|
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 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 GI PROC 78299
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 78299
|
| Hospital Charge Code |
34100022
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 |
$210.06 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 |
$210.06 |
| Max. Negotiated Rate |
$750.34 |
| Rate for Payer: Aetna Commercial |
$675.31
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$727.83
|
| Rate for Payer: ASR Commercial |
$727.83
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$614.45
|
| Rate for Payer: BCN Commercial |
$581.74
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$750.34
|
| Rate for Payer: Healthscope Whirlpool |
$727.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$675.31
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$637.79
|
| Rate for Payer: Nomi Health Commercial |
$615.28
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$525.99
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 |
$210.06 |
| Max. Negotiated Rate |
$1,923.10 |
| Rate for Payer: Aetna Commercial |
$1,730.79
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,865.41
|
| Rate for Payer: ASR Commercial |
$1,865.41
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,574.83
|
| Rate for Payer: BCN Commercial |
$1,490.98
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,923.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,865.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,730.79
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.63
|
| Rate for Payer: Nomi Health Commercial |
$1,576.94
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,348.09
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,692.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 |
$1,634.63
|
| 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
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 78999
|
| Hospital Charge Code |
34100061
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 RADPHARM THER 799
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 79999
|
| Hospital Charge Code |
34100066
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$117.16 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$218.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$273.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$273.24
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$123.02
|
| Rate for Payer: BCBS MAPPO |
$218.59
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$218.59
|
| 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 |
$218.59
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$218.59
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$117.16
|
| Rate for Payer: Mclaren Medicare |
$218.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.52
|
| Rate for Payer: Meridian Medicaid |
$123.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$207.66
|
| Rate for Payer: PACE SWMI |
$218.59
|
| Rate for Payer: PHP Commercial |
$240.45
|
| Rate for Payer: PHP Medicaid |
$117.16
|
| Rate for Payer: PHP Medicare Advantage |
$218.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.16
|
| 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 |
$218.59
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$218.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.59
|
| Rate for Payer: UHC Exchange |
$338.81
|
| Rate for Payer: UHC Medicare Advantage |
$218.59
|
| Rate for Payer: UHCCP DNSP |
$218.59
|
| Rate for Payer: UHCCP Medicaid |
$117.16
|
| Rate for Payer: VA VA |
$218.59
|
|
|
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 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 |
$210.06 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$723.17
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$779.41
|
| Rate for Payer: ASR Commercial |
$779.41
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$658.00
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$803.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$723.17
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$563.27
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$707.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC RADXF UNL ULTRASOUND 76999
|
Facility
|
IP
|
$217.26
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
40200051
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$217.26 |
| Rate for Payer: Aetna Commercial |
$195.53
|
| Rate for Payer: ASR ASR |
$210.74
|
| Rate for Payer: ASR Commercial |
$210.74
|
| Rate for Payer: BCBS Trust/PPO |
$177.05
|
| Rate for Payer: BCN Commercial |
$168.44
|
| Rate for Payer: Cash Price |
$173.81
|
| Rate for Payer: Cofinity Commercial |
$204.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.81
|
| Rate for Payer: Healthscope Commercial |
$217.26
|
| Rate for Payer: Healthscope Whirlpool |
$210.74
|
| Rate for Payer: Mclaren Commercial |
$195.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.67
|
| Rate for Payer: Nomi Health Commercial |
$178.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.19
|
|
|
HC RADXF UNL ULTRASOUND 76999
|
Facility
|
OP
|
$217.26
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
40200051
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$217.26 |
| Rate for Payer: Aetna Commercial |
$195.53
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$210.74
|
| Rate for Payer: ASR Commercial |
$210.74
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$177.91
|
| Rate for Payer: BCN Commercial |
$168.44
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$173.81
|
| Rate for Payer: Cash Price |
$173.81
|
| Rate for Payer: Cofinity Commercial |
$204.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$217.26
|
| Rate for Payer: Healthscope Whirlpool |
$210.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$195.53
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.67
|
| Rate for Payer: Nomi Health Commercial |
$178.15
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.36
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$152.30
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC RAGWEED SHORT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200056
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC RAGWEED SHORT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200056
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC RAJI CELL ASSAY
|
Facility
|
IP
|
$150.96
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200192
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$98.12 |
| Max. Negotiated Rate |
$150.96 |
| Rate for Payer: Aetna Commercial |
$135.86
|
| Rate for Payer: ASR ASR |
$146.43
|
| Rate for Payer: ASR Commercial |
$146.43
|
| Rate for Payer: BCBS Trust/PPO |
$123.02
|
| Rate for Payer: BCN Commercial |
$117.04
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.77
|
| Rate for Payer: Healthscope Commercial |
$150.96
|
| Rate for Payer: Healthscope Whirlpool |
$146.43
|
| Rate for Payer: Mclaren Commercial |
$135.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.32
|
| Rate for Payer: Nomi Health Commercial |
$123.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.84
|
|
|
HC RAJI CELL ASSAY
|
Facility
|
OP
|
$150.96
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200192
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$150.96 |
| Rate for Payer: Aetna Commercial |
$135.86
|
| Rate for Payer: Aetna Medicare |
$24.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.46
|
| Rate for Payer: ASR ASR |
$146.43
|
| Rate for Payer: ASR Commercial |
$146.43
|
| Rate for Payer: BCBS Complete |
$13.72
|
| Rate for Payer: BCBS MAPPO |
$24.37
|
| Rate for Payer: BCBS Trust/PPO |
$123.62
|
| Rate for Payer: BCN Commercial |
$117.04
|
| Rate for Payer: BCN Medicare Advantage |
$24.37
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.37
|
| Rate for Payer: Healthscope Commercial |
$150.96
|
| Rate for Payer: Healthscope Whirlpool |
$146.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.37
|
| Rate for Payer: Mclaren Commercial |
$135.86
|
| Rate for Payer: Mclaren Medicaid |
$13.06
|
| Rate for Payer: Mclaren Medicare |
$24.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.59
|
| Rate for Payer: Meridian Medicaid |
$13.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.32
|
| Rate for Payer: Nomi Health Commercial |
$123.79
|
| Rate for Payer: PACE Medicare |
$23.15
|
| Rate for Payer: PACE SWMI |
$24.37
|
| Rate for Payer: PHP Commercial |
$26.81
|
| Rate for Payer: PHP Medicaid |
$13.06
|
| Rate for Payer: PHP Medicare Advantage |
$24.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.27
|
| Rate for Payer: Priority Health Medicare |
$24.37
|
| Rate for Payer: Priority Health Narrow Network |
$105.82
|
| Rate for Payer: Railroad Medicare Medicare |
$24.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.37
|
| Rate for Payer: UHC Exchange |
$37.77
|
| Rate for Payer: UHC Medicare Advantage |
$24.37
|
| Rate for Payer: UHCCP DNSP |
$24.37
|
| Rate for Payer: UHCCP Medicaid |
$13.06
|
| Rate for Payer: VA VA |
$24.37
|
|
|
HC RAPID DESENSITIZATION PROC EA HOUR
|
Facility
|
IP
|
$540.75
|
|
|
Service Code
|
CPT 95180
|
| Hospital Charge Code |
76100075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.49 |
| Max. Negotiated Rate |
$540.75 |
| Rate for Payer: Aetna Commercial |
$486.68
|
| Rate for Payer: ASR ASR |
$524.53
|
| Rate for Payer: ASR Commercial |
$524.53
|
| Rate for Payer: BCBS Trust/PPO |
$440.66
|
| Rate for Payer: BCN Commercial |
$419.24
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cofinity Commercial |
$508.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.60
|
| Rate for Payer: Healthscope Commercial |
$540.75
|
| Rate for Payer: Healthscope Whirlpool |
$524.53
|
| Rate for Payer: Mclaren Commercial |
$486.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.64
|
| Rate for Payer: Nomi Health Commercial |
$443.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$475.86
|
|
|
HC RAPID DESENSITIZATION PROC EA HOUR
|
Facility
|
OP
|
$540.75
|
|
|
Service Code
|
CPT 95180
|
| Hospital Charge Code |
76100075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.60 |
| Max. Negotiated Rate |
$603.23 |
| Rate for Payer: Aetna Commercial |
$486.68
|
| Rate for Payer: Aetna Medicare |
$389.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$486.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$486.48
|
| Rate for Payer: ASR ASR |
$524.53
|
| Rate for Payer: ASR Commercial |
$524.53
|
| Rate for Payer: BCBS Complete |
$219.03
|
| Rate for Payer: BCBS MAPPO |
$389.18
|
| Rate for Payer: BCBS Trust/PPO |
$442.82
|
| Rate for Payer: BCN Commercial |
$419.24
|
| Rate for Payer: BCN Medicare Advantage |
$389.18
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cofinity Commercial |
$508.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.18
|
| Rate for Payer: Healthscope Commercial |
$540.75
|
| Rate for Payer: Healthscope Whirlpool |
$524.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.18
|
| Rate for Payer: Mclaren Commercial |
$486.68
|
| Rate for Payer: Mclaren Medicaid |
$208.60
|
| Rate for Payer: Mclaren Medicare |
$389.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.64
|
| Rate for Payer: Meridian Medicaid |
$219.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$447.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.64
|
| Rate for Payer: Nomi Health Commercial |
$443.42
|
| Rate for Payer: PACE Medicare |
$369.72
|
| Rate for Payer: PACE SWMI |
$389.18
|
| Rate for Payer: PHP Commercial |
$428.10
|
| Rate for Payer: PHP Medicaid |
$208.60
|
| Rate for Payer: PHP Medicare Advantage |
$389.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$473.81
|
| Rate for Payer: Priority Health Medicare |
$389.18
|
| Rate for Payer: Priority Health Narrow Network |
$379.07
|
| Rate for Payer: Railroad Medicare Medicare |
$389.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$475.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.18
|
| Rate for Payer: UHC Exchange |
$603.23
|
| Rate for Payer: UHC Medicare Advantage |
$389.18
|
| Rate for Payer: UHCCP DNSP |
$389.18
|
| Rate for Payer: UHCCP Medicaid |
$208.60
|
| Rate for Payer: VA VA |
$389.18
|
|
|
HC RAPID HIV ANTIBODY
|
Facility
|
IP
|
$153.71
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
30200290
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.91 |
| Max. Negotiated Rate |
$153.71 |
| Rate for Payer: Aetna Commercial |
$138.34
|
| Rate for Payer: ASR ASR |
$149.10
|
| Rate for Payer: ASR Commercial |
$149.10
|
| Rate for Payer: BCBS Trust/PPO |
$125.26
|
| Rate for Payer: BCN Commercial |
$119.17
|
| Rate for Payer: Cash Price |
$122.97
|
| Rate for Payer: Cofinity Commercial |
$144.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.97
|
| Rate for Payer: Healthscope Commercial |
$153.71
|
| Rate for Payer: Healthscope Whirlpool |
$149.10
|
| Rate for Payer: Mclaren Commercial |
$138.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.65
|
| Rate for Payer: Nomi Health Commercial |
$126.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.26
|
|
|
HC RAPID HIV ANTIBODY
|
Facility
|
OP
|
$153.71
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
30200290
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$153.71 |
| Rate for Payer: Aetna Commercial |
$138.34
|
| Rate for Payer: Aetna Medicare |
$8.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: ASR ASR |
$149.10
|
| Rate for Payer: ASR Commercial |
$149.10
|
| Rate for Payer: BCBS Complete |
$5.00
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$125.87
|
| Rate for Payer: BCN Commercial |
$119.17
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$122.97
|
| Rate for Payer: Cash Price |
$122.97
|
| Rate for Payer: Cofinity Commercial |
$144.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$153.71
|
| Rate for Payer: Healthscope Whirlpool |
$149.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.89
|
| Rate for Payer: Mclaren Commercial |
$138.34
|
| Rate for Payer: Mclaren Medicaid |
$4.77
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: Meridian Medicaid |
$5.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.65
|
| Rate for Payer: Nomi Health Commercial |
$126.04
|
| Rate for Payer: PACE Medicare |
$8.45
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PHP Commercial |
$9.78
|
| Rate for Payer: PHP Medicaid |
$4.77
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.68
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Narrow Network |
$107.75
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.89
|
| Rate for Payer: UHC Exchange |
$13.78
|
| Rate for Payer: UHC Medicare Advantage |
$8.89
|
| Rate for Payer: UHCCP DNSP |
$8.89
|
| Rate for Payer: UHCCP Medicaid |
$4.77
|
| Rate for Payer: VA VA |
$8.89
|
|
