|
HC RMVL FB XTRNL EYE CORNEAL W SLIT LAMP
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
76200521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$305.15
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$251.30
|
| Rate for Payer: Cofinity Commercial |
$308.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$323.10
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.15
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$305.15
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$226.17
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health SBD |
$44.98
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| 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 |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| 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 |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.49
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| 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 |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health SBD |
$22.16
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| 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 |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health SBD |
$22.16
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health SBD |
$22.16
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| 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 |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
OP
|
$223.79
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$89.52 |
| Max. Negotiated Rate |
$201.41 |
| Rate for Payer: Aetna Commercial |
$190.22
|
| Rate for Payer: Aetna Medicare |
$111.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.46
|
| Rate for Payer: BCBS Complete |
$89.52
|
| Rate for Payer: Cash Price |
$179.03
|
| Rate for Payer: Cofinity Commercial |
$156.65
|
| Rate for Payer: Cofinity Commercial |
$192.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.03
|
| Rate for Payer: Healthscope Commercial |
$201.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.22
|
| Rate for Payer: PHP Commercial |
$190.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.46
|
| Rate for Payer: Priority Health SBD |
$140.99
|
| Rate for Payer: UHC Core |
$165.60
|
| Rate for Payer: UHC Exchange |
$165.60
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
IP
|
$223.79
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$140.99 |
| Max. Negotiated Rate |
$201.41 |
| Rate for Payer: Aetna Commercial |
$190.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.46
|
| Rate for Payer: Cash Price |
$179.03
|
| Rate for Payer: Cofinity Commercial |
$156.65
|
| Rate for Payer: Cofinity Commercial |
$192.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.03
|
| Rate for Payer: Healthscope Commercial |
$201.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.22
|
| Rate for Payer: PHP Commercial |
$190.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.46
|
| Rate for Payer: Priority Health SBD |
$140.99
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$2,959.20 |
| Rate for Payer: Aetna Commercial |
$2,794.80
|
| Rate for Payer: Aetna Medicare |
$586.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,137.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$705.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$705.21
|
| Rate for Payer: BCBS Complete |
$317.51
|
| Rate for Payer: BCBS MAPPO |
$564.17
|
| Rate for Payer: BCN Medicare Advantage |
$564.17
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cofinity Commercial |
$2,827.68
|
| Rate for Payer: Cofinity Commercial |
$2,301.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,301.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,630.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.17
|
| Rate for Payer: Healthscope Commercial |
$2,959.20
|
| Rate for Payer: Mclaren Medicaid |
$302.40
|
| Rate for Payer: Mclaren Medicare |
$564.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.38
|
| Rate for Payer: Meridian Medicaid |
$317.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$648.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,794.80
|
| Rate for Payer: PACE Medicare |
$535.96
|
| Rate for Payer: PACE SWMI |
$564.17
|
| Rate for Payer: PHP Commercial |
$2,794.80
|
| Rate for Payer: PHP Medicare Advantage |
$564.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,137.20
|
| Rate for Payer: Priority Health Medicare |
$564.17
|
| Rate for Payer: Priority Health SBD |
$2,071.44
|
| Rate for Payer: Railroad Medicare Medicare |
$564.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,588.08
|
| Rate for Payer: UHC Core |
$2,433.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.17
|
| Rate for Payer: UHC Exchange |
$2,433.12
|
| Rate for Payer: UHC Medicare Advantage |
$564.17
|
| Rate for Payer: UHCCP Medicaid |
$317.63
|
| Rate for Payer: VA VA |
$564.17
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,071.44 |
| Max. Negotiated Rate |
$2,959.20 |
| Rate for Payer: Aetna Commercial |
$2,794.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,137.20
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cofinity Commercial |
$2,301.60
|
| Rate for Payer: Cofinity Commercial |
$2,827.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,301.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,630.40
|
| Rate for Payer: Healthscope Commercial |
$2,959.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,794.80
|
| Rate for Payer: PHP Commercial |
$2,794.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,137.20
|
| Rate for Payer: Priority Health SBD |
$2,071.44
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$2,959.20 |
| Rate for Payer: Aetna Commercial |
$2,794.80
|
| Rate for Payer: Aetna Medicare |
$586.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,137.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$705.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$705.21
|
| Rate for Payer: BCBS Complete |
$317.51
|
| Rate for Payer: BCBS MAPPO |
$564.17
|
| Rate for Payer: BCN Medicare Advantage |
$564.17
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cofinity Commercial |
$2,827.68
|
| Rate for Payer: Cofinity Commercial |
$2,301.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,301.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,630.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.17
|
| Rate for Payer: Healthscope Commercial |
$2,959.20
|
| Rate for Payer: Mclaren Medicaid |
$302.40
|
| Rate for Payer: Mclaren Medicare |
$564.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.38
|
| Rate for Payer: Meridian Medicaid |
$317.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$648.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,794.80
|
| Rate for Payer: PACE Medicare |
$535.96
|
| Rate for Payer: PACE SWMI |
$564.17
|
| Rate for Payer: PHP Commercial |
$2,794.80
|
| Rate for Payer: PHP Medicare Advantage |
$564.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,137.20
|
| Rate for Payer: Priority Health Medicare |
$564.17
|
| Rate for Payer: Priority Health SBD |
$2,071.44
|
| Rate for Payer: Railroad Medicare Medicare |
$564.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,588.08
|
| Rate for Payer: UHC Core |
$2,433.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.17
|
| Rate for Payer: UHC Exchange |
$2,433.12
|
| Rate for Payer: UHC Medicare Advantage |
$564.17
|
| Rate for Payer: UHCCP Medicaid |
$317.63
|
| Rate for Payer: VA VA |
$564.17
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,071.44 |
| Max. Negotiated Rate |
$2,959.20 |
| Rate for Payer: Aetna Commercial |
$2,794.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,137.20
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cofinity Commercial |
$2,301.60
|
| Rate for Payer: Cofinity Commercial |
$2,827.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,301.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,630.40
|
| Rate for Payer: Healthscope Commercial |
$2,959.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,794.80
|
| Rate for Payer: PHP Commercial |
$2,794.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,137.20
|
| Rate for Payer: Priority Health SBD |
$2,071.44
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
IP
|
$331.89
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$209.09 |
| Max. Negotiated Rate |
$298.70 |
| Rate for Payer: Aetna Commercial |
$282.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.73
|
| Rate for Payer: Cash Price |
$265.51
|
| Rate for Payer: Cofinity Commercial |
$232.32
|
| Rate for Payer: Cofinity Commercial |
$285.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.51
|
| Rate for Payer: Healthscope Commercial |
$298.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.11
|
| Rate for Payer: PHP Commercial |
$282.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.73
|
| Rate for Payer: Priority Health SBD |
$209.09
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
OP
|
$331.89
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$137.47 |
| Max. Negotiated Rate |
$721.97 |
| Rate for Payer: Aetna Commercial |
$282.11
|
| Rate for Payer: Aetna Medicare |
$266.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$320.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$320.60
|
| Rate for Payer: BCBS Complete |
$144.35
|
| Rate for Payer: BCBS MAPPO |
$256.48
|
| Rate for Payer: BCN Medicare Advantage |
$256.48
|
| Rate for Payer: Cash Price |
$265.51
|
| Rate for Payer: Cash Price |
$265.51
|
| Rate for Payer: Cofinity Commercial |
$285.43
|
| Rate for Payer: Cofinity Commercial |
$232.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.48
|
| Rate for Payer: Healthscope Commercial |
$298.70
|
| Rate for Payer: Mclaren Medicaid |
$137.47
|
| Rate for Payer: Mclaren Medicare |
$256.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$269.30
|
| Rate for Payer: Meridian Medicaid |
$144.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.11
|
| Rate for Payer: PACE Medicare |
$243.66
|
| Rate for Payer: PACE SWMI |
$256.48
|
| Rate for Payer: PHP Commercial |
$282.11
|
| Rate for Payer: PHP Medicare Advantage |
$256.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.73
|
| Rate for Payer: Priority Health Medicare |
$256.48
|
| Rate for Payer: Priority Health SBD |
$209.09
|
| Rate for Payer: Railroad Medicare Medicare |
$256.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.97
|
| Rate for Payer: UHC Core |
$245.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.48
|
| Rate for Payer: UHC Exchange |
$245.60
|
| Rate for Payer: UHC Medicare Advantage |
$256.48
|
| Rate for Payer: UHCCP Medicaid |
$144.40
|
| Rate for Payer: VA VA |
$256.48
|
|
|
HC RO INS VAG BRACHTHER DEVICE
|
Facility
|
OP
|
$550.40
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
36100444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$835.10 |
| Rate for Payer: Aetna Commercial |
$467.84
|
| Rate for Payer: Aetna Medicare |
$308.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.84
|
| Rate for Payer: BCBS Complete |
$166.97
|
| Rate for Payer: BCBS MAPPO |
$296.67
|
| Rate for Payer: BCN Medicare Advantage |
$296.67
|
| Rate for Payer: Cash Price |
$440.32
|
| Rate for Payer: Cash Price |
$440.32
|
| Rate for Payer: Cofinity Commercial |
$473.34
|
| Rate for Payer: Cofinity Commercial |
$385.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$385.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.67
|
| Rate for Payer: Healthscope Commercial |
$495.36
|
| Rate for Payer: Mclaren Medicaid |
$159.02
|
| Rate for Payer: Mclaren Medicare |
$296.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.50
|
| Rate for Payer: Meridian Medicaid |
$166.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$467.84
|
| Rate for Payer: PACE Medicare |
$281.84
|
| Rate for Payer: PACE SWMI |
$296.67
|
| Rate for Payer: PHP Commercial |
$467.84
|
| Rate for Payer: PHP Medicare Advantage |
$296.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.76
|
| Rate for Payer: Priority Health Medicare |
$296.67
|
| Rate for Payer: Priority Health SBD |
$346.75
|
| Rate for Payer: Railroad Medicare Medicare |
$296.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.67
|
| Rate for Payer: UHC Medicare Advantage |
$296.67
|
| Rate for Payer: UHCCP Medicaid |
$167.03
|
| Rate for Payer: VA VA |
$296.67
|
|
|
HC RO INS VAG BRACHTHER DEVICE
|
Facility
|
IP
|
$550.40
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
36100444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$346.75 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$467.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.76
|
| Rate for Payer: Cash Price |
$440.32
|
| Rate for Payer: Cofinity Commercial |
$385.28
|
| Rate for Payer: Cofinity Commercial |
$473.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$385.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.32
|
| Rate for Payer: Healthscope Commercial |
$495.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$467.84
|
| Rate for Payer: PHP Commercial |
$467.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.76
|
| Rate for Payer: Priority Health SBD |
$346.75
|
|
|
HC RO INTRSTI RADELEMENT APPL CMPLX
|
Facility
|
IP
|
$2,837.17
|
|
|
Service Code
|
CPT 77778
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,787.42 |
| Max. Negotiated Rate |
$2,553.45 |
| Rate for Payer: Aetna Commercial |
$2,411.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,844.16
|
| Rate for Payer: Cash Price |
$2,269.74
|
| Rate for Payer: Cofinity Commercial |
$1,986.02
|
| Rate for Payer: Cofinity Commercial |
$2,439.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,986.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,269.74
|
| Rate for Payer: Healthscope Commercial |
$2,553.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,411.59
|
| Rate for Payer: PHP Commercial |
$2,411.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.16
|
| Rate for Payer: Priority Health SBD |
$1,787.42
|
|
|
HC RO INTRSTI RADELEMENT APPL CMPLX
|
Facility
|
OP
|
$2,837.17
|
|
|
Service Code
|
CPT 77778
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.69 |
| Max. Negotiated Rate |
$2,553.45 |
| Rate for Payer: Aetna Commercial |
$2,411.59
|
| Rate for Payer: Aetna Medicare |
$703.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,844.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$845.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$845.83
|
| Rate for Payer: BCBS Complete |
$380.82
|
| Rate for Payer: BCBS MAPPO |
$676.66
|
| Rate for Payer: BCN Medicare Advantage |
$676.66
|
| Rate for Payer: Cash Price |
$2,269.74
|
| Rate for Payer: Cash Price |
$2,269.74
|
| Rate for Payer: Cofinity Commercial |
$2,439.97
|
| Rate for Payer: Cofinity Commercial |
$1,986.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,986.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,269.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.66
|
| Rate for Payer: Healthscope Commercial |
$2,553.45
|
| Rate for Payer: Mclaren Medicaid |
$362.69
|
| Rate for Payer: Mclaren Medicare |
$676.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.49
|
| Rate for Payer: Meridian Medicaid |
$380.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$778.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,411.59
|
| Rate for Payer: PACE Medicare |
$642.83
|
| Rate for Payer: PACE SWMI |
$676.66
|
| Rate for Payer: PHP Commercial |
$2,411.59
|
| Rate for Payer: PHP Medicare Advantage |
$676.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.16
|
| Rate for Payer: Priority Health Medicare |
$676.66
|
| Rate for Payer: Priority Health SBD |
$1,787.42
|
| Rate for Payer: Railroad Medicare Medicare |
$676.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,904.73
|
| Rate for Payer: UHC Core |
$2,099.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.66
|
| Rate for Payer: UHC Exchange |
$2,099.51
|
| Rate for Payer: UHC Medicare Advantage |
$676.66
|
| Rate for Payer: UHCCP Medicaid |
$380.96
|
| Rate for Payer: VA VA |
$676.66
|
|
|
HC RO ISODOSE BRACH CALC SIMPLE
|
Facility
|
IP
|
$234.86
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$147.96 |
| Max. Negotiated Rate |
$211.37 |
| Rate for Payer: Aetna Commercial |
$199.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.66
|
| Rate for Payer: Cash Price |
$187.89
|
| Rate for Payer: Cofinity Commercial |
$164.40
|
| Rate for Payer: Cofinity Commercial |
$201.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.89
|
| Rate for Payer: Healthscope Commercial |
$211.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.63
|
| Rate for Payer: PHP Commercial |
$199.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.66
|
| Rate for Payer: Priority Health SBD |
$147.96
|
|
|
HC RO ISODOSE BRACH CALC SIMPLE
|
Facility
|
OP
|
$234.86
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$147.96 |
| Max. Negotiated Rate |
$1,004.98 |
| Rate for Payer: Aetna Commercial |
$199.63
|
| Rate for Payer: Aetna Medicare |
$371.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$187.89
|
| Rate for Payer: Cash Price |
$187.89
|
| Rate for Payer: Cofinity Commercial |
$201.98
|
| Rate for Payer: Cofinity Commercial |
$164.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$211.37
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.63
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$199.63
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.66
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health SBD |
$147.96
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.98
|
| Rate for Payer: UHC Core |
$173.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$173.80
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$201.00
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC RO ISODOSE BRACHY CALC COMPLEX
|
Facility
|
OP
|
$684.94
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$1,004.98 |
| Rate for Payer: Aetna Commercial |
$582.20
|
| Rate for Payer: Aetna Medicare |
$371.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Cofinity Commercial |
$589.05
|
| Rate for Payer: Cofinity Commercial |
$479.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$479.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$616.45
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$582.20
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$582.20
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.21
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health SBD |
$431.51
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.98
|
| Rate for Payer: UHC Core |
$506.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$506.86
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$201.00
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC RO ISODOSE BRACHY CALC COMPLEX
|
Facility
|
IP
|
$684.94
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$431.51 |
| Max. Negotiated Rate |
$616.45 |
| Rate for Payer: Aetna Commercial |
$582.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.21
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Cofinity Commercial |
$479.46
|
| Rate for Payer: Cofinity Commercial |
$589.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$479.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.95
|
| Rate for Payer: Healthscope Commercial |
$616.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$582.20
|
| Rate for Payer: PHP Commercial |
$582.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.21
|
| Rate for Payer: Priority Health SBD |
$431.51
|
|
