|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
OP
|
$228.27
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$84.46 |
| Max. Negotiated Rate |
$228.27 |
| Rate for Payer: Aetna Commercial |
$205.44
|
| Rate for Payer: Aetna Medicare |
$84.46
|
| Rate for Payer: ASR ASR |
$221.42
|
| Rate for Payer: BCBS Complete |
$91.31
|
| Rate for Payer: BCBS Trust/PPO |
$188.21
|
| Rate for Payer: BCN Commercial |
$188.21
|
| Rate for Payer: Cash Price |
$182.62
|
| Rate for Payer: Cofinity Commercial |
$214.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.62
|
| Rate for Payer: Healthscope Commercial |
$221.42
|
| Rate for Payer: Healthscope Whirlpool |
$228.27
|
| Rate for Payer: Mclaren Commercial |
$205.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.03
|
| Rate for Payer: Nomi Health Commercial |
$187.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$200.01
|
| Rate for Payer: Priority Health Narrow Network |
$160.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.88
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
IP
|
$3,353.76
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,515.32 |
| Max. Negotiated Rate |
$3,353.76 |
| Rate for Payer: Aetna Commercial |
$3,018.38
|
| Rate for Payer: ASR ASR |
$3,253.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,754.11
|
| Rate for Payer: BCN Commercial |
$2,754.11
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cofinity Commercial |
$3,152.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,683.01
|
| Rate for Payer: Healthscope Commercial |
$3,253.15
|
| Rate for Payer: Healthscope Whirlpool |
$3,353.76
|
| Rate for Payer: Mclaren Commercial |
$3,018.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,850.70
|
| Rate for Payer: Nomi Health Commercial |
$2,750.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,515.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,951.31
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
OP
|
$3,353.76
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,240.89 |
| Max. Negotiated Rate |
$3,353.76 |
| Rate for Payer: Aetna Commercial |
$3,018.38
|
| Rate for Payer: Aetna Medicare |
$1,240.89
|
| Rate for Payer: ASR ASR |
$3,253.15
|
| Rate for Payer: BCBS Complete |
$1,341.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,765.18
|
| Rate for Payer: BCN Commercial |
$2,765.18
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cofinity Commercial |
$3,152.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,683.01
|
| Rate for Payer: Healthscope Commercial |
$3,253.15
|
| Rate for Payer: Healthscope Whirlpool |
$3,353.76
|
| Rate for Payer: Mclaren Commercial |
$3,018.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,683.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,850.70
|
| Rate for Payer: Nomi Health Commercial |
$2,750.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,515.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,938.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,350.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,951.31
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
IP
|
$3,353.76
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,515.32 |
| Max. Negotiated Rate |
$3,353.76 |
| Rate for Payer: Aetna Commercial |
$3,018.38
|
| Rate for Payer: ASR ASR |
$3,253.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,754.11
|
| Rate for Payer: BCN Commercial |
$2,754.11
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cofinity Commercial |
$3,152.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,683.01
|
| Rate for Payer: Healthscope Commercial |
$3,253.15
|
| Rate for Payer: Healthscope Whirlpool |
$3,353.76
|
| Rate for Payer: Mclaren Commercial |
$3,018.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,850.70
|
| Rate for Payer: Nomi Health Commercial |
$2,750.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,515.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,951.31
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
OP
|
$3,353.76
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,240.89 |
| Max. Negotiated Rate |
$3,353.76 |
| Rate for Payer: Aetna Commercial |
$3,018.38
|
| Rate for Payer: Aetna Medicare |
$1,240.89
|
| Rate for Payer: ASR ASR |
$3,253.15
|
| Rate for Payer: BCBS Complete |
$1,341.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,765.18
|
| Rate for Payer: BCN Commercial |
$2,765.18
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cofinity Commercial |
$3,152.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,683.01
|
| Rate for Payer: Healthscope Commercial |
$3,253.15
|
| Rate for Payer: Healthscope Whirlpool |
$3,353.76
|
| Rate for Payer: Mclaren Commercial |
$3,018.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,683.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,850.70
|
| Rate for Payer: Nomi Health Commercial |
$2,750.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,515.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,938.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,350.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,951.31
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
OP
|
$338.53
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$200.99 |
| Max. Negotiated Rate |
$595.68 |
| Rate for Payer: Aetna Commercial |
$304.68
|
| Rate for Payer: Aetna Medicare |
$384.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: ASR ASR |
$328.37
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$279.12
|
| Rate for Payer: BCN Commercial |
$279.12
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$270.82
|
| Rate for Payer: Cash Price |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$318.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$328.37
|
| Rate for Payer: Healthscope Whirlpool |
$338.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$384.31
|
| Rate for Payer: Mclaren Commercial |
$304.68
|
| Rate for Payer: Mclaren Medicaid |
$384.31
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$211.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.75
|
| Rate for Payer: Nomi Health Commercial |
$277.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.90
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$422.74
|
| Rate for Payer: PHP Medicaid |
$205.99
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$296.62
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health Narrow Network |
$237.31
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$595.68
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP DNSP |
$384.31
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: VA VA |
$384.31
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
IP
|
$338.53
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$253.90 |
| Max. Negotiated Rate |
$338.53 |
| Rate for Payer: Aetna Commercial |
$304.68
|
| Rate for Payer: ASR ASR |
$328.37
|
| Rate for Payer: BCBS Trust/PPO |
$278.00
|
| Rate for Payer: BCN Commercial |
$278.00
|
| Rate for Payer: Cash Price |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$318.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.82
|
| Rate for Payer: Healthscope Commercial |
$328.37
|
| Rate for Payer: Healthscope Whirlpool |
$338.53
|
| Rate for Payer: Mclaren Commercial |
$304.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.75
|
| Rate for Payer: Nomi Health Commercial |
$277.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.91
|
|
|
HC RO INS VAG BRACHTHER DEVICE
|
Facility
|
OP
|
$561.41
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
36100444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$561.41 |
| Rate for Payer: Aetna Commercial |
$505.27
|
| Rate for Payer: Aetna Medicare |
$303.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: ASR ASR |
$544.57
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$462.88
|
| Rate for Payer: BCN Commercial |
$462.88
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cofinity Commercial |
$527.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Healthscope Commercial |
$544.57
|
| Rate for Payer: Healthscope Whirlpool |
$561.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.63
|
| Rate for Payer: Mclaren Commercial |
$505.27
|
| Rate for Payer: Mclaren Medicaid |
$303.63
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$166.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.20
|
| Rate for Payer: Nomi Health Commercial |
$460.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.06
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Commercial |
$333.99
|
| Rate for Payer: PHP Medicaid |
$162.75
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$491.91
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health Narrow Network |
$393.55
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Exchange |
$470.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP DNSP |
$303.63
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
HC RO INS VAG BRACHTHER DEVICE
|
Facility
|
IP
|
$561.41
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
36100444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$421.06 |
| Max. Negotiated Rate |
$561.41 |
| Rate for Payer: Aetna Commercial |
$505.27
|
| Rate for Payer: ASR ASR |
$544.57
|
| Rate for Payer: BCBS Trust/PPO |
$461.03
|
| Rate for Payer: BCN Commercial |
$461.03
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cofinity Commercial |
$527.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.13
|
| Rate for Payer: Healthscope Commercial |
$544.57
|
| Rate for Payer: Healthscope Whirlpool |
$561.41
|
| Rate for Payer: Mclaren Commercial |
$505.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.20
|
| Rate for Payer: Nomi Health Commercial |
$460.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.04
|
|
|
HC RO INTRSTI RADELEMENT APPL CMPLX
|
Facility
|
IP
|
$2,893.91
|
|
|
Service Code
|
CPT 77778
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,170.43 |
| Max. Negotiated Rate |
$2,893.91 |
| Rate for Payer: Aetna Commercial |
$2,604.52
|
| Rate for Payer: ASR ASR |
$2,807.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,376.48
|
| Rate for Payer: BCN Commercial |
$2,376.48
|
| Rate for Payer: Cash Price |
$2,315.13
|
| Rate for Payer: Cofinity Commercial |
$2,720.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,315.13
|
| Rate for Payer: Healthscope Commercial |
$2,807.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,893.91
|
| Rate for Payer: Mclaren Commercial |
$2,604.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,459.82
|
| Rate for Payer: Nomi Health Commercial |
$2,373.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,170.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,546.64
|
|
|
HC RO INTRSTI RADELEMENT APPL CMPLX
|
Facility
|
OP
|
$2,893.91
|
|
|
Service Code
|
CPT 77778
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.95 |
| Max. Negotiated Rate |
$2,893.91 |
| Rate for Payer: Aetna Commercial |
$2,604.52
|
| Rate for Payer: Aetna Medicare |
$693.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$867.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$867.46
|
| Rate for Payer: ASR ASR |
$2,807.09
|
| Rate for Payer: BCBS Complete |
$381.13
|
| Rate for Payer: BCBS MAPPO |
$693.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,386.03
|
| Rate for Payer: BCN Commercial |
$2,386.03
|
| Rate for Payer: BCN Medicare Advantage |
$693.97
|
| Rate for Payer: Cash Price |
$2,315.13
|
| Rate for Payer: Cash Price |
$2,315.13
|
| Rate for Payer: Cofinity Commercial |
$2,720.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,315.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.97
|
| Rate for Payer: Healthscope Commercial |
$2,807.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,893.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$693.97
|
| Rate for Payer: Mclaren Commercial |
$2,604.52
|
| Rate for Payer: Mclaren Medicaid |
$693.97
|
| Rate for Payer: Mclaren Medicare |
$693.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.67
|
| Rate for Payer: Meridian Medicaid |
$381.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$798.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$763.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,459.82
|
| Rate for Payer: Nomi Health Commercial |
$2,373.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,170.43
|
| Rate for Payer: PACE Medicare |
$659.27
|
| Rate for Payer: PACE SWMI |
$693.97
|
| Rate for Payer: PHP Commercial |
$763.37
|
| Rate for Payer: PHP Medicaid |
$371.97
|
| Rate for Payer: PHP Medicare Advantage |
$693.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,535.64
|
| Rate for Payer: Priority Health Medicare |
$693.97
|
| Rate for Payer: Priority Health Narrow Network |
$2,028.63
|
| Rate for Payer: Railroad Medicare Medicare |
$693.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,546.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$693.97
|
| Rate for Payer: UHC Exchange |
$1,075.65
|
| Rate for Payer: UHC Medicaid |
$362.95
|
| Rate for Payer: UHCCP DNSP |
$693.97
|
| Rate for Payer: UHCCP Medicaid |
$362.95
|
| Rate for Payer: VA VA |
$693.97
|
|
|
HC RO ISODOSE BRACH CALC SIMPLE
|
Facility
|
OP
|
$239.56
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$167.93 |
| Max. Negotiated Rate |
$578.27 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Aetna Medicare |
$373.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: ASR ASR |
$232.37
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$197.52
|
| Rate for Payer: BCN Commercial |
$197.52
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$191.65
|
| Rate for Payer: Cash Price |
$191.65
|
| Rate for Payer: Cofinity Commercial |
$225.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$232.37
|
| Rate for Payer: Healthscope Whirlpool |
$239.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$373.08
|
| Rate for Payer: Mclaren Commercial |
$215.60
|
| Rate for Payer: Mclaren Medicaid |
$373.08
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$204.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.63
|
| Rate for Payer: Nomi Health Commercial |
$196.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.67
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$410.39
|
| Rate for Payer: PHP Medicaid |
$199.97
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$209.90
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health Narrow Network |
$167.93
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$578.27
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP DNSP |
$373.08
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC RO ISODOSE BRACH CALC SIMPLE
|
Facility
|
IP
|
$239.56
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$179.67 |
| Max. Negotiated Rate |
$239.56 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: ASR ASR |
$232.37
|
| Rate for Payer: BCBS Trust/PPO |
$196.73
|
| Rate for Payer: BCN Commercial |
$196.73
|
| Rate for Payer: Cash Price |
$191.65
|
| Rate for Payer: Cofinity Commercial |
$225.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.65
|
| Rate for Payer: Healthscope Commercial |
$232.37
|
| Rate for Payer: Healthscope Whirlpool |
$239.56
|
| Rate for Payer: Mclaren Commercial |
$215.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.63
|
| Rate for Payer: Nomi Health Commercial |
$196.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.81
|
|
|
HC RO ISODOSE BRACHY CALC COMPLEX
|
Facility
|
OP
|
$698.64
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$698.64 |
| Rate for Payer: Aetna Commercial |
$628.78
|
| Rate for Payer: Aetna Medicare |
$373.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: ASR ASR |
$677.68
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$576.03
|
| Rate for Payer: BCN Commercial |
$576.03
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$558.91
|
| Rate for Payer: Cash Price |
$558.91
|
| Rate for Payer: Cofinity Commercial |
$656.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$677.68
|
| Rate for Payer: Healthscope Whirlpool |
$698.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$373.08
|
| Rate for Payer: Mclaren Commercial |
$628.78
|
| Rate for Payer: Mclaren Medicaid |
$373.08
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$204.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.84
|
| Rate for Payer: Nomi Health Commercial |
$572.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$523.98
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$410.39
|
| Rate for Payer: PHP Medicaid |
$199.97
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$612.15
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health Narrow Network |
$489.75
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$614.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$578.27
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP DNSP |
$373.08
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC RO ISODOSE BRACHY CALC COMPLEX
|
Facility
|
IP
|
$698.64
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$523.98 |
| Max. Negotiated Rate |
$698.64 |
| Rate for Payer: Aetna Commercial |
$628.78
|
| Rate for Payer: ASR ASR |
$677.68
|
| Rate for Payer: BCBS Trust/PPO |
$573.72
|
| Rate for Payer: BCN Commercial |
$573.72
|
| Rate for Payer: Cash Price |
$558.91
|
| Rate for Payer: Cofinity Commercial |
$656.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.91
|
| Rate for Payer: Healthscope Commercial |
$677.68
|
| Rate for Payer: Healthscope Whirlpool |
$698.64
|
| Rate for Payer: Mclaren Commercial |
$628.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.84
|
| Rate for Payer: Nomi Health Commercial |
$572.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$523.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$614.80
|
|
|
HC RO ISODOSE BRACHY CALC INTRM
|
Facility
|
IP
|
$635.12
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$476.34 |
| Max. Negotiated Rate |
$635.12 |
| Rate for Payer: Aetna Commercial |
$571.61
|
| Rate for Payer: ASR ASR |
$616.07
|
| Rate for Payer: BCBS Trust/PPO |
$521.56
|
| Rate for Payer: BCN Commercial |
$521.56
|
| Rate for Payer: Cash Price |
$508.10
|
| Rate for Payer: Cofinity Commercial |
$597.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.10
|
| Rate for Payer: Healthscope Commercial |
$616.07
|
| Rate for Payer: Healthscope Whirlpool |
$635.12
|
| Rate for Payer: Mclaren Commercial |
$571.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.85
|
| Rate for Payer: Nomi Health Commercial |
$520.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$476.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$558.91
|
|
|
HC RO ISODOSE BRACHY CALC INTRM
|
Facility
|
OP
|
$635.12
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$635.12 |
| Rate for Payer: Aetna Commercial |
$571.61
|
| Rate for Payer: Aetna Medicare |
$373.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: ASR ASR |
$616.07
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$523.66
|
| Rate for Payer: BCN Commercial |
$523.66
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$508.10
|
| Rate for Payer: Cash Price |
$508.10
|
| Rate for Payer: Cofinity Commercial |
$597.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$616.07
|
| Rate for Payer: Healthscope Whirlpool |
$635.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$373.08
|
| Rate for Payer: Mclaren Commercial |
$571.61
|
| Rate for Payer: Mclaren Medicaid |
$373.08
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$204.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.85
|
| Rate for Payer: Nomi Health Commercial |
$520.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$476.34
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$410.39
|
| Rate for Payer: PHP Medicaid |
$199.97
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$556.49
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health Narrow Network |
$445.22
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$558.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$578.27
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP DNSP |
$373.08
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC RO ISODOSE TELETHRPY COMPLEX
|
Facility
|
IP
|
$1,181.13
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$885.85 |
| Max. Negotiated Rate |
$1,181.13 |
| Rate for Payer: Aetna Commercial |
$1,063.02
|
| Rate for Payer: ASR ASR |
$1,145.70
|
| Rate for Payer: BCBS Trust/PPO |
$969.94
|
| Rate for Payer: BCN Commercial |
$969.94
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cofinity Commercial |
$1,110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.90
|
| Rate for Payer: Healthscope Commercial |
$1,145.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,181.13
|
| Rate for Payer: Mclaren Commercial |
$1,063.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,003.96
|
| Rate for Payer: Nomi Health Commercial |
$968.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$885.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,039.39
|
|
|
HC RO ISODOSE TELETHRPY COMPLEX
|
Facility
|
OP
|
$1,181.13
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$1,181.13 |
| Rate for Payer: Aetna Commercial |
$1,063.02
|
| Rate for Payer: Aetna Medicare |
$373.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: ASR ASR |
$1,145.70
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$973.84
|
| Rate for Payer: BCN Commercial |
$973.84
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cofinity Commercial |
$1,110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$1,145.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,181.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$373.08
|
| Rate for Payer: Mclaren Commercial |
$1,063.02
|
| Rate for Payer: Mclaren Medicaid |
$373.08
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$204.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,003.96
|
| Rate for Payer: Nomi Health Commercial |
$968.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$885.85
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$410.39
|
| Rate for Payer: PHP Medicaid |
$199.97
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,034.91
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health Narrow Network |
$827.97
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,039.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$578.27
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP DNSP |
$373.08
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC RO ISODOSE TELETHRPY SIMPLE
|
Facility
|
OP
|
$257.88
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$180.77 |
| Max. Negotiated Rate |
$578.27 |
| Rate for Payer: Aetna Commercial |
$232.09
|
| Rate for Payer: Aetna Medicare |
$373.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: ASR ASR |
$250.14
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$212.62
|
| Rate for Payer: BCN Commercial |
$212.62
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cofinity Commercial |
$242.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$250.14
|
| Rate for Payer: Healthscope Whirlpool |
$257.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$373.08
|
| Rate for Payer: Mclaren Commercial |
$232.09
|
| Rate for Payer: Mclaren Medicaid |
$373.08
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$204.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.20
|
| Rate for Payer: Nomi Health Commercial |
$211.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.41
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$410.39
|
| Rate for Payer: PHP Medicaid |
$199.97
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$225.95
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health Narrow Network |
$180.77
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$578.27
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP DNSP |
$373.08
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC RO ISODOSE TELETHRPY SIMPLE
|
Facility
|
IP
|
$257.88
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$193.41 |
| Max. Negotiated Rate |
$257.88 |
| Rate for Payer: Aetna Commercial |
$232.09
|
| Rate for Payer: ASR ASR |
$250.14
|
| Rate for Payer: BCBS Trust/PPO |
$211.77
|
| Rate for Payer: BCN Commercial |
$211.77
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cofinity Commercial |
$242.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.30
|
| Rate for Payer: Healthscope Commercial |
$250.14
|
| Rate for Payer: Healthscope Whirlpool |
$257.88
|
| Rate for Payer: Mclaren Commercial |
$232.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.20
|
| Rate for Payer: Nomi Health Commercial |
$211.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.93
|
|
|
HC RO LINAC SBRT PER SESSION
|
Facility
|
IP
|
$3,616.93
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,712.70 |
| Max. Negotiated Rate |
$3,616.93 |
| Rate for Payer: Aetna Commercial |
$3,255.24
|
| Rate for Payer: ASR ASR |
$3,508.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,970.22
|
| Rate for Payer: BCN Commercial |
$2,970.22
|
| Rate for Payer: Cash Price |
$2,893.54
|
| Rate for Payer: Cofinity Commercial |
$3,399.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,893.54
|
| Rate for Payer: Healthscope Commercial |
$3,508.42
|
| Rate for Payer: Healthscope Whirlpool |
$3,616.93
|
| Rate for Payer: Mclaren Commercial |
$3,255.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,074.39
|
| Rate for Payer: Nomi Health Commercial |
$2,965.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,712.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,182.90
|
|
|
HC RO LINAC SBRT PER SESSION
|
Facility
|
OP
|
$3,616.93
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$931.79 |
| Max. Negotiated Rate |
$3,616.93 |
| Rate for Payer: Aetna Commercial |
$3,255.24
|
| Rate for Payer: Aetna Medicare |
$1,781.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,227.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,227.03
|
| Rate for Payer: ASR ASR |
$3,508.42
|
| Rate for Payer: BCBS Complete |
$978.47
|
| Rate for Payer: BCBS MAPPO |
$1,781.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,982.16
|
| Rate for Payer: BCN Commercial |
$2,982.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,781.62
|
| Rate for Payer: Cash Price |
$2,893.54
|
| Rate for Payer: Cash Price |
$2,893.54
|
| Rate for Payer: Cofinity Commercial |
$3,399.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,893.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,781.62
|
| Rate for Payer: Healthscope Commercial |
$3,508.42
|
| Rate for Payer: Healthscope Whirlpool |
$3,616.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,781.62
|
| Rate for Payer: Mclaren Commercial |
$3,255.24
|
| Rate for Payer: Mclaren Medicaid |
$1,781.62
|
| Rate for Payer: Mclaren Medicare |
$1,781.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,870.70
|
| Rate for Payer: Meridian Medicaid |
$978.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,048.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,959.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,074.39
|
| Rate for Payer: Nomi Health Commercial |
$2,965.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,712.70
|
| Rate for Payer: PACE Medicare |
$1,692.54
|
| Rate for Payer: PACE SWMI |
$1,781.62
|
| Rate for Payer: PHP Commercial |
$1,959.78
|
| Rate for Payer: PHP Medicaid |
$954.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,781.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$931.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,169.15
|
| Rate for Payer: Priority Health Medicare |
$1,781.62
|
| Rate for Payer: Priority Health Narrow Network |
$2,535.47
|
| Rate for Payer: Railroad Medicare Medicare |
$1,781.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,182.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,781.62
|
| Rate for Payer: UHC Exchange |
$2,761.51
|
| Rate for Payer: UHC Medicaid |
$931.79
|
| Rate for Payer: UHCCP DNSP |
$1,781.62
|
| Rate for Payer: UHCCP Medicaid |
$931.79
|
| Rate for Payer: VA VA |
$1,781.62
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
OP
|
$11.67
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$18.89 |
| Rate for Payer: Aetna Commercial |
$10.50
|
| Rate for Payer: Aetna Medicare |
$12.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.24
|
| Rate for Payer: ASR ASR |
$11.32
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS MAPPO |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$9.62
|
| Rate for Payer: BCN Commercial |
$9.62
|
| Rate for Payer: BCN Medicare Advantage |
$12.19
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.19
|
| Rate for Payer: Healthscope Commercial |
$11.32
|
| Rate for Payer: Healthscope Whirlpool |
$11.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.19
|
| Rate for Payer: Mclaren Commercial |
$10.50
|
| Rate for Payer: Mclaren Medicaid |
$12.19
|
| Rate for Payer: Mclaren Medicare |
$12.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.80
|
| Rate for Payer: Meridian Medicaid |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.75
|
| Rate for Payer: PACE Medicare |
$11.58
|
| Rate for Payer: PACE SWMI |
$12.19
|
| Rate for Payer: PHP Commercial |
$13.41
|
| Rate for Payer: PHP Medicaid |
$6.53
|
| Rate for Payer: PHP Medicare Advantage |
$12.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.57
|
| Rate for Payer: Priority Health Medicare |
$12.19
|
| Rate for Payer: Priority Health Narrow Network |
$10.06
|
| Rate for Payer: Railroad Medicare Medicare |
$12.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.19
|
| Rate for Payer: UHC Exchange |
$18.89
|
| Rate for Payer: UHC Medicaid |
$6.38
|
| Rate for Payer: UHCCP DNSP |
$12.19
|
| Rate for Payer: UHCCP Medicaid |
$6.38
|
| Rate for Payer: VA VA |
$12.19
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
IP
|
$11.67
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$11.67 |
| Rate for Payer: Aetna Commercial |
$10.50
|
| Rate for Payer: ASR ASR |
$11.32
|
| Rate for Payer: BCBS Trust/PPO |
$9.58
|
| Rate for Payer: BCN Commercial |
$9.58
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$11.32
|
| Rate for Payer: Healthscope Whirlpool |
$11.67
|
| Rate for Payer: Mclaren Commercial |
$10.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.27
|
|
