|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
OP
|
$2,444.94
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Commercial |
$2,078.20
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,589.21
|
| 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 |
$181.00
|
| Rate for Payer: BCN Commercial |
$181.00
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$1,955.95
|
| Rate for Payer: Cash Price |
$1,955.95
|
| Rate for Payer: Cash Price |
$1,955.95
|
| Rate for Payer: Cofinity Advantage |
$1,711.46
|
| Rate for Payer: Cofinity Commercial |
$2,102.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$2,200.45
|
| 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 |
$2,078.20
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,833.70
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$2,078.20
|
| 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 |
$1,540.31
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,589.21
|
| Rate for Payer: UHC Core |
$1,273.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Exchange |
$960.86
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC RMVL FB XTRNL EYE CORNEAL W SLIT LAMP
|
Facility
|
IP
|
$366.18
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
76200521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.69 |
| Max. Negotiated Rate |
$329.56 |
| Rate for Payer: Aetna Commercial |
$311.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.02
|
| Rate for Payer: Cash Price |
$292.94
|
| Rate for Payer: Cofinity Advantage |
$256.33
|
| Rate for Payer: Cofinity Commercial |
$314.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.94
|
| Rate for Payer: Healthscope Commercial |
$329.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.63
|
| Rate for Payer: PHP Commercial |
$311.25
|
| Rate for Payer: Priority Health SBD |
$230.69
|
|
|
HC RMVL FB XTRNL EYE CORNEAL W SLIT LAMP
|
Facility
|
OP
|
$366.18
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
76200521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$311.25
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$128.61
|
| Rate for Payer: BCN Commercial |
$128.61
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$292.94
|
| Rate for Payer: Cash Price |
$292.94
|
| Rate for Payer: Cash Price |
$292.94
|
| Rate for Payer: Cofinity Advantage |
$256.33
|
| Rate for Payer: Cofinity Commercial |
$314.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$329.56
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.25
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.63
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$311.25
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$230.69
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.02
|
| Rate for Payer: UHC Core |
$190.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$143.91
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Facility
|
IP
|
$10,002.80
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
48100138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,301.76 |
| Max. Negotiated Rate |
$9,002.52 |
| Rate for Payer: Aetna Commercial |
$8,502.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,501.82
|
| Rate for Payer: Cash Price |
$8,002.24
|
| Rate for Payer: Cofinity Advantage |
$7,001.96
|
| Rate for Payer: Cofinity Commercial |
$8,602.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,002.24
|
| Rate for Payer: Healthscope Commercial |
$9,002.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,502.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,502.10
|
| Rate for Payer: PHP Commercial |
$8,502.38
|
| Rate for Payer: Priority Health SBD |
$6,301.76
|
|
|
HC RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Facility
|
OP
|
$10,002.80
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
48100138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,757.36 |
| Max. Negotiated Rate |
$12,041.54 |
| Rate for Payer: Aetna Commercial |
$8,502.38
|
| Rate for Payer: Aetna Medicare |
$3,872.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,501.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,654.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,654.40
|
| Rate for Payer: BCBS Complete |
$2,044.96
|
| Rate for Payer: BCBS MAPPO |
$3,723.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.36
|
| Rate for Payer: BCN Commercial |
$1,757.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,723.52
|
| Rate for Payer: Cash Price |
$8,002.24
|
| Rate for Payer: Cash Price |
$8,002.24
|
| Rate for Payer: Cash Price |
$8,002.24
|
| Rate for Payer: Cofinity Advantage |
$7,001.96
|
| Rate for Payer: Cofinity Commercial |
$8,602.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,002.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,723.52
|
| Rate for Payer: Healthscope Commercial |
$9,002.52
|
| Rate for Payer: Mclaren Medicaid |
$1,947.40
|
| Rate for Payer: Mclaren Medicare |
$3,723.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,909.70
|
| Rate for Payer: Meridian Medicaid |
$3,909.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,282.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,095.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,502.38
|
| Rate for Payer: Nomi Health Commercial |
$11,170.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,502.10
|
| Rate for Payer: PACE Medicare |
$3,537.34
|
| Rate for Payer: PACE SWMI |
$3,723.52
|
| Rate for Payer: PHP Commercial |
$8,502.38
|
| Rate for Payer: PHP Medicare Advantage |
$3,723.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,947.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,041.54
|
| Rate for Payer: Priority Health Medicare |
$3,723.52
|
| Rate for Payer: Priority Health SBD |
$6,301.76
|
| Rate for Payer: Priority Health Tiered Network |
$9,633.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3,723.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,723.52
|
| Rate for Payer: UHC Medicaid |
$1,947.40
|
| Rate for Payer: UHCCP Medicaid |
$1,947.40
|
| Rate for Payer: VA VA |
$3,723.52
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$12.30
|
| Rate for Payer: BCN Commercial |
$12.30
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Mclaren Medicaid |
$6.03
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.53
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: Priority Health Tiered Network |
$9.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.30
|
| Rate for Payer: UHC Core |
$17.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.30
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health SBD |
$45.88
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health SBD |
$22.60
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| 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 |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.60
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| 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 |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.60
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health SBD |
$22.60
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| 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 |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.60
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health SBD |
$22.60
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
IP
|
$228.27
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$143.81 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$194.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.38
|
| Rate for Payer: Cash Price |
$182.62
|
| Rate for Payer: Cofinity Advantage |
$159.79
|
| Rate for Payer: Cofinity Commercial |
$196.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.62
|
| Rate for Payer: Healthscope Commercial |
$205.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.20
|
| Rate for Payer: PHP Commercial |
$194.03
|
| Rate for Payer: Priority Health SBD |
$143.81
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
OP
|
$228.27
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$89.71 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$194.03
|
| Rate for Payer: Aetna Medicare |
$114.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.38
|
| Rate for Payer: BCBS Complete |
$91.31
|
| Rate for Payer: BCBS Trust/PPO |
$160.78
|
| Rate for Payer: BCN Commercial |
$160.78
|
| Rate for Payer: Cash Price |
$182.62
|
| Rate for Payer: Cash Price |
$182.62
|
| Rate for Payer: Cofinity Advantage |
$159.79
|
| Rate for Payer: Cofinity Commercial |
$196.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.62
|
| Rate for Payer: Healthscope Commercial |
$205.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.20
|
| Rate for Payer: PHP Commercial |
$194.03
|
| Rate for Payer: Priority Health SBD |
$143.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.38
|
| Rate for Payer: UHC Core |
$118.93
|
| Rate for Payer: UHC Exchange |
$89.71
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
OP
|
$3,353.76
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$751.33 |
| Max. Negotiated Rate |
$3,018.38 |
| Rate for Payer: Aetna Commercial |
$2,850.70
|
| Rate for Payer: Aetna Medicare |
$1,676.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,179.94
|
| Rate for Payer: BCBS Complete |
$1,341.50
|
| Rate for Payer: BCBS Trust/PPO |
$751.33
|
| Rate for Payer: BCN Commercial |
$751.33
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cofinity Advantage |
$2,347.63
|
| Rate for Payer: Cofinity Commercial |
$2,884.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,683.01
|
| Rate for Payer: Healthscope Commercial |
$3,018.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,683.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,850.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,515.32
|
| Rate for Payer: PHP Commercial |
$2,850.70
|
| Rate for Payer: Priority Health SBD |
$2,112.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,179.94
|
| Rate for Payer: UHC Core |
$1,747.31
|
| Rate for Payer: UHC Exchange |
$1,318.03
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
IP
|
$3,353.76
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,112.87 |
| Max. Negotiated Rate |
$3,018.38 |
| Rate for Payer: Aetna Commercial |
$2,850.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,179.94
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cofinity Advantage |
$2,347.63
|
| Rate for Payer: Cofinity Commercial |
$2,884.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,683.01
|
| Rate for Payer: Healthscope Commercial |
$3,018.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,850.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,515.32
|
| Rate for Payer: PHP Commercial |
$2,850.70
|
| Rate for Payer: Priority Health SBD |
$2,112.87
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
IP
|
$3,353.76
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,112.87 |
| Max. Negotiated Rate |
$3,018.38 |
| Rate for Payer: Aetna Commercial |
$2,850.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,179.94
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cofinity Advantage |
$2,347.63
|
| Rate for Payer: Cofinity Commercial |
$2,884.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,683.01
|
| Rate for Payer: Healthscope Commercial |
$3,018.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,850.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,515.32
|
| Rate for Payer: PHP Commercial |
$2,850.70
|
| Rate for Payer: Priority Health SBD |
$2,112.87
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
OP
|
$3,353.76
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$751.33 |
| Max. Negotiated Rate |
$3,018.38 |
| Rate for Payer: Aetna Commercial |
$2,850.70
|
| Rate for Payer: Aetna Medicare |
$1,676.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,179.94
|
| Rate for Payer: BCBS Complete |
$1,341.50
|
| Rate for Payer: BCBS Trust/PPO |
$751.33
|
| Rate for Payer: BCN Commercial |
$751.33
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cofinity Advantage |
$2,347.63
|
| Rate for Payer: Cofinity Commercial |
$2,884.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,683.01
|
| Rate for Payer: Healthscope Commercial |
$3,018.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,683.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,850.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,515.32
|
| Rate for Payer: PHP Commercial |
$2,850.70
|
| Rate for Payer: Priority Health SBD |
$2,112.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,179.94
|
| Rate for Payer: UHC Core |
$1,747.31
|
| Rate for Payer: UHC Exchange |
$1,318.03
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
OP
|
$338.53
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$133.04 |
| Max. Negotiated Rate |
$1,242.83 |
| Rate for Payer: Aetna Commercial |
$287.75
|
| Rate for Payer: Aetna Medicare |
$399.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$304.38
|
| Rate for Payer: BCN Commercial |
$304.38
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$270.82
|
| Rate for Payer: Cash Price |
$270.82
|
| Rate for Payer: Cofinity Advantage |
$236.97
|
| Rate for Payer: Cofinity Commercial |
$291.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$304.68
|
| Rate for Payer: Mclaren Medicaid |
$200.99
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$403.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.75
|
| Rate for Payer: Nomi Health Commercial |
$1,152.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.90
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$287.75
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,242.83
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health SBD |
$213.27
|
| Rate for Payer: Priority Health Tiered Network |
$994.26
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.04
|
| Rate for Payer: UHC Core |
$176.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$133.04
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: VA VA |
$384.31
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
IP
|
$338.53
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$213.27 |
| Max. Negotiated Rate |
$304.68 |
| Rate for Payer: Aetna Commercial |
$287.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.04
|
| Rate for Payer: Cash Price |
$270.82
|
| Rate for Payer: Cofinity Advantage |
$236.97
|
| Rate for Payer: Cofinity Commercial |
$291.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.82
|
| Rate for Payer: Healthscope Commercial |
$304.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.90
|
| Rate for Payer: PHP Commercial |
$287.75
|
| Rate for Payer: Priority Health SBD |
$213.27
|
|
|
HC RO INS VAG BRACHTHER DEVICE
|
Facility
|
IP
|
$561.41
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
36100444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$353.69 |
| Max. Negotiated Rate |
$505.27 |
| Rate for Payer: Aetna Commercial |
$477.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.92
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cofinity Advantage |
$392.99
|
| Rate for Payer: Cofinity Commercial |
$482.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.13
|
| Rate for Payer: Healthscope Commercial |
$505.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.06
|
| Rate for Payer: PHP Commercial |
$477.20
|
| Rate for Payer: Priority Health SBD |
$353.69
|
|
|
HC RO INS VAG BRACHTHER DEVICE
|
Facility
|
OP
|
$561.41
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
36100444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$981.93 |
| Rate for Payer: Aetna Commercial |
$477.20
|
| Rate for Payer: Aetna Medicare |
$315.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$240.72
|
| Rate for Payer: BCN Commercial |
$240.72
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cofinity Advantage |
$392.99
|
| Rate for Payer: Cofinity Commercial |
$482.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Healthscope Commercial |
$505.27
|
| Rate for Payer: Mclaren Medicaid |
$158.80
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$318.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.20
|
| Rate for Payer: Nomi Health Commercial |
$910.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.06
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Commercial |
$477.20
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$981.93
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health SBD |
$353.69
|
| Rate for Payer: Priority Health Tiered Network |
$785.54
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
HC RO INTRSTI RADELEMENT APPL CMPLX
|
Facility
|
IP
|
$2,893.91
|
|
|
Service Code
|
CPT 77778
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,823.16 |
| Max. Negotiated Rate |
$2,604.52 |
| Rate for Payer: Aetna Commercial |
$2,459.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,881.04
|
| Rate for Payer: Cash Price |
$2,315.13
|
| Rate for Payer: Cofinity Advantage |
$2,025.74
|
| Rate for Payer: Cofinity Commercial |
$2,488.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,315.13
|
| Rate for Payer: Healthscope Commercial |
$2,604.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,459.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,170.43
|
| Rate for Payer: PHP Commercial |
$2,459.82
|
| Rate for Payer: Priority Health SBD |
$1,823.16
|
|
|
HC RO INTRSTI RADELEMENT APPL CMPLX
|
Facility
|
OP
|
$2,893.91
|
|
|
Service Code
|
CPT 77778
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.95 |
| Max. Negotiated Rate |
$2,604.52 |
| Rate for Payer: Aetna Commercial |
$2,459.82
|
| Rate for Payer: Aetna Medicare |
$721.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,881.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$867.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$867.46
|
| Rate for Payer: BCBS Complete |
$381.13
|
| Rate for Payer: BCBS MAPPO |
$693.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,068.33
|
| Rate for Payer: BCN Commercial |
$1,068.33
|
| Rate for Payer: BCN Medicare Advantage |
$693.97
|
| Rate for Payer: Cash Price |
$2,315.13
|
| Rate for Payer: Cash Price |
$2,315.13
|
| Rate for Payer: Cofinity Advantage |
$2,025.74
|
| Rate for Payer: Cofinity Commercial |
$2,488.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,315.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.97
|
| Rate for Payer: Healthscope Commercial |
$2,604.52
|
| Rate for Payer: Mclaren Medicaid |
$362.95
|
| Rate for Payer: Mclaren Medicare |
$693.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.67
|
| Rate for Payer: Meridian Medicaid |
$728.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$798.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$763.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,459.82
|
| Rate for Payer: Nomi Health Commercial |
$2,081.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,170.43
|
| Rate for Payer: PACE Medicare |
$659.27
|
| Rate for Payer: PACE SWMI |
$693.97
|
| Rate for Payer: PHP Commercial |
$2,459.82
|
| Rate for Payer: PHP Medicare Advantage |
$693.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,244.23
|
| Rate for Payer: Priority Health Medicare |
$693.97
|
| Rate for Payer: Priority Health SBD |
$1,823.16
|
| Rate for Payer: Priority Health Tiered Network |
$1,795.38
|
| Rate for Payer: Railroad Medicare Medicare |
$693.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,881.04
|
| Rate for Payer: UHC Core |
$1,507.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$693.97
|
| Rate for Payer: UHC Exchange |
$1,137.31
|
| Rate for Payer: UHC Medicaid |
$362.95
|
| Rate for Payer: UHCCP Medicaid |
$362.95
|
| Rate for Payer: VA VA |
$693.97
|
|
