|
HC RISPERIDONE AND METABOLIT
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: ASR ASR |
$107.67
|
| Rate for Payer: BCBS Trust/PPO |
$86.06
|
| Rate for Payer: BCN Commercial |
$86.06
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$104.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Healthscope Commercial |
$111.00
|
| Rate for Payer: Healthscope Whirlpool |
$107.67
|
| Rate for Payer: Mclaren Commercial |
$99.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.68
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
OP
|
$67.73
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$67.73 |
| Rate for Payer: Aetna Commercial |
$60.96
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: ASR ASR |
$65.70
|
| Rate for Payer: BCBS Complete |
$13.18
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$52.51
|
| Rate for Payer: BCN Commercial |
$52.51
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$63.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$67.73
|
| Rate for Payer: Healthscope Whirlpool |
$65.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.94
|
| Rate for Payer: Mclaren Commercial |
$60.96
|
| Rate for Payer: Mclaren Medicaid |
$12.55
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Medicaid |
$13.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.57
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$25.23
|
| Rate for Payer: PHP Medicaid |
$12.55
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.63
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Narrow Network |
$48.09
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.60
|
| Rate for Payer: UHC Medicare Advantage |
$23.63
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
IP
|
$67.73
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.41 |
| Max. Negotiated Rate |
$67.73 |
| Rate for Payer: Aetna Commercial |
$60.96
|
| Rate for Payer: ASR ASR |
$65.70
|
| Rate for Payer: BCBS Trust/PPO |
$52.51
|
| Rate for Payer: BCN Commercial |
$52.51
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$63.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.18
|
| Rate for Payer: Healthscope Commercial |
$67.73
|
| Rate for Payer: Healthscope Whirlpool |
$65.70
|
| Rate for Payer: Mclaren Commercial |
$60.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.60
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
IP
|
$93.30
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.31 |
| Max. Negotiated Rate |
$93.30 |
| Rate for Payer: Aetna Commercial |
$83.97
|
| Rate for Payer: ASR ASR |
$90.50
|
| Rate for Payer: BCBS Trust/PPO |
$72.34
|
| Rate for Payer: BCN Commercial |
$72.34
|
| Rate for Payer: Cash Price |
$74.64
|
| Rate for Payer: Cofinity Commercial |
$87.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.64
|
| Rate for Payer: Healthscope Commercial |
$93.30
|
| Rate for Payer: Healthscope Whirlpool |
$90.50
|
| Rate for Payer: Mclaren Commercial |
$83.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.10
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
OP
|
$93.30
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$93.30 |
| Rate for Payer: Aetna Commercial |
$83.97
|
| Rate for Payer: ASR ASR |
$90.50
|
| Rate for Payer: BCBS Complete |
$37.32
|
| Rate for Payer: BCBS Trust/PPO |
$72.34
|
| Rate for Payer: BCN Commercial |
$72.34
|
| Rate for Payer: Cash Price |
$74.64
|
| Rate for Payer: Cofinity Commercial |
$87.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.64
|
| Rate for Payer: Healthscope Commercial |
$93.30
|
| Rate for Payer: Healthscope Whirlpool |
$90.50
|
| Rate for Payer: Mclaren Commercial |
$83.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.90
|
| Rate for Payer: Priority Health Narrow Network |
$66.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.10
|
|
|
HC RLC W INTERVENTION
|
Facility
|
OP
|
$10,979.89
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,584.36 |
| Max. Negotiated Rate |
$10,979.89 |
| Rate for Payer: Aetna Commercial |
$9,881.90
|
| Rate for Payer: Aetna Medicare |
$2,896.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,620.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,620.58
|
| Rate for Payer: ASR ASR |
$10,650.49
|
| Rate for Payer: BCBS Complete |
$1,663.73
|
| Rate for Payer: BCBS MAPPO |
$2,896.46
|
| Rate for Payer: BCBS Trust/PPO |
$8,512.71
|
| Rate for Payer: BCN Commercial |
$8,512.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,896.46
|
| Rate for Payer: Cash Price |
$8,783.91
|
| Rate for Payer: Cash Price |
$8,783.91
|
| Rate for Payer: Cofinity Commercial |
$10,321.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,783.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,896.46
|
| Rate for Payer: Healthscope Commercial |
$10,979.89
|
| Rate for Payer: Healthscope Whirlpool |
$10,650.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,896.46
|
| Rate for Payer: Mclaren Commercial |
$9,881.90
|
| Rate for Payer: Mclaren Medicaid |
$1,584.36
|
| Rate for Payer: Mclaren Medicare |
$2,896.46
|
| Rate for Payer: Meridian Medicaid |
$1,663.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,041.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,330.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,332.91
|
| Rate for Payer: PACE Medicare |
$2,751.64
|
| Rate for Payer: PACE SWMI |
$2,896.46
|
| Rate for Payer: PHP Commercial |
$3,186.11
|
| Rate for Payer: PHP Medicaid |
$1,584.36
|
| Rate for Payer: PHP Medicare Advantage |
$2,896.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,584.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,685.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.70
|
| Rate for Payer: Priority Health Medicare |
$2,896.46
|
| Rate for Payer: Priority Health Narrow Network |
$7,795.72
|
| Rate for Payer: Railroad Medicare Medicare |
$2,896.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,662.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,983.35
|
| Rate for Payer: VA VA |
$2,896.46
|
|
|
HC RLC W INTERVENTION
|
Facility
|
IP
|
$10,979.89
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,685.92 |
| Max. Negotiated Rate |
$10,979.89 |
| Rate for Payer: Aetna Commercial |
$9,881.90
|
| Rate for Payer: ASR ASR |
$10,650.49
|
| Rate for Payer: BCBS Trust/PPO |
$8,512.71
|
| Rate for Payer: BCN Commercial |
$8,512.71
|
| Rate for Payer: Cash Price |
$8,783.91
|
| Rate for Payer: Cofinity Commercial |
$10,321.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,783.91
|
| Rate for Payer: Healthscope Commercial |
$10,979.89
|
| Rate for Payer: Healthscope Whirlpool |
$10,650.49
|
| Rate for Payer: Mclaren Commercial |
$9,881.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,332.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,685.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,662.30
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,645.00 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$2,115.00
|
| Rate for Payer: ASR ASR |
$2,279.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,821.96
|
| Rate for Payer: BCN Commercial |
$1,821.96
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cofinity Commercial |
$2,209.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,880.00
|
| Rate for Payer: Healthscope Commercial |
$2,350.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,279.50
|
| Rate for Payer: Mclaren Commercial |
$2,115.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,997.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,645.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,068.00
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.53 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$2,115.00
|
| 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 |
$2,279.50
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,821.96
|
| Rate for Payer: BCN Commercial |
$1,821.96
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cofinity Commercial |
$2,209.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,880.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$2,350.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,279.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$805.75
|
| Rate for Payer: Mclaren Commercial |
$2,115.00
|
| 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 |
$1,997.50
|
| 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 |
$1,645.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.41
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$75.53
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,068.00
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: ASR ASR |
$67.90
|
| Rate for Payer: BCBS Trust/PPO |
$54.27
|
| Rate for Payer: BCN Commercial |
$54.27
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$65.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$70.00
|
| Rate for Payer: Healthscope Whirlpool |
$67.90
|
| Rate for Payer: Mclaren Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.60
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$67.90
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$54.27
|
| Rate for Payer: BCN Commercial |
$54.27
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$65.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$70.00
|
| Rate for Payer: Healthscope Whirlpool |
$67.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$63.00
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.31
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.03
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$157.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.60
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$143.67 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.81
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.67
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$114.94
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$143.67 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.81
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.67
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$114.94
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$143.67 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.81
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.67
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$114.94
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
OP
|
$219.40
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$87.76 |
| Max. Negotiated Rate |
$219.40 |
| Rate for Payer: Aetna Commercial |
$197.46
|
| Rate for Payer: Aetna Commercial |
$958.50
|
| Rate for Payer: ASR ASR |
$212.82
|
| Rate for Payer: ASR ASR |
$1,033.05
|
| Rate for Payer: BCBS Complete |
$426.00
|
| Rate for Payer: BCBS Complete |
$87.76
|
| Rate for Payer: BCBS Trust/PPO |
$170.10
|
| Rate for Payer: BCBS Trust/PPO |
$825.69
|
| Rate for Payer: BCN Commercial |
$825.69
|
| Rate for Payer: BCN Commercial |
$170.10
|
| Rate for Payer: Cash Price |
$175.52
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cofinity Commercial |
$206.24
|
| Rate for Payer: Cofinity Commercial |
$1,001.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$852.00
|
| Rate for Payer: Healthscope Commercial |
$219.40
|
| Rate for Payer: Healthscope Commercial |
$1,065.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,033.05
|
| Rate for Payer: Healthscope Whirlpool |
$212.82
|
| Rate for Payer: Mclaren Commercial |
$197.46
|
| Rate for Payer: Mclaren Commercial |
$958.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$905.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$969.15
|
| Rate for Payer: Priority Health Narrow Network |
$756.15
|
| Rate for Payer: Priority Health Narrow Network |
$155.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$937.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.07
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
IP
|
$219.40
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$153.58 |
| Max. Negotiated Rate |
$219.40 |
| Rate for Payer: Aetna Commercial |
$197.46
|
| Rate for Payer: Aetna Commercial |
$958.50
|
| Rate for Payer: ASR ASR |
$212.82
|
| Rate for Payer: ASR ASR |
$1,033.05
|
| Rate for Payer: BCBS Trust/PPO |
$170.10
|
| Rate for Payer: BCBS Trust/PPO |
$825.69
|
| Rate for Payer: BCN Commercial |
$170.10
|
| Rate for Payer: BCN Commercial |
$825.69
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cash Price |
$175.52
|
| Rate for Payer: Cofinity Commercial |
$206.24
|
| Rate for Payer: Cofinity Commercial |
$1,001.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$852.00
|
| Rate for Payer: Healthscope Commercial |
$1,065.00
|
| Rate for Payer: Healthscope Commercial |
$219.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,033.05
|
| Rate for Payer: Healthscope Whirlpool |
$212.82
|
| Rate for Payer: Mclaren Commercial |
$958.50
|
| Rate for Payer: Mclaren Commercial |
$197.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$905.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$937.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.07
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
OP
|
$5,296.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$286.22 |
| Max. Negotiated Rate |
$5,296.00 |
| Rate for Payer: Aetna Commercial |
$4,766.40
|
| Rate for Payer: Aetna Commercial |
$2,901.18
|
| Rate for Payer: Aetna Medicare |
$523.25
|
| Rate for Payer: Aetna Medicare |
$523.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.06
|
| Rate for Payer: ASR ASR |
$3,126.82
|
| Rate for Payer: ASR ASR |
$5,137.12
|
| Rate for Payer: BCBS Complete |
$300.55
|
| Rate for Payer: BCBS Complete |
$300.55
|
| Rate for Payer: BCBS MAPPO |
$523.25
|
| Rate for Payer: BCBS MAPPO |
$523.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,499.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,105.99
|
| Rate for Payer: BCN Commercial |
$4,105.99
|
| Rate for Payer: BCN Commercial |
$2,499.20
|
| Rate for Payer: BCN Medicare Advantage |
$523.25
|
| Rate for Payer: BCN Medicare Advantage |
$523.25
|
| Rate for Payer: Cash Price |
$4,236.80
|
| Rate for Payer: Cash Price |
$4,236.80
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cofinity Commercial |
$3,030.12
|
| Rate for Payer: Cofinity Commercial |
$4,978.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,236.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.25
|
| Rate for Payer: Healthscope Commercial |
$5,296.00
|
| Rate for Payer: Healthscope Commercial |
$3,223.53
|
| Rate for Payer: Healthscope Whirlpool |
$5,137.12
|
| Rate for Payer: Healthscope Whirlpool |
$3,126.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$523.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$523.25
|
| Rate for Payer: Mclaren Commercial |
$4,766.40
|
| Rate for Payer: Mclaren Commercial |
$2,901.18
|
| Rate for Payer: Mclaren Medicaid |
$286.22
|
| Rate for Payer: Mclaren Medicaid |
$286.22
|
| Rate for Payer: Mclaren Medicare |
$523.25
|
| Rate for Payer: Mclaren Medicare |
$523.25
|
| Rate for Payer: Meridian Medicaid |
$300.55
|
| Rate for Payer: Meridian Medicaid |
$300.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,740.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,501.60
|
| Rate for Payer: PACE Medicare |
$497.09
|
| Rate for Payer: PACE Medicare |
$497.09
|
| Rate for Payer: PACE SWMI |
$523.25
|
| Rate for Payer: PACE SWMI |
$523.25
|
| Rate for Payer: PHP Commercial |
$575.58
|
| Rate for Payer: PHP Commercial |
$575.58
|
| Rate for Payer: PHP Medicaid |
$286.22
|
| Rate for Payer: PHP Medicaid |
$286.22
|
| Rate for Payer: PHP Medicare Advantage |
$523.25
|
| Rate for Payer: PHP Medicare Advantage |
$523.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,707.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,933.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,819.36
|
| Rate for Payer: Priority Health Medicare |
$523.25
|
| Rate for Payer: Priority Health Medicare |
$523.25
|
| Rate for Payer: Priority Health Narrow Network |
$3,760.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,288.71
|
| Rate for Payer: Railroad Medicare Medicare |
$523.25
|
| Rate for Payer: Railroad Medicare Medicare |
$523.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,660.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,836.71
|
| Rate for Payer: UHC Medicare Advantage |
$538.95
|
| Rate for Payer: UHC Medicare Advantage |
$538.95
|
| Rate for Payer: VA VA |
$523.25
|
| Rate for Payer: VA VA |
$523.25
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
IP
|
$5,296.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,707.20 |
| Max. Negotiated Rate |
$5,296.00 |
| Rate for Payer: Aetna Commercial |
$4,766.40
|
| Rate for Payer: Aetna Commercial |
$2,901.18
|
| Rate for Payer: ASR ASR |
$5,137.12
|
| Rate for Payer: ASR ASR |
$3,126.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,499.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,105.99
|
| Rate for Payer: BCN Commercial |
$4,105.99
|
| Rate for Payer: BCN Commercial |
$2,499.20
|
| Rate for Payer: Cash Price |
$4,236.80
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cofinity Commercial |
$3,030.12
|
| Rate for Payer: Cofinity Commercial |
$4,978.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,236.80
|
| Rate for Payer: Healthscope Commercial |
$3,223.53
|
| Rate for Payer: Healthscope Commercial |
$5,296.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,137.12
|
| Rate for Payer: Healthscope Whirlpool |
$3,126.82
|
| Rate for Payer: Mclaren Commercial |
$2,901.18
|
| Rate for Payer: Mclaren Commercial |
$4,766.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,740.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,501.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,707.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,836.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,660.48
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
OP
|
$3,223.53
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$286.22 |
| Max. Negotiated Rate |
$3,223.53 |
| Rate for Payer: Aetna Commercial |
$2,901.18
|
| Rate for Payer: Aetna Commercial |
$4,586.40
|
| Rate for Payer: Aetna Medicare |
$523.25
|
| Rate for Payer: Aetna Medicare |
$523.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.06
|
| Rate for Payer: ASR ASR |
$4,943.12
|
| Rate for Payer: ASR ASR |
$3,126.82
|
| Rate for Payer: BCBS Complete |
$300.55
|
| Rate for Payer: BCBS Complete |
$300.55
|
| Rate for Payer: BCBS MAPPO |
$523.25
|
| Rate for Payer: BCBS MAPPO |
$523.25
|
| Rate for Payer: BCBS Trust/PPO |
$3,950.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,499.20
|
| Rate for Payer: BCN Commercial |
$2,499.20
|
| Rate for Payer: BCN Commercial |
$3,950.93
|
| Rate for Payer: BCN Medicare Advantage |
$523.25
|
| Rate for Payer: BCN Medicare Advantage |
$523.25
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$4,076.80
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$4,076.80
|
| Rate for Payer: Cofinity Commercial |
$3,030.12
|
| Rate for Payer: Cofinity Commercial |
$4,790.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,076.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.25
|
| Rate for Payer: Healthscope Commercial |
$5,096.00
|
| Rate for Payer: Healthscope Commercial |
$3,223.53
|
| Rate for Payer: Healthscope Whirlpool |
$4,943.12
|
| Rate for Payer: Healthscope Whirlpool |
$3,126.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$523.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$523.25
|
| Rate for Payer: Mclaren Commercial |
$4,586.40
|
| Rate for Payer: Mclaren Commercial |
$2,901.18
|
| Rate for Payer: Mclaren Medicaid |
$286.22
|
| Rate for Payer: Mclaren Medicaid |
$286.22
|
| Rate for Payer: Mclaren Medicare |
$523.25
|
| Rate for Payer: Mclaren Medicare |
$523.25
|
| Rate for Payer: Meridian Medicaid |
$300.55
|
| Rate for Payer: Meridian Medicaid |
$300.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,331.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,740.00
|
| Rate for Payer: PACE Medicare |
$497.09
|
| Rate for Payer: PACE Medicare |
$497.09
|
| Rate for Payer: PACE SWMI |
$523.25
|
| Rate for Payer: PACE SWMI |
$523.25
|
| Rate for Payer: PHP Commercial |
$575.58
|
| Rate for Payer: PHP Commercial |
$575.58
|
| Rate for Payer: PHP Medicaid |
$286.22
|
| Rate for Payer: PHP Medicaid |
$286.22
|
| Rate for Payer: PHP Medicare Advantage |
$523.25
|
| Rate for Payer: PHP Medicare Advantage |
$523.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,567.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,933.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,637.36
|
| Rate for Payer: Priority Health Medicare |
$523.25
|
| Rate for Payer: Priority Health Medicare |
$523.25
|
| Rate for Payer: Priority Health Narrow Network |
$3,618.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,288.71
|
| Rate for Payer: Railroad Medicare Medicare |
$523.25
|
| Rate for Payer: Railroad Medicare Medicare |
$523.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,484.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,836.71
|
| Rate for Payer: UHC Medicare Advantage |
$538.95
|
| Rate for Payer: UHC Medicare Advantage |
$538.95
|
| Rate for Payer: VA VA |
$523.25
|
| Rate for Payer: VA VA |
$523.25
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
IP
|
$5,096.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,567.20 |
| Max. Negotiated Rate |
$5,096.00 |
| Rate for Payer: Aetna Commercial |
$4,586.40
|
| Rate for Payer: Aetna Commercial |
$2,901.18
|
| Rate for Payer: ASR ASR |
$4,943.12
|
| Rate for Payer: ASR ASR |
$3,126.82
|
| Rate for Payer: BCBS Trust/PPO |
$3,950.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,499.20
|
| Rate for Payer: BCN Commercial |
$3,950.93
|
| Rate for Payer: BCN Commercial |
$2,499.20
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$4,076.80
|
| Rate for Payer: Cofinity Commercial |
$4,790.24
|
| Rate for Payer: Cofinity Commercial |
$3,030.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,076.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.82
|
| Rate for Payer: Healthscope Commercial |
$3,223.53
|
| Rate for Payer: Healthscope Commercial |
$5,096.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,126.82
|
| Rate for Payer: Healthscope Whirlpool |
$4,943.12
|
| Rate for Payer: Mclaren Commercial |
$2,901.18
|
| Rate for Payer: Mclaren Commercial |
$4,586.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,740.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,331.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,567.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,836.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,484.48
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
IP
|
$325.38
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$227.77 |
| Max. Negotiated Rate |
$325.38 |
| Rate for Payer: Aetna Commercial |
$292.84
|
| Rate for Payer: ASR ASR |
$315.62
|
| Rate for Payer: BCBS Trust/PPO |
$252.27
|
| Rate for Payer: BCN Commercial |
$252.27
|
| Rate for Payer: Cash Price |
$260.30
|
| Rate for Payer: Cofinity Commercial |
$305.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.30
|
| Rate for Payer: Healthscope Commercial |
$325.38
|
| Rate for Payer: Healthscope Whirlpool |
$315.62
|
| Rate for Payer: Mclaren Commercial |
$292.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.33
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
OP
|
$325.38
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.67 |
| Max. Negotiated Rate |
$325.38 |
| Rate for Payer: Aetna Commercial |
$292.84
|
| Rate for Payer: Aetna Medicare |
$238.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.60
|
| Rate for Payer: ASR ASR |
$315.62
|
| Rate for Payer: BCBS Complete |
$137.21
|
| Rate for Payer: BCBS MAPPO |
$238.88
|
| Rate for Payer: BCBS Trust/PPO |
$252.27
|
| Rate for Payer: BCN Commercial |
$252.27
|
| Rate for Payer: BCN Medicare Advantage |
$238.88
|
| Rate for Payer: Cash Price |
$260.30
|
| Rate for Payer: Cash Price |
$260.30
|
| Rate for Payer: Cofinity Commercial |
$305.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.88
|
| Rate for Payer: Healthscope Commercial |
$325.38
|
| Rate for Payer: Healthscope Whirlpool |
$315.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$238.88
|
| Rate for Payer: Mclaren Commercial |
$292.84
|
| Rate for Payer: Mclaren Medicaid |
$130.67
|
| Rate for Payer: Mclaren Medicare |
$238.88
|
| Rate for Payer: Meridian Medicaid |
$137.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.57
|
| Rate for Payer: PACE Medicare |
$226.94
|
| Rate for Payer: PACE SWMI |
$238.88
|
| Rate for Payer: PHP Commercial |
$262.77
|
| Rate for Payer: PHP Medicaid |
$130.67
|
| Rate for Payer: PHP Medicare Advantage |
$238.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.10
|
| Rate for Payer: Priority Health Medicare |
$238.88
|
| Rate for Payer: Priority Health Narrow Network |
$231.02
|
| Rate for Payer: Railroad Medicare Medicare |
$238.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.33
|
| Rate for Payer: UHC Medicare Advantage |
$246.05
|
| Rate for Payer: VA VA |
$238.88
|
|
