|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
IP
|
$115.06
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.54 |
| Max. Negotiated Rate |
$115.06 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: ASR ASR |
$111.61
|
| Rate for Payer: BCBS Trust/PPO |
$89.21
|
| Rate for Payer: BCN Commercial |
$89.21
|
| Rate for Payer: Cash Price |
$92.05
|
| Rate for Payer: Cofinity Commercial |
$108.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.05
|
| Rate for Payer: Healthscope Commercial |
$115.06
|
| Rate for Payer: Healthscope Whirlpool |
$111.61
|
| Rate for Payer: Mclaren Commercial |
$103.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.25
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: ASR ASR |
$54.32
|
| Rate for Payer: BCBS Trust/PPO |
$43.42
|
| Rate for Payer: BCN Commercial |
$43.42
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Healthscope Whirlpool |
$54.32
|
| Rate for Payer: Mclaren Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Medicare |
$14.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.25
|
| Rate for Payer: ASR ASR |
$54.32
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS MAPPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$43.42
|
| Rate for Payer: BCN Commercial |
$43.42
|
| Rate for Payer: BCN Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.60
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Healthscope Whirlpool |
$54.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.60
|
| Rate for Payer: Mclaren Commercial |
$50.40
|
| Rate for Payer: Mclaren Medicaid |
$7.99
|
| Rate for Payer: Mclaren Medicare |
$14.60
|
| Rate for Payer: Meridian Medicaid |
$8.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PACE Medicare |
$13.87
|
| Rate for Payer: PACE SWMI |
$14.60
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: PHP Medicaid |
$7.99
|
| Rate for Payer: PHP Medicare Advantage |
$14.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.39
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health Narrow Network |
$43.51
|
| Rate for Payer: Railroad Medicare Medicare |
$14.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
| Rate for Payer: UHC Medicare Advantage |
$15.04
|
| Rate for Payer: VA VA |
$14.60
|
|
|
HC RABIES VACCINE IM
|
Facility
|
IP
|
$1,016.90
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$711.83 |
| Max. Negotiated Rate |
$1,016.90 |
| Rate for Payer: Aetna Commercial |
$915.21
|
| Rate for Payer: ASR ASR |
$986.39
|
| Rate for Payer: BCBS Trust/PPO |
$788.40
|
| Rate for Payer: BCN Commercial |
$788.40
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cofinity Commercial |
$955.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.52
|
| Rate for Payer: Healthscope Commercial |
$1,016.90
|
| Rate for Payer: Healthscope Whirlpool |
$986.39
|
| Rate for Payer: Mclaren Commercial |
$915.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$864.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$894.87
|
|
|
HC RABIES VACCINE IM
|
Facility
|
OP
|
$1,016.90
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$1,016.90 |
| Rate for Payer: Aetna Commercial |
$915.21
|
| Rate for Payer: Aetna Medicare |
$324.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$405.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$405.93
|
| Rate for Payer: ASR ASR |
$986.39
|
| Rate for Payer: BCBS Complete |
$186.53
|
| Rate for Payer: BCBS MAPPO |
$324.74
|
| Rate for Payer: BCBS Trust/PPO |
$788.40
|
| Rate for Payer: BCN Commercial |
$788.40
|
| Rate for Payer: BCN Medicare Advantage |
$324.74
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cofinity Commercial |
$955.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.74
|
| Rate for Payer: Healthscope Commercial |
$1,016.90
|
| Rate for Payer: Healthscope Whirlpool |
$986.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$324.74
|
| Rate for Payer: Mclaren Commercial |
$915.21
|
| Rate for Payer: Mclaren Medicaid |
$177.63
|
| Rate for Payer: Mclaren Medicare |
$324.74
|
| Rate for Payer: Meridian Medicaid |
$186.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$340.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$864.36
|
| Rate for Payer: PACE Medicare |
$308.51
|
| Rate for Payer: PACE SWMI |
$324.74
|
| Rate for Payer: PHP Commercial |
$357.22
|
| Rate for Payer: PHP Medicaid |
$177.63
|
| Rate for Payer: PHP Medicare Advantage |
$324.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$925.38
|
| Rate for Payer: Priority Health Medicare |
$324.74
|
| Rate for Payer: Priority Health Narrow Network |
$722.00
|
| Rate for Payer: Railroad Medicare Medicare |
$324.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$894.87
|
| Rate for Payer: UHC Medicare Advantage |
$334.49
|
| Rate for Payer: VA VA |
$324.74
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
IP
|
$184.92
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$129.44 |
| Max. Negotiated Rate |
$184.92 |
| Rate for Payer: Aetna Commercial |
$166.43
|
| Rate for Payer: ASR ASR |
$179.37
|
| Rate for Payer: BCBS Trust/PPO |
$143.37
|
| Rate for Payer: BCN Commercial |
$143.37
|
| Rate for Payer: Cash Price |
$147.94
|
| Rate for Payer: Cofinity Commercial |
$173.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.94
|
| Rate for Payer: Healthscope Commercial |
$184.92
|
| Rate for Payer: Healthscope Whirlpool |
$179.37
|
| Rate for Payer: Mclaren Commercial |
$166.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.73
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
OP
|
$184.92
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.97 |
| Max. Negotiated Rate |
$184.92 |
| Rate for Payer: Aetna Commercial |
$166.43
|
| Rate for Payer: ASR ASR |
$179.37
|
| Rate for Payer: BCBS Complete |
$73.97
|
| Rate for Payer: BCBS Trust/PPO |
$143.37
|
| Rate for Payer: BCN Commercial |
$143.37
|
| Rate for Payer: Cash Price |
$147.94
|
| Rate for Payer: Cofinity Commercial |
$173.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.94
|
| Rate for Payer: Healthscope Commercial |
$184.92
|
| Rate for Payer: Healthscope Whirlpool |
$179.37
|
| Rate for Payer: Mclaren Commercial |
$166.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.28
|
| Rate for Payer: Priority Health Narrow Network |
$131.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.73
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
IP
|
$421.26
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$294.88 |
| Max. Negotiated Rate |
$421.26 |
| Rate for Payer: Aetna Commercial |
$379.13
|
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: ASR ASR |
$429.71
|
| Rate for Payer: ASR ASR |
$408.62
|
| Rate for Payer: BCBS Trust/PPO |
$326.60
|
| Rate for Payer: BCBS Trust/PPO |
$343.46
|
| Rate for Payer: BCN Commercial |
$343.46
|
| Rate for Payer: BCN Commercial |
$326.60
|
| Rate for Payer: Cash Price |
$337.01
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$395.98
|
| Rate for Payer: Cofinity Commercial |
$416.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.01
|
| Rate for Payer: Healthscope Commercial |
$421.26
|
| Rate for Payer: Healthscope Commercial |
$443.00
|
| Rate for Payer: Healthscope Whirlpool |
$408.62
|
| Rate for Payer: Healthscope Whirlpool |
$429.71
|
| Rate for Payer: Mclaren Commercial |
$398.70
|
| Rate for Payer: Mclaren Commercial |
$379.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.84
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
OP
|
$421.26
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$421.26 |
| Rate for Payer: Aetna Commercial |
$379.13
|
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: ASR ASR |
$408.62
|
| Rate for Payer: ASR ASR |
$429.71
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS Trust/PPO |
$343.46
|
| Rate for Payer: BCBS Trust/PPO |
$326.60
|
| Rate for Payer: BCN Commercial |
$343.46
|
| Rate for Payer: BCN Commercial |
$326.60
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: Cash Price |
$337.01
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$337.01
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$416.42
|
| Rate for Payer: Cofinity Commercial |
$395.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Healthscope Commercial |
$443.00
|
| Rate for Payer: Healthscope Commercial |
$421.26
|
| Rate for Payer: Healthscope Whirlpool |
$429.71
|
| Rate for Payer: Healthscope Whirlpool |
$408.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Mclaren Commercial |
$398.70
|
| Rate for Payer: Mclaren Commercial |
$379.13
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.55
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$403.13
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Narrow Network |
$299.09
|
| Rate for Payer: Priority Health Narrow Network |
$314.53
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.71
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: VA VA |
$120.61
|
| Rate for Payer: VA VA |
$120.61
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
IP
|
$280.58
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.41 |
| Max. Negotiated Rate |
$280.58 |
| Rate for Payer: Aetna Commercial |
$252.52
|
| Rate for Payer: ASR ASR |
$272.16
|
| Rate for Payer: BCBS Trust/PPO |
$217.53
|
| Rate for Payer: BCN Commercial |
$217.53
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cofinity Commercial |
$263.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.46
|
| Rate for Payer: Healthscope Commercial |
$280.58
|
| Rate for Payer: Healthscope Whirlpool |
$272.16
|
| Rate for Payer: Mclaren Commercial |
$252.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.91
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
OP
|
$280.58
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$280.58 |
| Rate for Payer: Aetna Commercial |
$252.52
|
| Rate for Payer: Aetna Medicare |
$161.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$201.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$201.45
|
| Rate for Payer: ASR ASR |
$272.16
|
| Rate for Payer: BCBS Complete |
$92.57
|
| Rate for Payer: BCBS MAPPO |
$161.16
|
| Rate for Payer: BCBS Trust/PPO |
$217.53
|
| Rate for Payer: BCN Commercial |
$217.53
|
| Rate for Payer: BCN Medicare Advantage |
$161.16
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cofinity Commercial |
$263.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.16
|
| Rate for Payer: Healthscope Commercial |
$280.58
|
| Rate for Payer: Healthscope Whirlpool |
$272.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$161.16
|
| Rate for Payer: Mclaren Commercial |
$252.52
|
| Rate for Payer: Mclaren Medicaid |
$88.16
|
| Rate for Payer: Mclaren Medicare |
$161.16
|
| Rate for Payer: Meridian Medicaid |
$92.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$169.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.49
|
| Rate for Payer: PACE Medicare |
$153.10
|
| Rate for Payer: PACE SWMI |
$161.16
|
| Rate for Payer: PHP Commercial |
$177.28
|
| Rate for Payer: PHP Medicaid |
$88.16
|
| Rate for Payer: PHP Medicare Advantage |
$161.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.33
|
| Rate for Payer: Priority Health Medicare |
$161.16
|
| Rate for Payer: Priority Health Narrow Network |
$199.21
|
| Rate for Payer: Railroad Medicare Medicare |
$161.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.91
|
| Rate for Payer: UHC Medicare Advantage |
$166.00
|
| Rate for Payer: VA VA |
$161.16
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
IP
|
$3,844.61
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,691.23 |
| Max. Negotiated Rate |
$3,844.61 |
| Rate for Payer: Aetna Commercial |
$3,460.15
|
| Rate for Payer: ASR ASR |
$3,729.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,980.73
|
| Rate for Payer: BCN Commercial |
$2,980.73
|
| Rate for Payer: Cash Price |
$3,075.69
|
| Rate for Payer: Cofinity Commercial |
$3,613.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,075.69
|
| Rate for Payer: Healthscope Commercial |
$3,844.61
|
| Rate for Payer: Healthscope Whirlpool |
$3,729.27
|
| Rate for Payer: Mclaren Commercial |
$3,460.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,267.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,383.26
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
OP
|
$3,844.61
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.75 |
| Max. Negotiated Rate |
$3,844.61 |
| Rate for Payer: Aetna Commercial |
$3,460.15
|
| Rate for Payer: Aetna Medicare |
$805.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: ASR ASR |
$3,729.27
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,980.73
|
| Rate for Payer: BCN Commercial |
$2,980.73
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$3,075.69
|
| Rate for Payer: Cash Price |
$3,075.69
|
| Rate for Payer: Cofinity Commercial |
$3,613.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,075.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$3,844.61
|
| Rate for Payer: Healthscope Whirlpool |
$3,729.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$805.75
|
| Rate for Payer: Mclaren Commercial |
$3,460.15
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,267.92
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$886.32
|
| Rate for Payer: PHP Medicaid |
$440.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,743.50
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,994.80
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,383.26
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$267.00 |
| Rate for Payer: Aetna Commercial |
$240.30
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$258.99
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$207.01
|
| Rate for Payer: BCN Commercial |
$207.01
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$267.00
|
| Rate for Payer: Healthscope Whirlpool |
$258.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$240.30
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.95
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.97
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$189.57
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.96
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$186.90 |
| Max. Negotiated Rate |
$267.00 |
| Rate for Payer: Aetna Commercial |
$240.30
|
| Rate for Payer: ASR ASR |
$258.99
|
| Rate for Payer: BCBS Trust/PPO |
$207.01
|
| Rate for Payer: BCN Commercial |
$207.01
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.60
|
| Rate for Payer: Healthscope Commercial |
$267.00
|
| Rate for Payer: Healthscope Whirlpool |
$258.99
|
| Rate for Payer: Mclaren Commercial |
$240.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.96
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
OP
|
$88.16
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$100.96 |
| Rate for Payer: Aetna Commercial |
$79.34
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$85.52
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$68.35
|
| Rate for Payer: BCN Commercial |
$68.35
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Commercial |
$82.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$88.16
|
| Rate for Payer: Healthscope Whirlpool |
$85.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$79.34
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.94
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.35
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$73.88
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.58
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
IP
|
$88.16
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.71 |
| Max. Negotiated Rate |
$88.16 |
| Rate for Payer: Aetna Commercial |
$79.34
|
| Rate for Payer: ASR ASR |
$85.52
|
| Rate for Payer: BCBS Trust/PPO |
$68.35
|
| Rate for Payer: BCN Commercial |
$68.35
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Commercial |
$82.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.53
|
| Rate for Payer: Healthscope Commercial |
$88.16
|
| Rate for Payer: Healthscope Whirlpool |
$85.52
|
| Rate for Payer: Mclaren Commercial |
$79.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.58
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
IP
|
$281.68
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$197.18 |
| Max. Negotiated Rate |
$281.68 |
| Rate for Payer: Aetna Commercial |
$253.51
|
| Rate for Payer: ASR ASR |
$273.23
|
| Rate for Payer: BCBS Trust/PPO |
$218.39
|
| Rate for Payer: BCN Commercial |
$218.39
|
| Rate for Payer: Cash Price |
$225.34
|
| Rate for Payer: Cofinity Commercial |
$264.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.34
|
| Rate for Payer: Healthscope Commercial |
$281.68
|
| Rate for Payer: Healthscope Whirlpool |
$273.23
|
| Rate for Payer: Mclaren Commercial |
$253.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.88
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
OP
|
$281.68
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$281.68 |
| Rate for Payer: Aetna Commercial |
$253.51
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$273.23
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$218.39
|
| Rate for Payer: BCN Commercial |
$218.39
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$225.34
|
| Rate for Payer: Cash Price |
$225.34
|
| Rate for Payer: Cofinity Commercial |
$264.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$281.68
|
| Rate for Payer: Healthscope Whirlpool |
$273.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$253.51
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.43
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.37
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$137.10
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.88
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
OP
|
$937.20
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$937.20 |
| Rate for Payer: Aetna Commercial |
$843.48
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$909.08
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$726.61
|
| Rate for Payer: BCN Commercial |
$726.61
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$749.76
|
| Rate for Payer: Cash Price |
$749.76
|
| Rate for Payer: Cofinity Commercial |
$880.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$937.20
|
| Rate for Payer: Healthscope Whirlpool |
$909.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$843.48
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$796.62
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$852.85
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$665.41
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$824.74
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
IP
|
$937.20
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$656.04 |
| Max. Negotiated Rate |
$937.20 |
| Rate for Payer: Aetna Commercial |
$843.48
|
| Rate for Payer: ASR ASR |
$909.08
|
| Rate for Payer: BCBS Trust/PPO |
$726.61
|
| Rate for Payer: BCN Commercial |
$726.61
|
| Rate for Payer: Cash Price |
$749.76
|
| Rate for Payer: Cofinity Commercial |
$880.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.76
|
| Rate for Payer: Healthscope Commercial |
$937.20
|
| Rate for Payer: Healthscope Whirlpool |
$909.08
|
| Rate for Payer: Mclaren Commercial |
$843.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$796.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$824.74
|
|
|
HC RADXF UNL NM CARDIOVASC 78499
|
Facility
|
OP
|
$787.76
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$787.76 |
| Rate for Payer: Aetna Commercial |
$708.98
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$764.13
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$610.75
|
| Rate for Payer: BCN Commercial |
$610.75
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$740.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$787.76
|
| Rate for Payer: Healthscope Whirlpool |
$764.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$708.98
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.86
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$559.31
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$693.23
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC RADXF UNL NM CARDIOVASC 78499
|
Facility
|
IP
|
$787.76
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$551.43 |
| Max. Negotiated Rate |
$787.76 |
| Rate for Payer: Aetna Commercial |
$708.98
|
| Rate for Payer: ASR ASR |
$764.13
|
| Rate for Payer: BCBS Trust/PPO |
$610.75
|
| Rate for Payer: BCN Commercial |
$610.75
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$740.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.21
|
| Rate for Payer: Healthscope Commercial |
$787.76
|
| Rate for Payer: Healthscope Whirlpool |
$764.13
|
| Rate for Payer: Mclaren Commercial |
$708.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$693.23
|
|
|
HC RADXF UNL NM CNS 78699
|
Facility
|
OP
|
$787.76
|
|
|
Service Code
|
CPT 78699
|
| Hospital Charge Code |
34100043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$787.76 |
| Rate for Payer: Aetna Commercial |
$708.98
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$764.13
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$610.75
|
| Rate for Payer: BCN Commercial |
$610.75
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$740.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$787.76
|
| Rate for Payer: Healthscope Whirlpool |
$764.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$708.98
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.86
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$559.31
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$693.23
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC RADXF UNL NM CNS 78699
|
Facility
|
IP
|
$787.76
|
|
|
Service Code
|
CPT 78699
|
| Hospital Charge Code |
34100043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$551.43 |
| Max. Negotiated Rate |
$787.76 |
| Rate for Payer: Aetna Commercial |
$708.98
|
| Rate for Payer: ASR ASR |
$764.13
|
| Rate for Payer: BCBS Trust/PPO |
$610.75
|
| Rate for Payer: BCN Commercial |
$610.75
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$740.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.21
|
| Rate for Payer: Healthscope Commercial |
$787.76
|
| Rate for Payer: Healthscope Whirlpool |
$764.13
|
| Rate for Payer: Mclaren Commercial |
$708.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$693.23
|
|
