|
HC QUINIDINE LEVEL
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.13
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health SBD |
$35.99
|
|
|
HC RABIES VACCINE IM
|
Facility
|
IP
|
$1,037.24
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$653.46 |
| Max. Negotiated Rate |
$933.52 |
| Rate for Payer: Aetna Commercial |
$881.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.21
|
| Rate for Payer: Cash Price |
$829.79
|
| Rate for Payer: Cofinity Commercial |
$726.07
|
| Rate for Payer: Cofinity Commercial |
$892.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$726.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.79
|
| Rate for Payer: Healthscope Commercial |
$933.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.65
|
| Rate for Payer: PHP Commercial |
$881.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.21
|
| Rate for Payer: Priority Health SBD |
$653.46
|
|
|
HC RABIES VACCINE IM
|
Facility
|
OP
|
$1,037.24
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.13 |
| Max. Negotiated Rate |
$933.52 |
| Rate for Payer: Aetna Commercial |
$881.65
|
| Rate for Payer: Aetna Medicare |
$326.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$392.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$392.10
|
| Rate for Payer: BCBS Complete |
$176.54
|
| Rate for Payer: BCBS MAPPO |
$313.68
|
| Rate for Payer: BCN Medicare Advantage |
$313.68
|
| Rate for Payer: Cash Price |
$829.79
|
| Rate for Payer: Cash Price |
$829.79
|
| Rate for Payer: Cofinity Commercial |
$892.03
|
| Rate for Payer: Cofinity Commercial |
$726.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$726.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.68
|
| Rate for Payer: Healthscope Commercial |
$933.52
|
| Rate for Payer: Mclaren Medicaid |
$168.13
|
| Rate for Payer: Mclaren Medicare |
$313.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.36
|
| Rate for Payer: Meridian Medicaid |
$176.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.65
|
| Rate for Payer: PACE Medicare |
$298.00
|
| Rate for Payer: PACE SWMI |
$313.68
|
| Rate for Payer: PHP Commercial |
$881.65
|
| Rate for Payer: PHP Medicare Advantage |
$313.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.21
|
| Rate for Payer: Priority Health Medicare |
$313.68
|
| Rate for Payer: Priority Health SBD |
$653.46
|
| Rate for Payer: Railroad Medicare Medicare |
$313.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$882.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.68
|
| Rate for Payer: UHC Medicare Advantage |
$313.68
|
| Rate for Payer: UHCCP Medicaid |
$176.60
|
| Rate for Payer: VA VA |
$313.68
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
IP
|
$188.62
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$118.83 |
| Max. Negotiated Rate |
$169.76 |
| Rate for Payer: Aetna Commercial |
$160.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.60
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cofinity Commercial |
$132.03
|
| Rate for Payer: Cofinity Commercial |
$162.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.90
|
| Rate for Payer: Healthscope Commercial |
$169.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.33
|
| Rate for Payer: PHP Commercial |
$160.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.60
|
| Rate for Payer: Priority Health SBD |
$118.83
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
OP
|
$188.62
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.45 |
| Max. Negotiated Rate |
$169.76 |
| Rate for Payer: Aetna Commercial |
$160.33
|
| Rate for Payer: Aetna Medicare |
$94.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.60
|
| Rate for Payer: BCBS Complete |
$75.45
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cofinity Commercial |
$132.03
|
| Rate for Payer: Cofinity Commercial |
$162.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.90
|
| Rate for Payer: Healthscope Commercial |
$169.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.33
|
| Rate for Payer: PHP Commercial |
$160.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.60
|
| Rate for Payer: Priority Health SBD |
$118.83
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
IP
|
$429.69
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$270.70 |
| Max. Negotiated Rate |
$386.72 |
| Rate for Payer: Aetna Commercial |
$365.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.30
|
| Rate for Payer: Cash Price |
$343.75
|
| Rate for Payer: Cofinity Commercial |
$300.78
|
| Rate for Payer: Cofinity Commercial |
$369.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.75
|
| Rate for Payer: Healthscope Commercial |
$386.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.24
|
| Rate for Payer: PHP Commercial |
$365.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.30
|
| Rate for Payer: Priority Health SBD |
$270.70
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
OP
|
$429.69
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.41 |
| Max. Negotiated Rate |
$386.72 |
| Rate for Payer: Aetna Commercial |
$365.24
|
| Rate for Payer: Aetna Medicare |
$134.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.86
|
| Rate for Payer: BCBS Complete |
$72.88
|
| Rate for Payer: BCBS MAPPO |
$129.49
|
| Rate for Payer: BCN Medicare Advantage |
$129.49
|
| Rate for Payer: Cash Price |
$343.75
|
| Rate for Payer: Cash Price |
$343.75
|
| Rate for Payer: Cofinity Commercial |
$369.53
|
| Rate for Payer: Cofinity Commercial |
$300.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.49
|
| Rate for Payer: Healthscope Commercial |
$386.72
|
| Rate for Payer: Mclaren Medicaid |
$69.41
|
| Rate for Payer: Mclaren Medicare |
$129.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.96
|
| Rate for Payer: Meridian Medicaid |
$72.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.24
|
| Rate for Payer: PACE Medicare |
$123.02
|
| Rate for Payer: PACE SWMI |
$129.49
|
| Rate for Payer: PHP Commercial |
$365.24
|
| Rate for Payer: PHP Medicare Advantage |
$129.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.30
|
| Rate for Payer: Priority Health Medicare |
$129.49
|
| Rate for Payer: Priority Health SBD |
$270.70
|
| Rate for Payer: Railroad Medicare Medicare |
$129.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.50
|
| Rate for Payer: UHC Core |
$317.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.49
|
| Rate for Payer: UHC Exchange |
$317.97
|
| Rate for Payer: UHC Medicare Advantage |
$129.49
|
| Rate for Payer: UHCCP Medicaid |
$72.90
|
| Rate for Payer: VA VA |
$129.49
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
OP
|
$286.19
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$484.78 |
| Rate for Payer: Aetna Commercial |
$243.26
|
| Rate for Payer: Aetna Medicare |
$179.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.28
|
| Rate for Payer: BCBS Complete |
$96.93
|
| Rate for Payer: BCBS MAPPO |
$172.22
|
| Rate for Payer: BCN Medicare Advantage |
$172.22
|
| Rate for Payer: Cash Price |
$228.95
|
| Rate for Payer: Cash Price |
$228.95
|
| Rate for Payer: Cofinity Commercial |
$200.33
|
| Rate for Payer: Cofinity Commercial |
$246.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.22
|
| Rate for Payer: Healthscope Commercial |
$257.57
|
| Rate for Payer: Mclaren Medicaid |
$92.31
|
| Rate for Payer: Mclaren Medicare |
$172.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.83
|
| Rate for Payer: Meridian Medicaid |
$96.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.26
|
| Rate for Payer: PACE Medicare |
$163.61
|
| Rate for Payer: PACE SWMI |
$172.22
|
| Rate for Payer: PHP Commercial |
$243.26
|
| Rate for Payer: PHP Medicare Advantage |
$172.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.02
|
| Rate for Payer: Priority Health Medicare |
$172.22
|
| Rate for Payer: Priority Health SBD |
$180.30
|
| Rate for Payer: Railroad Medicare Medicare |
$172.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$484.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.22
|
| Rate for Payer: UHC Medicare Advantage |
$172.22
|
| Rate for Payer: UHCCP Medicaid |
$96.96
|
| Rate for Payer: VA VA |
$172.22
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
IP
|
$286.19
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.30 |
| Max. Negotiated Rate |
$257.57 |
| Rate for Payer: Aetna Commercial |
$243.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.02
|
| Rate for Payer: Cash Price |
$228.95
|
| Rate for Payer: Cofinity Commercial |
$200.33
|
| Rate for Payer: Cofinity Commercial |
$246.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.95
|
| Rate for Payer: Healthscope Commercial |
$257.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.26
|
| Rate for Payer: PHP Commercial |
$243.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.02
|
| Rate for Payer: Priority Health SBD |
$180.30
|
|
|
HC RAD TX ANAL CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1073
|
| Hospital Charge Code |
33300063
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
|
|
HC RAD TX ANAL CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1073
|
| Hospital Charge Code |
33300063
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC RAD TX BREAST CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1081
|
| Hospital Charge Code |
33300067
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
|
|
HC RAD TX BREAST CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1081
|
| Hospital Charge Code |
33300067
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC RAD TX CERVIAL CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1085
|
| Hospital Charge Code |
33300069
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC RAD TX CERVIAL CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1085
|
| Hospital Charge Code |
33300069
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
|
|
HC RAD TX CNS TUMOR ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1083
|
| Hospital Charge Code |
33300068
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
|
|
HC RAD TX CNS TUMOR ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1083
|
| Hospital Charge Code |
33300068
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC RAD TX COLORECTAL CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1087
|
| Hospital Charge Code |
33300070
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC RAD TX COLORECTAL CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1087
|
| Hospital Charge Code |
33300070
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
|
|
HC RAD TX HEAD & NECK CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1089
|
| Hospital Charge Code |
33300071
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
|
|
HC RAD TX HEAD & NECK CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1089
|
| Hospital Charge Code |
33300071
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
OP
|
$3,921.50
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$3,529.35 |
| Rate for Payer: Aetna Commercial |
$3,333.28
|
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,548.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$3,137.20
|
| Rate for Payer: Cash Price |
$3,137.20
|
| Rate for Payer: Cofinity Commercial |
$3,372.49
|
| Rate for Payer: Cofinity Commercial |
$2,745.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,745.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,137.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$3,529.35
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,333.28
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$3,333.28
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,548.97
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health SBD |
$2,470.55
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$514.80
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
IP
|
$3,921.50
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,470.55 |
| Max. Negotiated Rate |
$3,529.35 |
| Rate for Payer: Aetna Commercial |
$3,333.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,548.97
|
| Rate for Payer: Cash Price |
$3,137.20
|
| Rate for Payer: Cofinity Commercial |
$2,745.05
|
| Rate for Payer: Cofinity Commercial |
$3,372.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,745.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,137.20
|
| Rate for Payer: Healthscope Commercial |
$3,529.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,333.28
|
| Rate for Payer: PHP Commercial |
$3,333.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,548.97
|
| Rate for Payer: Priority Health SBD |
$2,470.55
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
OP
|
$272.34
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$245.11 |
| Rate for Payer: Aetna Commercial |
$231.49
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$217.87
|
| Rate for Payer: Cash Price |
$217.87
|
| Rate for Payer: Cofinity Commercial |
$234.21
|
| Rate for Payer: Cofinity Commercial |
$190.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$245.11
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.49
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$231.49
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.02
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$171.57
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$201.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$201.53
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
IP
|
$272.34
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$171.57 |
| Max. Negotiated Rate |
$245.11 |
| Rate for Payer: Aetna Commercial |
$231.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.02
|
| Rate for Payer: Cash Price |
$217.87
|
| Rate for Payer: Cofinity Commercial |
$190.64
|
| Rate for Payer: Cofinity Commercial |
$234.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.87
|
| Rate for Payer: Healthscope Commercial |
$245.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.49
|
| Rate for Payer: PHP Commercial |
$231.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.02
|
| Rate for Payer: Priority Health SBD |
$171.57
|
|
