|
HC RABIES VACCINE IM
|
Facility
|
IP
|
$1,037.24
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$674.21 |
| Max. Negotiated Rate |
$1,037.24 |
| Rate for Payer: Aetna Commercial |
$933.52
|
| Rate for Payer: ASR ASR |
$1,006.12
|
| Rate for Payer: ASR Commercial |
$1,006.12
|
| Rate for Payer: BCBS Trust/PPO |
$845.25
|
| Rate for Payer: BCN Commercial |
$804.17
|
| Rate for Payer: Cash Price |
$829.79
|
| Rate for Payer: Cofinity Commercial |
$975.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.79
|
| Rate for Payer: Healthscope Commercial |
$1,037.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,006.12
|
| Rate for Payer: Mclaren Commercial |
$933.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.65
|
| Rate for Payer: Nomi Health Commercial |
$850.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$912.77
|
|
|
HC RABIES VACCINE IM
|
Facility
|
OP
|
$1,037.24
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.69 |
| Max. Negotiated Rate |
$1,037.24 |
| Rate for Payer: Aetna Commercial |
$933.52
|
| Rate for Payer: Aetna Medicare |
$327.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$409.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$409.72
|
| Rate for Payer: ASR ASR |
$1,006.12
|
| Rate for Payer: ASR Commercial |
$1,006.12
|
| Rate for Payer: BCBS Complete |
$184.47
|
| Rate for Payer: BCBS MAPPO |
$327.78
|
| Rate for Payer: BCBS Trust/PPO |
$849.40
|
| Rate for Payer: BCN Commercial |
$804.17
|
| Rate for Payer: BCN Medicare Advantage |
$327.78
|
| Rate for Payer: Cash Price |
$829.79
|
| Rate for Payer: Cash Price |
$829.79
|
| Rate for Payer: Cofinity Commercial |
$975.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.78
|
| Rate for Payer: Healthscope Commercial |
$1,037.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,006.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$327.78
|
| Rate for Payer: Mclaren Commercial |
$933.52
|
| Rate for Payer: Mclaren Medicaid |
$175.69
|
| Rate for Payer: Mclaren Medicare |
$327.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.17
|
| Rate for Payer: Meridian Medicaid |
$184.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.65
|
| Rate for Payer: Nomi Health Commercial |
$850.54
|
| Rate for Payer: PACE Medicare |
$311.39
|
| Rate for Payer: PACE SWMI |
$327.78
|
| Rate for Payer: PHP Commercial |
$360.56
|
| Rate for Payer: PHP Medicaid |
$175.69
|
| Rate for Payer: PHP Medicare Advantage |
$327.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.86
|
| Rate for Payer: Priority Health Medicare |
$327.78
|
| Rate for Payer: Priority Health Narrow Network |
$377.49
|
| Rate for Payer: Railroad Medicare Medicare |
$327.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$912.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.78
|
| Rate for Payer: UHC Exchange |
$508.06
|
| Rate for Payer: UHC Medicare Advantage |
$327.78
|
| Rate for Payer: UHCCP DNSP |
$327.78
|
| Rate for Payer: UHCCP Medicaid |
$175.69
|
| Rate for Payer: VA VA |
$327.78
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
OP
|
$188.62
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.45 |
| Max. Negotiated Rate |
$188.62 |
| Rate for Payer: Aetna Commercial |
$169.76
|
| Rate for Payer: Aetna Medicare |
$94.31
|
| Rate for Payer: ASR ASR |
$182.96
|
| Rate for Payer: ASR Commercial |
$182.96
|
| Rate for Payer: BCBS Complete |
$75.45
|
| Rate for Payer: BCBS Trust/PPO |
$154.46
|
| Rate for Payer: BCN Commercial |
$146.24
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cofinity Commercial |
$177.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.90
|
| Rate for Payer: Healthscope Commercial |
$188.62
|
| Rate for Payer: Healthscope Whirlpool |
$182.96
|
| Rate for Payer: Mclaren Commercial |
$169.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.33
|
| Rate for Payer: Nomi Health Commercial |
$154.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.27
|
| Rate for Payer: Priority Health Narrow Network |
$132.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.99
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
IP
|
$188.62
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$188.62 |
| Rate for Payer: Aetna Commercial |
$169.76
|
| Rate for Payer: ASR ASR |
$182.96
|
| Rate for Payer: ASR Commercial |
$182.96
|
| Rate for Payer: BCBS Trust/PPO |
$153.71
|
| Rate for Payer: BCN Commercial |
$146.24
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cofinity Commercial |
$177.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.90
|
| Rate for Payer: Healthscope Commercial |
$188.62
|
| Rate for Payer: Healthscope Whirlpool |
$182.96
|
| Rate for Payer: Mclaren Commercial |
$169.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.33
|
| Rate for Payer: Nomi Health Commercial |
$154.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.99
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
IP
|
$429.69
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.30 |
| Max. Negotiated Rate |
$429.69 |
| Rate for Payer: Aetna Commercial |
$386.72
|
| Rate for Payer: ASR ASR |
$416.80
|
| Rate for Payer: ASR Commercial |
$416.80
|
| Rate for Payer: BCBS Trust/PPO |
$350.15
|
| Rate for Payer: BCN Commercial |
$333.14
|
| Rate for Payer: Cash Price |
$343.75
|
| Rate for Payer: Cofinity Commercial |
$403.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.75
|
| Rate for Payer: Healthscope Commercial |
$429.69
|
| Rate for Payer: Healthscope Whirlpool |
$416.80
|
| Rate for Payer: Mclaren Commercial |
$386.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.24
|
| Rate for Payer: Nomi Health Commercial |
$352.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.13
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
OP
|
$429.69
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.73 |
| Max. Negotiated Rate |
$429.69 |
| Rate for Payer: Aetna Commercial |
$386.72
|
| Rate for Payer: Aetna Medicare |
$130.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.61
|
| Rate for Payer: ASR ASR |
$416.80
|
| Rate for Payer: ASR Commercial |
$416.80
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$130.09
|
| Rate for Payer: BCBS Trust/PPO |
$351.87
|
| Rate for Payer: BCN Commercial |
$333.14
|
| Rate for Payer: BCN Medicare Advantage |
$130.09
|
| Rate for Payer: Cash Price |
$343.75
|
| Rate for Payer: Cash Price |
$343.75
|
| Rate for Payer: Cofinity Commercial |
$403.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.09
|
| Rate for Payer: Healthscope Commercial |
$429.69
|
| Rate for Payer: Healthscope Whirlpool |
$416.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$130.09
|
| Rate for Payer: Mclaren Commercial |
$386.72
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Mclaren Medicare |
$130.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.59
|
| Rate for Payer: Meridian Medicaid |
$73.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.24
|
| Rate for Payer: Nomi Health Commercial |
$352.35
|
| Rate for Payer: PACE Medicare |
$123.59
|
| Rate for Payer: PACE SWMI |
$130.09
|
| Rate for Payer: PHP Commercial |
$143.10
|
| Rate for Payer: PHP Medicaid |
$69.73
|
| Rate for Payer: PHP Medicare Advantage |
$130.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.49
|
| Rate for Payer: Priority Health Medicare |
$130.09
|
| Rate for Payer: Priority Health Narrow Network |
$301.21
|
| Rate for Payer: Railroad Medicare Medicare |
$130.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.09
|
| Rate for Payer: UHC Exchange |
$201.64
|
| Rate for Payer: UHC Medicare Advantage |
$130.09
|
| Rate for Payer: UHCCP DNSP |
$130.09
|
| Rate for Payer: UHCCP Medicaid |
$69.73
|
| Rate for Payer: VA VA |
$130.09
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
IP
|
$286.19
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.02 |
| Max. Negotiated Rate |
$286.19 |
| Rate for Payer: Aetna Commercial |
$257.57
|
| Rate for Payer: ASR ASR |
$277.60
|
| Rate for Payer: ASR Commercial |
$277.60
|
| Rate for Payer: BCBS Trust/PPO |
$233.22
|
| Rate for Payer: BCN Commercial |
$221.88
|
| Rate for Payer: Cash Price |
$228.95
|
| Rate for Payer: Cofinity Commercial |
$269.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.95
|
| Rate for Payer: Healthscope Commercial |
$286.19
|
| Rate for Payer: Healthscope Whirlpool |
$277.60
|
| Rate for Payer: Mclaren Commercial |
$257.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.26
|
| Rate for Payer: Nomi Health Commercial |
$234.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.85
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
OP
|
$286.19
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.43 |
| Max. Negotiated Rate |
$286.19 |
| Rate for Payer: Aetna Commercial |
$257.57
|
| Rate for Payer: Aetna Medicare |
$168.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.89
|
| Rate for Payer: ASR ASR |
$277.60
|
| Rate for Payer: ASR Commercial |
$277.60
|
| Rate for Payer: BCBS Complete |
$94.95
|
| Rate for Payer: BCBS MAPPO |
$168.71
|
| Rate for Payer: BCBS Trust/PPO |
$234.36
|
| Rate for Payer: BCN Commercial |
$221.88
|
| Rate for Payer: BCN Medicare Advantage |
$168.71
|
| Rate for Payer: Cash Price |
$228.95
|
| Rate for Payer: Cash Price |
$228.95
|
| Rate for Payer: Cofinity Commercial |
$269.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.71
|
| Rate for Payer: Healthscope Commercial |
$286.19
|
| Rate for Payer: Healthscope Whirlpool |
$277.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$168.71
|
| Rate for Payer: Mclaren Commercial |
$257.57
|
| Rate for Payer: Mclaren Medicaid |
$90.43
|
| Rate for Payer: Mclaren Medicare |
$168.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.15
|
| Rate for Payer: Meridian Medicaid |
$94.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.26
|
| Rate for Payer: Nomi Health Commercial |
$234.68
|
| Rate for Payer: PACE Medicare |
$160.27
|
| Rate for Payer: PACE SWMI |
$168.71
|
| Rate for Payer: PHP Commercial |
$185.58
|
| Rate for Payer: PHP Medicaid |
$90.43
|
| Rate for Payer: PHP Medicare Advantage |
$168.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.40
|
| Rate for Payer: Priority Health Medicare |
$168.71
|
| Rate for Payer: Priority Health Narrow Network |
$137.92
|
| Rate for Payer: Railroad Medicare Medicare |
$168.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.71
|
| Rate for Payer: UHC Exchange |
$261.50
|
| Rate for Payer: UHC Medicare Advantage |
$168.71
|
| Rate for Payer: UHCCP DNSP |
$168.71
|
| Rate for Payer: UHCCP Medicaid |
$90.43
|
| Rate for Payer: VA VA |
$168.71
|
|
|
HC RAD TX ANAL CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1073
|
| Hospital Charge Code |
33300063
|
|
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: ASR Commercial |
$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: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RAD TX ANAL CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1073
|
| Hospital Charge Code |
33300063
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$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: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 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: ASR Commercial |
$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: Priority Health Cigna Priority Health |
$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 |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$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: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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: ASR Commercial |
$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: Priority Health Cigna Priority Health |
$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 |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$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: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 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: ASR Commercial |
$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: Priority Health Cigna Priority Health |
$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 |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$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: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$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: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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: ASR Commercial |
$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: Priority Health Cigna Priority Health |
$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 |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$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: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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: ASR Commercial |
$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: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
IP
|
$3,921.50
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,548.98 |
| Max. Negotiated Rate |
$3,921.50 |
| Rate for Payer: Aetna Commercial |
$3,529.35
|
| Rate for Payer: ASR ASR |
$3,803.86
|
| Rate for Payer: ASR Commercial |
$3,803.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,195.63
|
| Rate for Payer: BCN Commercial |
$3,040.34
|
| Rate for Payer: Cash Price |
$3,137.20
|
| Rate for Payer: Cofinity Commercial |
$3,686.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,137.20
|
| Rate for Payer: Healthscope Commercial |
$3,921.50
|
| Rate for Payer: Healthscope Whirlpool |
$3,803.86
|
| Rate for Payer: Mclaren Commercial |
$3,529.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,333.28
|
| Rate for Payer: Nomi Health Commercial |
$3,215.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,548.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,450.92
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
OP
|
$3,921.50
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$492.37 |
| Max. Negotiated Rate |
$4,005.55 |
| Rate for Payer: Aetna Commercial |
$3,529.35
|
| Rate for Payer: Aetna Medicare |
$918.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: ASR ASR |
$3,803.86
|
| Rate for Payer: ASR Commercial |
$3,803.86
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,211.32
|
| Rate for Payer: BCN Commercial |
$3,040.34
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Cash Price |
$3,137.20
|
| Rate for Payer: Cash Price |
$3,137.20
|
| Rate for Payer: Cofinity Commercial |
$3,686.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,137.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Healthscope Commercial |
$3,921.50
|
| Rate for Payer: Healthscope Whirlpool |
$3,803.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$918.60
|
| Rate for Payer: Mclaren Commercial |
$3,529.35
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,333.28
|
| Rate for Payer: Nomi Health Commercial |
$3,215.63
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Commercial |
$1,010.46
|
| Rate for Payer: PHP Medicaid |
$492.37
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,548.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,005.55
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,204.44
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,450.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$1,423.83
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP DNSP |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: VA VA |
$918.60
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
IP
|
$272.34
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$177.02 |
| Max. Negotiated Rate |
$272.34 |
| Rate for Payer: Aetna Commercial |
$245.11
|
| Rate for Payer: ASR ASR |
$264.17
|
| Rate for Payer: ASR Commercial |
$264.17
|
| Rate for Payer: BCBS Trust/PPO |
$221.93
|
| Rate for Payer: BCN Commercial |
$211.15
|
| Rate for Payer: Cash Price |
$217.87
|
| Rate for Payer: Cofinity Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.87
|
| Rate for Payer: Healthscope Commercial |
$272.34
|
| Rate for Payer: Healthscope Whirlpool |
$264.17
|
| Rate for Payer: Mclaren Commercial |
$245.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.49
|
| Rate for Payer: Nomi Health Commercial |
$223.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.66
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
OP
|
$272.34
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$272.34 |
| Rate for Payer: Aetna Commercial |
$245.11
|
| Rate for Payer: Aetna Medicare |
$86.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: ASR ASR |
$264.17
|
| Rate for Payer: ASR Commercial |
$264.17
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$223.02
|
| Rate for Payer: BCN Commercial |
$211.15
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$217.87
|
| Rate for Payer: Cash Price |
$217.87
|
| Rate for Payer: Cofinity Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$272.34
|
| Rate for Payer: Healthscope Whirlpool |
$264.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$245.11
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.49
|
| Rate for Payer: Nomi Health Commercial |
$223.32
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicaid |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.62
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$190.91
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP DNSP |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
OP
|
$89.92
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$133.72 |
| Rate for Payer: Aetna Commercial |
$80.93
|
| Rate for Payer: Aetna Medicare |
$86.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: ASR ASR |
$87.22
|
| Rate for Payer: ASR Commercial |
$87.22
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$73.64
|
| Rate for Payer: BCN Commercial |
$69.71
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Cofinity Commercial |
$84.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$89.92
|
| Rate for Payer: Healthscope Whirlpool |
$87.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$80.93
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.43
|
| Rate for Payer: Nomi Health Commercial |
$73.73
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicaid |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.81
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$79.05
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP DNSP |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
