|
HC RO ISODOSE BRACH CALC SIMPLE
|
Facility
|
IP
|
$239.56
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$150.92 |
| Max. Negotiated Rate |
$215.60 |
| Rate for Payer: Aetna Commercial |
$203.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.71
|
| Rate for Payer: Cash Price |
$191.65
|
| Rate for Payer: Cofinity Advantage |
$167.69
|
| Rate for Payer: Cofinity Commercial |
$206.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.65
|
| Rate for Payer: Healthscope Commercial |
$215.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.67
|
| Rate for Payer: PHP Commercial |
$203.63
|
| Rate for Payer: Priority Health SBD |
$150.92
|
|
|
HC RO ISODOSE BRACH CALC SIMPLE
|
Facility
|
OP
|
$239.56
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Aetna Commercial |
$203.63
|
| Rate for Payer: Aetna Medicare |
$388.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$395.23
|
| Rate for Payer: BCN Commercial |
$395.23
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$191.65
|
| Rate for Payer: Cash Price |
$191.65
|
| Rate for Payer: Cofinity Advantage |
$167.69
|
| Rate for Payer: Cofinity Commercial |
$206.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$215.60
|
| Rate for Payer: Mclaren Medicaid |
$195.12
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$391.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.63
|
| Rate for Payer: Nomi Health Commercial |
$1,119.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.67
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$203.63
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,206.50
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health SBD |
$150.92
|
| Rate for Payer: Priority Health Tiered Network |
$965.20
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.71
|
| Rate for Payer: UHC Core |
$124.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$94.15
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC RO ISODOSE BRACHY CALC COMPLEX
|
Facility
|
IP
|
$698.64
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$440.14 |
| Max. Negotiated Rate |
$628.78 |
| Rate for Payer: Aetna Commercial |
$593.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.12
|
| Rate for Payer: Cash Price |
$558.91
|
| Rate for Payer: Cofinity Advantage |
$489.05
|
| Rate for Payer: Cofinity Commercial |
$600.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.91
|
| Rate for Payer: Healthscope Commercial |
$628.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$523.98
|
| Rate for Payer: PHP Commercial |
$593.84
|
| Rate for Payer: Priority Health SBD |
$440.14
|
|
|
HC RO ISODOSE BRACHY CALC COMPLEX
|
Facility
|
OP
|
$698.64
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Aetna Commercial |
$593.84
|
| Rate for Payer: Aetna Medicare |
$388.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$704.90
|
| Rate for Payer: BCN Commercial |
$704.90
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$558.91
|
| Rate for Payer: Cash Price |
$558.91
|
| Rate for Payer: Cofinity Advantage |
$489.05
|
| Rate for Payer: Cofinity Commercial |
$600.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$628.78
|
| Rate for Payer: Mclaren Medicaid |
$195.12
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$391.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.84
|
| Rate for Payer: Nomi Health Commercial |
$1,119.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$523.98
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$593.84
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,206.50
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health SBD |
$440.14
|
| Rate for Payer: Priority Health Tiered Network |
$965.20
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.12
|
| Rate for Payer: UHC Core |
$363.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$274.57
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC RO ISODOSE BRACHY CALC INTRM
|
Facility
|
OP
|
$635.12
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Aetna Commercial |
$539.85
|
| Rate for Payer: Aetna Medicare |
$388.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$520.92
|
| Rate for Payer: BCN Commercial |
$520.92
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$508.10
|
| Rate for Payer: Cash Price |
$508.10
|
| Rate for Payer: Cofinity Advantage |
$444.58
|
| Rate for Payer: Cofinity Commercial |
$546.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$571.61
|
| Rate for Payer: Mclaren Medicaid |
$195.12
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$391.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.85
|
| Rate for Payer: Nomi Health Commercial |
$1,119.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$476.34
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$539.85
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,206.50
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health SBD |
$400.13
|
| Rate for Payer: Priority Health Tiered Network |
$965.20
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.83
|
| Rate for Payer: UHC Core |
$330.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$249.60
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC RO ISODOSE BRACHY CALC INTRM
|
Facility
|
IP
|
$635.12
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$400.13 |
| Max. Negotiated Rate |
$571.61 |
| Rate for Payer: Aetna Commercial |
$539.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.83
|
| Rate for Payer: Cash Price |
$508.10
|
| Rate for Payer: Cofinity Advantage |
$444.58
|
| Rate for Payer: Cofinity Commercial |
$546.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.10
|
| Rate for Payer: Healthscope Commercial |
$571.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$476.34
|
| Rate for Payer: PHP Commercial |
$539.85
|
| Rate for Payer: Priority Health SBD |
$400.13
|
|
|
HC RO ISODOSE TELETHRPY COMPLEX
|
Facility
|
OP
|
$1,181.13
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Aetna Commercial |
$1,003.96
|
| Rate for Payer: Aetna Medicare |
$388.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$313.46
|
| Rate for Payer: BCN Commercial |
$313.46
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cofinity Advantage |
$826.79
|
| Rate for Payer: Cofinity Commercial |
$1,015.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$1,063.02
|
| Rate for Payer: Mclaren Medicaid |
$195.12
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$391.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,003.96
|
| Rate for Payer: Nomi Health Commercial |
$1,119.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$885.85
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$1,003.96
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,206.50
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health SBD |
$744.11
|
| Rate for Payer: Priority Health Tiered Network |
$965.20
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$767.73
|
| Rate for Payer: UHC Core |
$615.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$464.18
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC RO ISODOSE TELETHRPY COMPLEX
|
Facility
|
IP
|
$1,181.13
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$744.11 |
| Max. Negotiated Rate |
$1,063.02 |
| Rate for Payer: Aetna Commercial |
$1,003.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.73
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cofinity Advantage |
$826.79
|
| Rate for Payer: Cofinity Commercial |
$1,015.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.90
|
| Rate for Payer: Healthscope Commercial |
$1,063.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,003.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$885.85
|
| Rate for Payer: PHP Commercial |
$1,003.96
|
| Rate for Payer: Priority Health SBD |
$744.11
|
|
|
HC RO ISODOSE TELETHRPY SIMPLE
|
Facility
|
IP
|
$257.88
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$162.46 |
| Max. Negotiated Rate |
$232.09 |
| Rate for Payer: Aetna Commercial |
$219.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.62
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cofinity Advantage |
$180.52
|
| Rate for Payer: Cofinity Commercial |
$221.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.30
|
| Rate for Payer: Healthscope Commercial |
$232.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.41
|
| Rate for Payer: PHP Commercial |
$219.20
|
| Rate for Payer: Priority Health SBD |
$162.46
|
|
|
HC RO ISODOSE TELETHRPY SIMPLE
|
Facility
|
OP
|
$257.88
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$101.35 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Aetna Commercial |
$219.20
|
| Rate for Payer: Aetna Medicare |
$388.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$172.62
|
| Rate for Payer: BCN Commercial |
$172.62
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cofinity Advantage |
$180.52
|
| Rate for Payer: Cofinity Commercial |
$221.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$232.09
|
| Rate for Payer: Mclaren Medicaid |
$195.12
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$391.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.20
|
| Rate for Payer: Nomi Health Commercial |
$1,119.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.41
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$219.20
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,206.50
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health SBD |
$162.46
|
| Rate for Payer: Priority Health Tiered Network |
$965.20
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.62
|
| Rate for Payer: UHC Core |
$134.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$101.35
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC RO LINAC SBRT PER SESSION
|
Facility
|
OP
|
$3,616.93
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$931.79 |
| Max. Negotiated Rate |
$5,761.61 |
| Rate for Payer: Aetna Commercial |
$3,074.39
|
| Rate for Payer: Aetna Medicare |
$1,852.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,351.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,227.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,227.03
|
| Rate for Payer: BCBS Complete |
$978.47
|
| Rate for Payer: BCBS MAPPO |
$1,781.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,222.22
|
| Rate for Payer: BCN Commercial |
$2,222.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,781.62
|
| Rate for Payer: Cash Price |
$2,893.54
|
| Rate for Payer: Cash Price |
$2,893.54
|
| Rate for Payer: Cofinity Advantage |
$2,531.85
|
| Rate for Payer: Cofinity Commercial |
$3,110.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,893.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,781.62
|
| Rate for Payer: Healthscope Commercial |
$3,255.24
|
| Rate for Payer: Mclaren Medicaid |
$931.79
|
| Rate for Payer: Mclaren Medicare |
$1,781.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,870.70
|
| Rate for Payer: Meridian Medicaid |
$1,870.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,048.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,959.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,074.39
|
| Rate for Payer: Nomi Health Commercial |
$5,344.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,712.70
|
| Rate for Payer: PACE Medicare |
$1,692.54
|
| Rate for Payer: PACE SWMI |
$1,781.62
|
| Rate for Payer: PHP Commercial |
$3,074.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,781.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$931.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,761.61
|
| Rate for Payer: Priority Health Medicare |
$1,781.62
|
| Rate for Payer: Priority Health SBD |
$2,278.67
|
| Rate for Payer: Priority Health Tiered Network |
$4,609.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,781.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,781.62
|
| Rate for Payer: UHC Medicaid |
$931.79
|
| Rate for Payer: UHCCP Medicaid |
$931.79
|
| Rate for Payer: VA VA |
$1,781.62
|
|
|
HC RO LINAC SBRT PER SESSION
|
Facility
|
IP
|
$3,616.93
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,278.67 |
| Max. Negotiated Rate |
$3,255.24 |
| Rate for Payer: Aetna Commercial |
$3,074.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,351.00
|
| Rate for Payer: Cash Price |
$2,893.54
|
| Rate for Payer: Cofinity Advantage |
$2,531.85
|
| Rate for Payer: Cofinity Commercial |
$3,110.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,893.54
|
| Rate for Payer: Healthscope Commercial |
$3,255.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,074.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,712.70
|
| Rate for Payer: PHP Commercial |
$3,074.39
|
| Rate for Payer: Priority Health SBD |
$2,278.67
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
OP
|
$11.67
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$38.06 |
| Rate for Payer: Aetna Commercial |
$9.92
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.24
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS MAPPO |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$30.36
|
| Rate for Payer: BCN Commercial |
$30.36
|
| Rate for Payer: BCN Medicare Advantage |
$12.19
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Advantage |
$8.17
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.19
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: Mclaren Medicaid |
$6.38
|
| Rate for Payer: Mclaren Medicare |
$12.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.80
|
| Rate for Payer: Meridian Medicaid |
$12.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$36.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.75
|
| Rate for Payer: PACE Medicare |
$11.58
|
| Rate for Payer: PACE SWMI |
$12.19
|
| Rate for Payer: PHP Commercial |
$9.92
|
| Rate for Payer: PHP Medicare Advantage |
$12.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.06
|
| Rate for Payer: Priority Health Medicare |
$12.19
|
| Rate for Payer: Priority Health SBD |
$7.35
|
| Rate for Payer: Priority Health Tiered Network |
$30.45
|
| Rate for Payer: Railroad Medicare Medicare |
$12.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.98
|
| Rate for Payer: UHC Core |
$19.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.19
|
| Rate for Payer: UHC Exchange |
$19.98
|
| Rate for Payer: UHC Medicaid |
$6.38
|
| Rate for Payer: UHCCP Medicaid |
$6.38
|
| Rate for Payer: VA VA |
$12.19
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
IP
|
$11.67
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$9.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Advantage |
$8.17
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.75
|
| Rate for Payer: PHP Commercial |
$9.92
|
| Rate for Payer: Priority Health SBD |
$7.35
|
|
|
HC ROOM & BOARD PSYCH
|
Facility
|
IP
|
$1,846.93
|
|
| Hospital Charge Code |
12400001
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,163.57 |
| Max. Negotiated Rate |
$1,662.24 |
| Rate for Payer: Aetna Commercial |
$1,569.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.50
|
| Rate for Payer: Cash Price |
$1,477.54
|
| Rate for Payer: Cofinity Advantage |
$1,292.85
|
| Rate for Payer: Cofinity Commercial |
$1,588.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.54
|
| Rate for Payer: Healthscope Commercial |
$1,662.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,385.20
|
| Rate for Payer: PHP Commercial |
$1,569.89
|
| Rate for Payer: Priority Health SBD |
$1,163.57
|
|
|
HC ROOM MED SURG
|
Facility
|
IP
|
$3,423.98
|
|
| Hospital Charge Code |
12100001
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,157.11 |
| Max. Negotiated Rate |
$3,081.58 |
| Rate for Payer: Aetna Commercial |
$2,910.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,225.59
|
| Rate for Payer: Cash Price |
$2,739.18
|
| Rate for Payer: Cofinity Advantage |
$2,396.79
|
| Rate for Payer: Cofinity Commercial |
$2,944.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,739.18
|
| Rate for Payer: Healthscope Commercial |
$3,081.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,910.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,567.99
|
| Rate for Payer: PHP Commercial |
$2,910.38
|
| Rate for Payer: Priority Health SBD |
$2,157.11
|
|
|
HC ROOM SCU
|
Facility
|
IP
|
$2,399.10
|
|
| Hospital Charge Code |
20000002
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$1,511.43 |
| Max. Negotiated Rate |
$2,159.19 |
| Rate for Payer: Aetna Commercial |
$2,039.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,559.41
|
| Rate for Payer: Cash Price |
$1,919.28
|
| Rate for Payer: Cofinity Advantage |
$1,679.37
|
| Rate for Payer: Cofinity Commercial |
$2,063.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,919.28
|
| Rate for Payer: Healthscope Commercial |
$2,159.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,039.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,799.33
|
| Rate for Payer: PHP Commercial |
$2,039.23
|
| Rate for Payer: Priority Health SBD |
$1,511.43
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
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 RO OR SSA SJOGRENS AB
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
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 ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$4.16
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Advantage |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.12
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health SBD |
$2.62
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Advantage |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.12
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health SBD |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
OP
|
$203.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$183.38 |
| Rate for Payer: Aetna Commercial |
$173.20
|
| Rate for Payer: Aetna Medicare |
$101.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.44
|
| Rate for Payer: BCBS Complete |
$81.50
|
| Rate for Payer: BCBS Trust/PPO |
$93.13
|
| Rate for Payer: BCN Commercial |
$93.13
|
| Rate for Payer: Cash Price |
$163.01
|
| Rate for Payer: Cash Price |
$163.01
|
| Rate for Payer: Cofinity Advantage |
$142.63
|
| Rate for Payer: Cofinity Commercial |
$175.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.01
|
| Rate for Payer: Healthscope Commercial |
$183.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.82
|
| Rate for Payer: PHP Commercial |
$173.20
|
| Rate for Payer: Priority Health SBD |
$128.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.44
|
| Rate for Payer: UHC Core |
$106.16
|
| Rate for Payer: UHC Exchange |
$80.08
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
IP
|
$203.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$128.37 |
| Max. Negotiated Rate |
$183.38 |
| Rate for Payer: Aetna Commercial |
$173.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.44
|
| Rate for Payer: Cash Price |
$163.01
|
| Rate for Payer: Cofinity Advantage |
$142.63
|
| Rate for Payer: Cofinity Commercial |
$175.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.01
|
| Rate for Payer: Healthscope Commercial |
$183.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.82
|
| Rate for Payer: PHP Commercial |
$173.20
|
| Rate for Payer: Priority Health SBD |
$128.37
|
|
|
HC ROTABLATOR BURR
|
Facility
|
IP
|
$4,268.40
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,689.09 |
| Max. Negotiated Rate |
$3,841.56 |
| Rate for Payer: Aetna Commercial |
$3,628.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,774.46
|
| Rate for Payer: Cash Price |
$3,414.72
|
| Rate for Payer: Cofinity Advantage |
$2,987.88
|
| Rate for Payer: Cofinity Commercial |
$3,670.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,414.72
|
| Rate for Payer: Healthscope Commercial |
$3,841.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,628.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,201.30
|
| Rate for Payer: PHP Commercial |
$3,628.14
|
| Rate for Payer: Priority Health SBD |
$2,689.09
|
|
|
HC ROTABLATOR BURR
|
Facility
|
OP
|
$4,268.40
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$3,841.56 |
| Rate for Payer: Aetna Commercial |
$3,628.14
|
| Rate for Payer: Aetna Medicare |
$2,134.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,774.46
|
| Rate for Payer: BCBS Complete |
$1,707.36
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$3,414.72
|
| Rate for Payer: Cash Price |
$3,414.72
|
| Rate for Payer: Cofinity Advantage |
$2,987.88
|
| Rate for Payer: Cofinity Commercial |
$3,670.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,414.72
|
| Rate for Payer: Healthscope Commercial |
$3,841.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,414.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,628.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,201.30
|
| Rate for Payer: PHP Commercial |
$3,628.14
|
| Rate for Payer: Priority Health SBD |
$2,689.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,774.46
|
| Rate for Payer: UHC Core |
$2,223.84
|
| Rate for Payer: UHC Exchange |
$1,677.48
|
|
