|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
IP
|
$89.92
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.45 |
| Max. Negotiated Rate |
$89.92 |
| Rate for Payer: Aetna Commercial |
$80.93
|
| Rate for Payer: ASR ASR |
$87.22
|
| Rate for Payer: ASR Commercial |
$87.22
|
| Rate for Payer: BCBS Trust/PPO |
$73.28
|
| Rate for Payer: BCN Commercial |
$69.71
|
| 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: Healthscope Commercial |
$89.92
|
| Rate for Payer: Healthscope Whirlpool |
$87.22
|
| Rate for Payer: Mclaren Commercial |
$80.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.43
|
| Rate for Payer: Nomi Health Commercial |
$73.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.13
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
OP
|
$287.31
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$287.31 |
| Rate for Payer: Aetna Commercial |
$258.58
|
| 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 |
$278.69
|
| Rate for Payer: ASR Commercial |
$278.69
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$235.28
|
| Rate for Payer: BCN Commercial |
$222.75
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cofinity Commercial |
$270.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$287.31
|
| Rate for Payer: Healthscope Whirlpool |
$278.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$258.58
|
| 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 |
$244.21
|
| Rate for Payer: Nomi Health Commercial |
$235.59
|
| 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 |
$186.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.37
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$146.70
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.83
|
| 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 FLUORO IR 76496
|
Facility
|
IP
|
$287.31
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.75 |
| Max. Negotiated Rate |
$287.31 |
| Rate for Payer: Aetna Commercial |
$258.58
|
| Rate for Payer: ASR ASR |
$278.69
|
| Rate for Payer: ASR Commercial |
$278.69
|
| Rate for Payer: BCBS Trust/PPO |
$234.13
|
| Rate for Payer: BCN Commercial |
$222.75
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cofinity Commercial |
$270.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.85
|
| Rate for Payer: Healthscope Commercial |
$287.31
|
| Rate for Payer: Healthscope Whirlpool |
$278.69
|
| Rate for Payer: Mclaren Commercial |
$258.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.21
|
| Rate for Payer: Nomi Health Commercial |
$235.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.83
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
IP
|
$955.94
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$621.36 |
| Max. Negotiated Rate |
$955.94 |
| Rate for Payer: Aetna Commercial |
$860.35
|
| Rate for Payer: ASR ASR |
$927.26
|
| Rate for Payer: ASR Commercial |
$927.26
|
| Rate for Payer: BCBS Trust/PPO |
$779.00
|
| Rate for Payer: BCN Commercial |
$741.14
|
| Rate for Payer: Cash Price |
$764.75
|
| Rate for Payer: Cofinity Commercial |
$898.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$764.75
|
| Rate for Payer: Healthscope Commercial |
$955.94
|
| Rate for Payer: Healthscope Whirlpool |
$927.26
|
| Rate for Payer: Mclaren Commercial |
$860.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$812.55
|
| Rate for Payer: Nomi Health Commercial |
$783.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$841.23
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
OP
|
$955.94
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$955.94 |
| Rate for Payer: Aetna Commercial |
$860.35
|
| 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 |
$927.26
|
| Rate for Payer: ASR Commercial |
$927.26
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$782.82
|
| Rate for Payer: BCN Commercial |
$741.14
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$764.75
|
| Rate for Payer: Cash Price |
$764.75
|
| Rate for Payer: Cofinity Commercial |
$898.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$764.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$955.94
|
| Rate for Payer: Healthscope Whirlpool |
$927.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$860.35
|
| 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 |
$812.55
|
| Rate for Payer: Nomi Health Commercial |
$783.87
|
| 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 |
$621.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$837.59
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$670.11
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$841.23
|
| 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 NM CARDIOVASC 78499
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Trust/PPO |
$654.79
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
|
|
HC RADXF UNL NM CARDIOVASC 78499
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.04
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC RADXF UNL NM CNS 78699
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
CPT 78699
|
| Hospital Charge Code |
34100043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Trust/PPO |
$654.79
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
|
|
HC RADXF UNL NM CNS 78699
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 78699
|
| Hospital Charge Code |
34100043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.04
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC RADXF UNL NM ENDOCR 78099
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
CPT 78099
|
| Hospital Charge Code |
34100008
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Trust/PPO |
$654.79
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
|
|
HC RADXF UNL NM ENDOCR 78099
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 78099
|
| Hospital Charge Code |
34100008
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.04
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC RADXF UNL NM GI PROC 78299
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 78299
|
| Hospital Charge Code |
34100022
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.04
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC RADXF UNL NM GI PROC 78299
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
CPT 78299
|
| Hospital Charge Code |
34100022
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Trust/PPO |
$654.79
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
|
|
HC RADXF UNL NM GU 78799
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 78799
|
| Hospital Charge Code |
34100051
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.04
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC RADXF UNL NM GU 78799
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
CPT 78799
|
| Hospital Charge Code |
34100051
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Trust/PPO |
$654.79
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
|
|
HC RADXF UNL NM H R L 78199
|
Facility
|
IP
|
$750.34
|
|
|
Service Code
|
CPT 78199
|
| Hospital Charge Code |
34100013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$487.72 |
| Max. Negotiated Rate |
$750.34 |
| Rate for Payer: Aetna Commercial |
$675.31
|
| Rate for Payer: ASR ASR |
$727.83
|
| Rate for Payer: ASR Commercial |
$727.83
|
| Rate for Payer: BCBS Trust/PPO |
$611.45
|
| Rate for Payer: BCN Commercial |
$581.74
|
| Rate for Payer: Cash Price |
$600.27
|
| Rate for Payer: Cofinity Commercial |
$705.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.27
|
| Rate for Payer: Healthscope Commercial |
$750.34
|
| Rate for Payer: Healthscope Whirlpool |
$727.83
|
| Rate for Payer: Mclaren Commercial |
$675.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$637.79
|
| Rate for Payer: Nomi Health Commercial |
$615.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.30
|
|
|
HC RADXF UNL NM H R L 78199
|
Facility
|
OP
|
$750.34
|
|
|
Service Code
|
CPT 78199
|
| Hospital Charge Code |
34100013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$750.34 |
| Rate for Payer: Aetna Commercial |
$675.31
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$727.83
|
| Rate for Payer: ASR Commercial |
$727.83
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$614.45
|
| Rate for Payer: BCN Commercial |
$581.74
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$600.27
|
| Rate for Payer: Cash Price |
$600.27
|
| Rate for Payer: Cofinity Commercial |
$705.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$750.34
|
| Rate for Payer: Healthscope Whirlpool |
$727.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$675.31
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$637.79
|
| Rate for Payer: Nomi Health Commercial |
$615.28
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$657.45
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$525.99
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC RADXF UNL NM MUSCSKL 78399
|
Facility
|
OP
|
$1,923.10
|
|
|
Service Code
|
CPT 78399
|
| Hospital Charge Code |
34100028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,923.10 |
| Rate for Payer: Aetna Commercial |
$1,730.79
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,865.41
|
| Rate for Payer: ASR Commercial |
$1,865.41
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,574.83
|
| Rate for Payer: BCN Commercial |
$1,490.98
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$1,538.48
|
| Rate for Payer: Cash Price |
$1,538.48
|
| Rate for Payer: Cofinity Commercial |
$1,807.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,923.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,865.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,730.79
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.64
|
| Rate for Payer: Nomi Health Commercial |
$1,576.94
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,250.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,685.02
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,348.09
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,692.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC RADXF UNL NM MUSCSKL 78399
|
Facility
|
IP
|
$1,923.10
|
|
|
Service Code
|
CPT 78399
|
| Hospital Charge Code |
34100028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,250.02 |
| Max. Negotiated Rate |
$1,923.10 |
| Rate for Payer: Aetna Commercial |
$1,730.79
|
| Rate for Payer: ASR ASR |
$1,865.41
|
| Rate for Payer: ASR Commercial |
$1,865.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,567.13
|
| Rate for Payer: BCN Commercial |
$1,490.98
|
| Rate for Payer: Cash Price |
$1,538.48
|
| Rate for Payer: Cofinity Commercial |
$1,807.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.48
|
| Rate for Payer: Healthscope Commercial |
$1,923.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,865.41
|
| Rate for Payer: Mclaren Commercial |
$1,730.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.64
|
| Rate for Payer: Nomi Health Commercial |
$1,576.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,250.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,692.33
|
|
|
HC RADXF UNL NM PROC MISC 78999
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
CPT 78999
|
| Hospital Charge Code |
34100061
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Trust/PPO |
$654.79
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
|
|
HC RADXF UNL NM PROC MISC 78999
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 78999
|
| Hospital Charge Code |
34100061
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.04
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC RADXF UNL NM RADPHARM THER 799
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
CPT 79999
|
| Hospital Charge Code |
34100066
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Trust/PPO |
$654.79
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
|
|
HC RADXF UNL NM RADPHARM THER 799
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 79999
|
| Hospital Charge Code |
34100066
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$117.71 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$219.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.50
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$123.59
|
| Rate for Payer: BCBS MAPPO |
$219.60
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$219.60
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.60
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.60
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$117.71
|
| Rate for Payer: Mclaren Medicare |
$219.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.58
|
| Rate for Payer: Meridian Medicaid |
$123.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$208.62
|
| Rate for Payer: PACE SWMI |
$219.60
|
| Rate for Payer: PHP Commercial |
$241.56
|
| Rate for Payer: PHP Medicaid |
$117.71
|
| Rate for Payer: PHP Medicare Advantage |
$219.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.04
|
| Rate for Payer: Priority Health Medicare |
$219.60
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$219.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.60
|
| Rate for Payer: UHC Exchange |
$340.38
|
| Rate for Payer: UHC Medicare Advantage |
$219.60
|
| Rate for Payer: UHCCP DNSP |
$219.60
|
| Rate for Payer: UHCCP Medicaid |
$117.71
|
| Rate for Payer: VA VA |
$219.60
|
|
|
HC RADXF UNL NM RESP 78599
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Trust/PPO |
$654.79
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
|
|
HC RADXF UNL NM RESP 78599
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$755.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.04
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
