|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
OP
|
$291.91
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.48 |
| Max. Negotiated Rate |
$291.91 |
| Rate for Payer: Aetna Commercial |
$262.72
|
| Rate for Payer: Aetna Medicare |
$171.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$213.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$213.86
|
| Rate for Payer: ASR ASR |
$283.15
|
| Rate for Payer: BCBS Complete |
$93.96
|
| Rate for Payer: BCBS MAPPO |
$171.09
|
| Rate for Payer: BCBS Trust/PPO |
$240.68
|
| Rate for Payer: BCN Commercial |
$240.68
|
| Rate for Payer: BCN Medicare Advantage |
$171.09
|
| Rate for Payer: Cash Price |
$233.53
|
| Rate for Payer: Cash Price |
$233.53
|
| Rate for Payer: Cofinity Commercial |
$274.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.09
|
| Rate for Payer: Healthscope Commercial |
$283.15
|
| Rate for Payer: Healthscope Whirlpool |
$291.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$171.09
|
| Rate for Payer: Mclaren Commercial |
$262.72
|
| Rate for Payer: Mclaren Medicaid |
$171.09
|
| Rate for Payer: Mclaren Medicare |
$171.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.64
|
| Rate for Payer: Meridian Medicaid |
$93.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$188.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.12
|
| Rate for Payer: Nomi Health Commercial |
$239.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.93
|
| Rate for Payer: PACE Medicare |
$162.54
|
| Rate for Payer: PACE SWMI |
$171.09
|
| Rate for Payer: PHP Commercial |
$188.20
|
| Rate for Payer: PHP Medicaid |
$91.70
|
| Rate for Payer: PHP Medicare Advantage |
$171.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$172.40
|
| Rate for Payer: Priority Health Medicare |
$171.09
|
| Rate for Payer: Priority Health Narrow Network |
$137.92
|
| Rate for Payer: Railroad Medicare Medicare |
$171.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$171.09
|
| Rate for Payer: UHC Exchange |
$265.19
|
| Rate for Payer: UHC Medicaid |
$89.48
|
| Rate for Payer: UHCCP DNSP |
$171.09
|
| Rate for Payer: UHCCP Medicaid |
$89.48
|
| Rate for Payer: VA VA |
$171.09
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
IP
|
$291.91
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.93 |
| Max. Negotiated Rate |
$291.91 |
| Rate for Payer: Aetna Commercial |
$262.72
|
| Rate for Payer: ASR ASR |
$283.15
|
| Rate for Payer: BCBS Trust/PPO |
$239.72
|
| Rate for Payer: BCN Commercial |
$239.72
|
| Rate for Payer: Cash Price |
$233.53
|
| Rate for Payer: Cofinity Commercial |
$274.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.53
|
| Rate for Payer: Healthscope Commercial |
$283.15
|
| Rate for Payer: Healthscope Whirlpool |
$291.91
|
| Rate for Payer: Mclaren Commercial |
$262.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.12
|
| Rate for Payer: Nomi Health Commercial |
$239.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.88
|
|
|
HC RAD TX BREAST CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1081
|
| Hospital Charge Code |
33300067
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RAD TX BREAST CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1081
|
| Hospital Charge Code |
33300067
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RAD TX CERVIAL CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1085
|
| Hospital Charge Code |
33300069
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RAD TX CERVIAL CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1085
|
| Hospital Charge Code |
33300069
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RAD TX CNS TUMOR ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1083
|
| Hospital Charge Code |
33300068
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RAD TX CNS TUMOR ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1083
|
| Hospital Charge Code |
33300068
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RAD TX COLORECTAL CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1087
|
| Hospital Charge Code |
33300070
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RAD TX COLORECTAL CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1087
|
| Hospital Charge Code |
33300070
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RAD TX HEAD & NECK CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1089
|
| Hospital Charge Code |
33300071
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RAD TX HEAD & NECK CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1089
|
| Hospital Charge Code |
33300071
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
IP
|
$3,999.93
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,999.95 |
| Max. Negotiated Rate |
$3,999.93 |
| Rate for Payer: Aetna Commercial |
$3,599.94
|
| Rate for Payer: ASR ASR |
$3,879.93
|
| Rate for Payer: BCBS Trust/PPO |
$3,284.74
|
| Rate for Payer: BCN Commercial |
$3,284.74
|
| Rate for Payer: Cash Price |
$3,199.94
|
| Rate for Payer: Cofinity Commercial |
$3,759.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,199.94
|
| Rate for Payer: Healthscope Commercial |
$3,879.93
|
| Rate for Payer: Healthscope Whirlpool |
$3,999.93
|
| Rate for Payer: Mclaren Commercial |
$3,599.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,399.94
|
| Rate for Payer: Nomi Health Commercial |
$3,279.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,999.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,519.94
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
OP
|
$3,999.93
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$4,416.12 |
| Rate for Payer: Aetna Commercial |
$3,599.94
|
| Rate for Payer: Aetna Medicare |
$903.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: ASR ASR |
$3,879.93
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,297.94
|
| Rate for Payer: BCN Commercial |
$3,297.94
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$3,199.94
|
| Rate for Payer: Cash Price |
$3,199.94
|
| Rate for Payer: Cofinity Commercial |
$3,759.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,199.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$3,879.93
|
| Rate for Payer: Healthscope Whirlpool |
$3,999.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$903.72
|
| Rate for Payer: Mclaren Commercial |
$3,599.94
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$496.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,399.94
|
| Rate for Payer: Nomi Health Commercial |
$3,279.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,999.95
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$994.09
|
| Rate for Payer: PHP Medicaid |
$484.39
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,416.12
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Narrow Network |
$3,532.90
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,519.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Exchange |
$1,400.77
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP DNSP |
$903.72
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
OP
|
$277.79
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$277.79 |
| Rate for Payer: Aetna Commercial |
$250.01
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$269.46
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$229.04
|
| Rate for Payer: BCN Commercial |
$229.04
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$222.23
|
| Rate for Payer: Cash Price |
$222.23
|
| Rate for Payer: Cofinity Commercial |
$261.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$269.46
|
| Rate for Payer: Healthscope Whirlpool |
$277.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$250.01
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.12
|
| Rate for Payer: Nomi Health Commercial |
$227.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.34
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$243.40
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$194.73
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
IP
|
$277.79
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$208.34 |
| Max. Negotiated Rate |
$277.79 |
| Rate for Payer: Aetna Commercial |
$250.01
|
| Rate for Payer: ASR ASR |
$269.46
|
| Rate for Payer: BCBS Trust/PPO |
$228.12
|
| Rate for Payer: BCN Commercial |
$228.12
|
| Rate for Payer: Cash Price |
$222.23
|
| Rate for Payer: Cofinity Commercial |
$261.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.23
|
| Rate for Payer: Healthscope Commercial |
$269.46
|
| Rate for Payer: Healthscope Whirlpool |
$277.79
|
| Rate for Payer: Mclaren Commercial |
$250.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.12
|
| Rate for Payer: Nomi Health Commercial |
$227.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.46
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
OP
|
$91.72
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$82.55
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$88.97
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$75.62
|
| Rate for Payer: BCN Commercial |
$75.62
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$73.38
|
| Rate for Payer: Cash Price |
$73.38
|
| Rate for Payer: Cofinity Commercial |
$86.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$88.97
|
| Rate for Payer: Healthscope Whirlpool |
$91.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$82.55
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.96
|
| Rate for Payer: Nomi Health Commercial |
$75.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.79
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$108.94
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$87.15
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
IP
|
$91.72
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.79 |
| Max. Negotiated Rate |
$91.72 |
| Rate for Payer: Aetna Commercial |
$82.55
|
| Rate for Payer: ASR ASR |
$88.97
|
| Rate for Payer: BCBS Trust/PPO |
$75.32
|
| Rate for Payer: BCN Commercial |
$75.32
|
| Rate for Payer: Cash Price |
$73.38
|
| Rate for Payer: Cofinity Commercial |
$86.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.38
|
| Rate for Payer: Healthscope Commercial |
$88.97
|
| Rate for Payer: Healthscope Whirlpool |
$91.72
|
| Rate for Payer: Mclaren Commercial |
$82.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.96
|
| Rate for Payer: Nomi Health Commercial |
$75.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.71
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
OP
|
$293.06
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$293.06 |
| Rate for Payer: Aetna Commercial |
$263.75
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$284.27
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$241.63
|
| Rate for Payer: BCN Commercial |
$241.63
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cofinity Commercial |
$275.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$284.27
|
| Rate for Payer: Healthscope Whirlpool |
$293.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$263.75
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.10
|
| Rate for Payer: Nomi Health Commercial |
$240.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.79
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$202.17
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$161.73
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
IP
|
$293.06
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.79 |
| Max. Negotiated Rate |
$293.06 |
| Rate for Payer: Aetna Commercial |
$263.75
|
| Rate for Payer: ASR ASR |
$284.27
|
| Rate for Payer: BCBS Trust/PPO |
$240.66
|
| Rate for Payer: BCN Commercial |
$240.66
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cofinity Commercial |
$275.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.45
|
| Rate for Payer: Healthscope Commercial |
$284.27
|
| Rate for Payer: Healthscope Whirlpool |
$293.06
|
| Rate for Payer: Mclaren Commercial |
$263.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.10
|
| Rate for Payer: Nomi Health Commercial |
$240.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.89
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
OP
|
$975.06
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$975.06 |
| Rate for Payer: Aetna Commercial |
$877.55
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$945.81
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$803.94
|
| Rate for Payer: BCN Commercial |
$803.94
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$780.05
|
| Rate for Payer: Cash Price |
$780.05
|
| Rate for Payer: Cofinity Commercial |
$916.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$945.81
|
| Rate for Payer: Healthscope Whirlpool |
$975.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$877.55
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.80
|
| Rate for Payer: Nomi Health Commercial |
$799.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.29
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$854.35
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$683.52
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$858.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
IP
|
$975.06
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$731.29 |
| Max. Negotiated Rate |
$975.06 |
| Rate for Payer: Aetna Commercial |
$877.55
|
| Rate for Payer: ASR ASR |
$945.81
|
| Rate for Payer: BCBS Trust/PPO |
$800.72
|
| Rate for Payer: BCN Commercial |
$800.72
|
| Rate for Payer: Cash Price |
$780.05
|
| Rate for Payer: Cofinity Commercial |
$916.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.05
|
| Rate for Payer: Healthscope Commercial |
$945.81
|
| Rate for Payer: Healthscope Whirlpool |
$975.06
|
| Rate for Payer: Mclaren Commercial |
$877.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.80
|
| Rate for Payer: Nomi Health Commercial |
$799.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$858.05
|
|
|
HC RADXF UNL NM CARDIOVASC 78499
|
Facility
|
IP
|
$819.59
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$614.69 |
| Max. Negotiated Rate |
$819.59 |
| Rate for Payer: Aetna Commercial |
$737.63
|
| Rate for Payer: ASR ASR |
$795.00
|
| Rate for Payer: BCBS Trust/PPO |
$673.05
|
| Rate for Payer: BCN Commercial |
$673.05
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$770.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Healthscope Commercial |
$795.00
|
| Rate for Payer: Healthscope Whirlpool |
$819.59
|
| Rate for Payer: Mclaren Commercial |
$737.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$721.24
|
|
|
HC RADXF UNL NM CARDIOVASC 78499
|
Facility
|
OP
|
$819.59
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$819.59 |
| Rate for Payer: Aetna Commercial |
$737.63
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$795.00
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$675.75
|
| Rate for Payer: BCN Commercial |
$675.75
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$770.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$795.00
|
| Rate for Payer: Healthscope Whirlpool |
$819.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$737.63
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$718.12
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$574.53
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$721.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC RADXF UNL NM CNS 78699
|
Facility
|
IP
|
$819.59
|
|
|
Service Code
|
CPT 78699
|
| Hospital Charge Code |
34100043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$614.69 |
| Max. Negotiated Rate |
$819.59 |
| Rate for Payer: Aetna Commercial |
$737.63
|
| Rate for Payer: ASR ASR |
$795.00
|
| Rate for Payer: BCBS Trust/PPO |
$673.05
|
| Rate for Payer: BCN Commercial |
$673.05
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$770.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Healthscope Commercial |
$795.00
|
| Rate for Payer: Healthscope Whirlpool |
$819.59
|
| Rate for Payer: Mclaren Commercial |
$737.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$721.24
|
|
