rate for Payer: PHP Commercial |
$249.10
|
| Rate for Payer: Priority Health SBD |
$184.63
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
OP
|
$293.06
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$249.10
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cofinity Advantage |
$205.14
|
| Rate for Payer: Cofinity Commercial |
$252.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$263.75
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.10
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.79
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$249.10
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$184.63
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.49
|
| Rate for Payer: UHC Core |
$152.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$115.17
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
OP
|
$975.06
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$877.55 |
| Rate for Payer: Aetna Commercial |
$828.80
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$780.05
|
| Rate for Payer: Cash Price |
$780.05
|
| Rate for Payer: Cofinity Advantage |
$682.54
|
| Rate for Payer: Cofinity Commercial |
$838.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$877.55
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.80
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.29
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$828.80
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$614.29
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.79
|
| Rate for Payer: UHC Core |
$508.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$383.20
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
IP
|
$975.06
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$614.29 |
| Max. Negotiated Rate |
$877.55 |
| Rate for Payer: Aetna Commercial |
$828.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.79
|
| Rate for Payer: Cash Price |
$780.05
|
| Rate for Payer: Cofinity Advantage |
$682.54
|
| Rate for Payer: Cofinity Commercial |
$838.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.05
|
| Rate for Payer: Healthscope Commercial |
$877.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.29
|
| Rate for Payer: PHP Commercial |
$828.80
|
| Rate for Payer: Priority Health SBD |
$614.29
|
|
|
HC RADXF UNL NM CARDIOVASC 78499
|
Facility
|
IP
|
$819.59
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$516.34 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.73
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Advantage |
$573.71
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: Priority Health SBD |
$516.34
|
|
|
HC RADXF UNL NM CARDIOVASC 78499
|
Facility
|
OP
|
$819.59
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Advantage |
$573.71
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$516.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.73
|
| Rate for Payer: UHC Core |
$427.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$322.10
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC RADXF UNL NM CNS 78699
|
Facility
|
IP
|
$819.59
|
|
|
Service Code
|
CPT 78699
|
| Hospital Charge Code |
34100043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$516.34 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.73
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Advantage |
$573.71
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: Priority Health SBD |
$516.34
|
|
|
HC RADXF UNL NM CNS 78699
|
Facility
|
OP
|
$819.59
|
|
|
Service Code
|
CPT 78699
|
| Hospital Charge Code |
34100043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Advantage |
$573.71
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$516.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.73
|
| Rate for Payer: UHC Core |
$427.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$322.10
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC RADXF UNL NM ENDOCR 78099
|
Facility
|
OP
|
$819.59
|
|
|
Service Code
|
CPT 78099
|
| Hospital Charge Code |
34100008
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Advantage |
$573.71
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$516.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.73
|
| Rate for Payer: UHC Core |
$427.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$322.10
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC RADXF UNL NM ENDOCR 78099
|
Facility
|
IP
|
$819.59
|
|
|
Service Code
|
CPT 78099
|
| Hospital Charge Code |
34100008
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$516.34 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.73
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Advantage |
$573.71
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: Priority Health SBD |
$516.34
|
|
|
HC RADXF UNL NM GI PROC 78299
|
Facility
|
OP
|
$819.59
|
|
|
Service Code
|
CPT 78299
|
| Hospital Charge Code |
34100022
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Advantage |
$573.71
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$516.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.73
|
| Rate for Payer: UHC Core |
$427.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$322.10
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC RADXF UNL NM GI PROC 78299
|
Facility
|
IP
|
$819.59
|
|
|
Service Code
|
CPT 78299
|
| Hospital Charge Code |
34100022
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$516.34 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.73
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Advantage |
$573.71
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: Priority Health SBD |
$516.34
|
|
|
HC RADXF UNL NM GU 78799
|
Facility
|
OP
|
$819.59
|
|
|
Service Code
|
CPT 78799
|
| Hospital Charge Code |
34100051
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Advantage |
$573.71
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$516.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.73
|
| Rate for Payer: UHC Core |
$427.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$322.10
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC RADXF UNL NM GU 78799
|
Facility
|
IP
|
$819.59
|
|
|
Service Code
|
CPT 78799
|
| Hospital Charge Code |
34100051
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$516.34 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.73
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Advantage |
$573.71
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: Priority Health SBD |
$516.34
|
|
|
HC RADXF UNL NM H R L 78199
|
Facility
|
IP
|
$765.35
|
|
|
Service Code
|
CPT 78199
|
| Hospital Charge Code |
34100013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$482.17 |
| Max. Negotiated Rate |
$688.82 |
| Rate for Payer: Aetna Commercial |
$650.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.48
|
| Rate for Payer: Cash Price |
$612.28
|
| Rate for Payer: Cofinity Advantage |
$535.75
|
| Rate for Payer: Cofinity Commercial |
$658.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.28
|
| Rate for Payer: Healthscope Commercial |
$688.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.01
|
| Rate for Payer: PHP Commercial |
$650.55
|
| Rate for Payer: Priority Health SBD |
$482.17
|
|
|
HC RADXF UNL NM H R L 78199
|
Facility
|
OP
|
$765.35
|
|
|
Service Code
|
CPT 78199
|
| Hospital Charge Code |
34100013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$650.55
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$612.28
|
| Rate for Payer: Cash Price |
$612.28
|
| Rate for Payer: Cofinity Advantage |
$535.75
|
| Rate for Payer: Cofinity Commercial |
$658.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$688.82
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.55
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.01
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$650.55
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$482.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.48
|
| Rate for Payer: UHC Core |
$398.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$300.78
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC RADXF UNL NM MUSCSKL 78399
|
Facility
|
IP
|
$1,961.56
|
|
|
Service Code
|
CPT 78399
|
| Hospital Charge Code |
34100028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,235.78 |
| Max. Negotiated Rate |
$1,765.40 |
| Rate for Payer: Aetna Commercial |
$1,667.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.01
|
| Rate for Payer: Cash Price |
$1,569.25
|
| Rate for Payer: Cofinity Advantage |
$1,373.09
|
| Rate for Payer: Cofinity Commercial |
$1,686.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,569.25
|
| Rate for Payer: Healthscope Commercial |
$1,765.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,667.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,471.17
|
| Rate for Payer: PHP Commercial |
$1,667.33
|
| Rate for Payer: Priority Health SBD |
$1,235.78
|
|
|
HC RADXF UNL NM MUSCSKL 78399
|
Facility
|
OP
|
$1,961.56
|
|
|
Service Code
|
CPT 78399
|
| Hospital Charge Code |
34100028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,765.40 |
| Rate for Payer: Aetna Commercial |
$1,667.33
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,569.25
|
| Rate for Payer: Cash Price |
$1,569.25
|
| Rate for Payer: Cofinity Advantage |
$1,373.09
|
| Rate for Payer: Cofinity Commercial |
$1,686.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,569.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,765.40
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,667.33
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,471.17
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,667.33
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$1,235.78
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,275.01
|
| Rate for Payer: UHC Core |
$1,021.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$770.89
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
