|
HC RO IMRT DEL COMPLEX
|
Facility
|
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,137.20 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,959.20
|
| Rate for Payer: ASR ASR |
$3,189.36
|
| Rate for Payer: ASR Commercial |
$3,189.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,679.39
|
| Rate for Payer: BCN Commercial |
$2,549.19
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cofinity Commercial |
$3,090.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,630.40
|
| Rate for Payer: Healthscope Commercial |
$3,288.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,189.36
|
| Rate for Payer: Mclaren Commercial |
$2,959.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,794.80
|
| Rate for Payer: Nomi Health Commercial |
$2,696.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,137.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,893.44
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,959.20
|
| Rate for Payer: Aetna Medicare |
$564.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$705.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$705.21
|
| Rate for Payer: ASR ASR |
$3,189.36
|
| Rate for Payer: ASR Commercial |
$3,189.36
|
| Rate for Payer: BCBS Complete |
$317.51
|
| Rate for Payer: BCBS MAPPO |
$564.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,692.54
|
| Rate for Payer: BCN Commercial |
$2,549.19
|
| Rate for Payer: BCN Medicare Advantage |
$564.17
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cofinity Commercial |
$3,090.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,630.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.17
|
| Rate for Payer: Healthscope Commercial |
$3,288.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,189.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$564.17
|
| Rate for Payer: Mclaren Commercial |
$2,959.20
|
| Rate for Payer: Mclaren Medicaid |
$302.40
|
| Rate for Payer: Mclaren Medicare |
$564.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.38
|
| Rate for Payer: Meridian Medicaid |
$317.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$648.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,794.80
|
| Rate for Payer: Nomi Health Commercial |
$2,696.16
|
| Rate for Payer: PACE Medicare |
$535.96
|
| Rate for Payer: PACE SWMI |
$564.17
|
| Rate for Payer: PHP Commercial |
$620.59
|
| Rate for Payer: PHP Medicaid |
$302.40
|
| Rate for Payer: PHP Medicare Advantage |
$564.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,137.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,880.95
|
| Rate for Payer: Priority Health Medicare |
$564.17
|
| Rate for Payer: Priority Health Narrow Network |
$2,304.89
|
| Rate for Payer: Railroad Medicare Medicare |
$564.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,893.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.17
|
| Rate for Payer: UHC Exchange |
$874.46
|
| Rate for Payer: UHC Medicare Advantage |
$564.17
|
| Rate for Payer: UHCCP DNSP |
$564.17
|
| Rate for Payer: UHCCP Medicaid |
$302.40
|
| Rate for Payer: VA VA |
$564.17
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,137.20 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,959.20
|
| Rate for Payer: ASR ASR |
$3,189.36
|
| Rate for Payer: ASR Commercial |
$3,189.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,679.39
|
| Rate for Payer: BCN Commercial |
$2,549.19
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cofinity Commercial |
$3,090.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,630.40
|
| Rate for Payer: Healthscope Commercial |
$3,288.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,189.36
|
| Rate for Payer: Mclaren Commercial |
$2,959.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,794.80
|
| Rate for Payer: Nomi Health Commercial |
$2,696.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,137.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,893.44
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,959.20
|
| Rate for Payer: Aetna Medicare |
$564.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$705.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$705.21
|
| Rate for Payer: ASR ASR |
$3,189.36
|
| Rate for Payer: ASR Commercial |
$3,189.36
|
| Rate for Payer: BCBS Complete |
$317.51
|
| Rate for Payer: BCBS MAPPO |
$564.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,692.54
|
| Rate for Payer: BCN Commercial |
$2,549.19
|
| Rate for Payer: BCN Medicare Advantage |
$564.17
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cofinity Commercial |
$3,090.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,630.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.17
|
| Rate for Payer: Healthscope Commercial |
$3,288.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,189.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$564.17
|
| Rate for Payer: Mclaren Commercial |
$2,959.20
|
| Rate for Payer: Mclaren Medicaid |
$302.40
|
| Rate for Payer: Mclaren Medicare |
$564.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.38
|
| Rate for Payer: Meridian Medicaid |
$317.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$648.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,794.80
|
| Rate for Payer: Nomi Health Commercial |
$2,696.16
|
| Rate for Payer: PACE Medicare |
$535.96
|
| Rate for Payer: PACE SWMI |
$564.17
|
| Rate for Payer: PHP Commercial |
$620.59
|
| Rate for Payer: PHP Medicaid |
$302.40
|
| Rate for Payer: PHP Medicare Advantage |
$564.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,137.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,880.95
|
| Rate for Payer: Priority Health Medicare |
$564.17
|
| Rate for Payer: Priority Health Narrow Network |
$2,304.89
|
| Rate for Payer: Railroad Medicare Medicare |
$564.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,893.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.17
|
| Rate for Payer: UHC Exchange |
$874.46
|
| Rate for Payer: UHC Medicare Advantage |
$564.17
|
| Rate for Payer: UHCCP DNSP |
$564.17
|
| Rate for Payer: UHCCP Medicaid |
$302.40
|
| Rate for Payer: VA VA |
$564.17
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
IP
|
$331.89
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$215.73 |
| Max. Negotiated Rate |
$331.89 |
| Rate for Payer: Aetna Commercial |
$298.70
|
| Rate for Payer: ASR ASR |
$321.93
|
| Rate for Payer: ASR Commercial |
$321.93
|
| Rate for Payer: BCBS Trust/PPO |
$270.46
|
| Rate for Payer: BCN Commercial |
$257.31
|
| Rate for Payer: Cash Price |
$265.51
|
| Rate for Payer: Cofinity Commercial |
$311.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.51
|
| Rate for Payer: Healthscope Commercial |
$331.89
|
| Rate for Payer: Healthscope Whirlpool |
$321.93
|
| Rate for Payer: Mclaren Commercial |
$298.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.11
|
| Rate for Payer: Nomi Health Commercial |
$272.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.06
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
OP
|
$331.89
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$137.47 |
| Max. Negotiated Rate |
$397.54 |
| Rate for Payer: Aetna Commercial |
$298.70
|
| Rate for Payer: Aetna Medicare |
$256.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$320.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$320.60
|
| Rate for Payer: ASR ASR |
$321.93
|
| Rate for Payer: ASR Commercial |
$321.93
|
| Rate for Payer: BCBS Complete |
$144.35
|
| Rate for Payer: BCBS MAPPO |
$256.48
|
| Rate for Payer: BCBS Trust/PPO |
$271.78
|
| Rate for Payer: BCN Commercial |
$257.31
|
| Rate for Payer: BCN Medicare Advantage |
$256.48
|
| Rate for Payer: Cash Price |
$265.51
|
| Rate for Payer: Cash Price |
$265.51
|
| Rate for Payer: Cofinity Commercial |
$311.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.48
|
| Rate for Payer: Healthscope Commercial |
$331.89
|
| Rate for Payer: Healthscope Whirlpool |
$321.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$256.48
|
| Rate for Payer: Mclaren Commercial |
$298.70
|
| Rate for Payer: Mclaren Medicaid |
$137.47
|
| Rate for Payer: Mclaren Medicare |
$256.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$269.30
|
| Rate for Payer: Meridian Medicaid |
$144.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.11
|
| Rate for Payer: Nomi Health Commercial |
$272.15
|
| Rate for Payer: PACE Medicare |
$243.66
|
| Rate for Payer: PACE SWMI |
$256.48
|
| Rate for Payer: PHP Commercial |
$282.13
|
| Rate for Payer: PHP Medicaid |
$137.47
|
| Rate for Payer: PHP Medicare Advantage |
$256.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.80
|
| Rate for Payer: Priority Health Medicare |
$256.48
|
| Rate for Payer: Priority Health Narrow Network |
$232.65
|
| Rate for Payer: Railroad Medicare Medicare |
$256.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.48
|
| Rate for Payer: UHC Exchange |
$397.54
|
| Rate for Payer: UHC Medicare Advantage |
$256.48
|
| Rate for Payer: UHCCP DNSP |
$256.48
|
| Rate for Payer: UHCCP Medicaid |
$137.47
|
| Rate for Payer: VA VA |
$256.48
|
|
|
HC RO INS VAG BRACHTHER DEVICE
|
Facility
|
OP
|
$550.40
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
36100444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$550.40 |
| Rate for Payer: Aetna Commercial |
$495.36
|
| Rate for Payer: Aetna Medicare |
$296.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.84
|
| Rate for Payer: ASR ASR |
$533.89
|
| Rate for Payer: ASR Commercial |
$533.89
|
| Rate for Payer: BCBS Complete |
$166.97
|
| Rate for Payer: BCBS MAPPO |
$296.67
|
| Rate for Payer: BCBS Trust/PPO |
$450.72
|
| Rate for Payer: BCN Commercial |
$426.73
|
| Rate for Payer: BCN Medicare Advantage |
$296.67
|
| Rate for Payer: Cash Price |
$440.32
|
| Rate for Payer: Cash Price |
$440.32
|
| Rate for Payer: Cofinity Commercial |
$517.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.67
|
| Rate for Payer: Healthscope Commercial |
$550.40
|
| Rate for Payer: Healthscope Whirlpool |
$533.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$296.67
|
| Rate for Payer: Mclaren Commercial |
$495.36
|
| Rate for Payer: Mclaren Medicaid |
$159.02
|
| Rate for Payer: Mclaren Medicare |
$296.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.50
|
| Rate for Payer: Meridian Medicaid |
$166.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$467.84
|
| Rate for Payer: Nomi Health Commercial |
$451.33
|
| Rate for Payer: PACE Medicare |
$281.84
|
| Rate for Payer: PACE SWMI |
$296.67
|
| Rate for Payer: PHP Commercial |
$326.34
|
| Rate for Payer: PHP Medicaid |
$159.02
|
| Rate for Payer: PHP Medicare Advantage |
$296.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$482.26
|
| Rate for Payer: Priority Health Medicare |
$296.67
|
| Rate for Payer: Priority Health Narrow Network |
$385.83
|
| Rate for Payer: Railroad Medicare Medicare |
$296.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.67
|
| Rate for Payer: UHC Exchange |
$459.84
|
| Rate for Payer: UHC Medicare Advantage |
$296.67
|
| Rate for Payer: UHCCP DNSP |
$296.67
|
| Rate for Payer: UHCCP Medicaid |
$159.02
|
| Rate for Payer: VA VA |
$296.67
|
|
|
HC RO INS VAG BRACHTHER DEVICE
|
Facility
|
IP
|
$550.40
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
36100444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.76 |
| Max. Negotiated Rate |
$550.40 |
| Rate for Payer: Aetna Commercial |
$495.36
|
| Rate for Payer: ASR ASR |
$533.89
|
| Rate for Payer: ASR Commercial |
$533.89
|
| Rate for Payer: BCBS Trust/PPO |
$448.52
|
| Rate for Payer: BCN Commercial |
$426.73
|
| Rate for Payer: Cash Price |
$440.32
|
| Rate for Payer: Cofinity Commercial |
$517.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.32
|
| Rate for Payer: Healthscope Commercial |
$550.40
|
| Rate for Payer: Healthscope Whirlpool |
$533.89
|
| Rate for Payer: Mclaren Commercial |
$495.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$467.84
|
| Rate for Payer: Nomi Health Commercial |
$451.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.35
|
|
|
HC RO INTRSTI RADELEMENT APPL CMPLX
|
Facility
|
OP
|
$2,837.17
|
|
|
Service Code
|
CPT 77778
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.69 |
| Max. Negotiated Rate |
$2,837.17 |
| Rate for Payer: Aetna Commercial |
$2,553.45
|
| Rate for Payer: Aetna Medicare |
$676.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$845.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$845.83
|
| Rate for Payer: ASR ASR |
$2,752.05
|
| Rate for Payer: ASR Commercial |
$2,752.05
|
| Rate for Payer: BCBS Complete |
$380.82
|
| Rate for Payer: BCBS MAPPO |
$676.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,323.36
|
| Rate for Payer: BCN Commercial |
$2,199.66
|
| Rate for Payer: BCN Medicare Advantage |
$676.66
|
| Rate for Payer: Cash Price |
$2,269.74
|
| Rate for Payer: Cash Price |
$2,269.74
|
| Rate for Payer: Cofinity Commercial |
$2,666.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,269.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.66
|
| Rate for Payer: Healthscope Commercial |
$2,837.17
|
| Rate for Payer: Healthscope Whirlpool |
$2,752.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$676.66
|
| Rate for Payer: Mclaren Commercial |
$2,553.45
|
| Rate for Payer: Mclaren Medicaid |
$362.69
|
| Rate for Payer: Mclaren Medicare |
$676.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.49
|
| Rate for Payer: Meridian Medicaid |
$380.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$778.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,411.59
|
| Rate for Payer: Nomi Health Commercial |
$2,326.48
|
| Rate for Payer: PACE Medicare |
$642.83
|
| Rate for Payer: PACE SWMI |
$676.66
|
| Rate for Payer: PHP Commercial |
$744.33
|
| Rate for Payer: PHP Medicaid |
$362.69
|
| Rate for Payer: PHP Medicare Advantage |
$676.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,485.93
|
| Rate for Payer: Priority Health Medicare |
$676.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,988.86
|
| Rate for Payer: Railroad Medicare Medicare |
$676.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,496.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.66
|
| Rate for Payer: UHC Exchange |
$1,048.82
|
| Rate for Payer: UHC Medicare Advantage |
$676.66
|
| Rate for Payer: UHCCP DNSP |
$676.66
|
| Rate for Payer: UHCCP Medicaid |
$362.69
|
| Rate for Payer: VA VA |
$676.66
|
|
|
HC RO INTRSTI RADELEMENT APPL CMPLX
|
Facility
|
IP
|
$2,837.17
|
|
|
Service Code
|
CPT 77778
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,844.16 |
| Max. Negotiated Rate |
$2,837.17 |
| Rate for Payer: Aetna Commercial |
$2,553.45
|
| Rate for Payer: ASR ASR |
$2,752.05
|
| Rate for Payer: ASR Commercial |
$2,752.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,312.01
|
| Rate for Payer: BCN Commercial |
$2,199.66
|
| Rate for Payer: Cash Price |
$2,269.74
|
| Rate for Payer: Cofinity Commercial |
$2,666.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,269.74
|
| Rate for Payer: Healthscope Commercial |
$2,837.17
|
| Rate for Payer: Healthscope Whirlpool |
$2,752.05
|
| Rate for Payer: Mclaren Commercial |
$2,553.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,411.59
|
| Rate for Payer: Nomi Health Commercial |
$2,326.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,496.71
|
|
|
HC RO ISODOSE BRACH CALC SIMPLE
|
Facility
|
OP
|
$234.86
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$152.66 |
| Max. Negotiated Rate |
$553.38 |
| Rate for Payer: Aetna Commercial |
$211.37
|
| Rate for Payer: Aetna Medicare |
$357.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: ASR ASR |
$227.81
|
| Rate for Payer: ASR Commercial |
$227.81
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCBS Trust/PPO |
$192.33
|
| Rate for Payer: BCN Commercial |
$182.09
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$187.89
|
| Rate for Payer: Cash Price |
$187.89
|
| Rate for Payer: Cofinity Commercial |
$220.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$234.86
|
| Rate for Payer: Healthscope Whirlpool |
$227.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.02
|
| Rate for Payer: Mclaren Commercial |
$211.37
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.63
|
| Rate for Payer: Nomi Health Commercial |
$192.59
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$392.72
|
| Rate for Payer: PHP Medicaid |
$191.36
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.78
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health Narrow Network |
$164.64
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$553.38
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP DNSP |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$191.36
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC RO ISODOSE BRACH CALC SIMPLE
|
Facility
|
IP
|
$234.86
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$152.66 |
| Max. Negotiated Rate |
$234.86 |
| Rate for Payer: Aetna Commercial |
$211.37
|
| Rate for Payer: ASR ASR |
$227.81
|
| Rate for Payer: ASR Commercial |
$227.81
|
| Rate for Payer: BCBS Trust/PPO |
$191.39
|
| Rate for Payer: BCN Commercial |
$182.09
|
| Rate for Payer: Cash Price |
$187.89
|
| Rate for Payer: Cofinity Commercial |
$220.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.89
|
| Rate for Payer: Healthscope Commercial |
$234.86
|
| Rate for Payer: Healthscope Whirlpool |
$227.81
|
| Rate for Payer: Mclaren Commercial |
$211.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.63
|
| Rate for Payer: Nomi Health Commercial |
$192.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.68
|
|
|
HC RO ISODOSE BRACHY CALC COMPLEX
|
Facility
|
OP
|
$684.94
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$684.94 |
| Rate for Payer: Aetna Commercial |
$616.45
|
| Rate for Payer: Aetna Medicare |
$357.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: ASR ASR |
$664.39
|
| Rate for Payer: ASR Commercial |
$664.39
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCBS Trust/PPO |
$560.90
|
| Rate for Payer: BCN Commercial |
$531.03
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Cofinity Commercial |
$643.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$684.94
|
| Rate for Payer: Healthscope Whirlpool |
$664.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.02
|
| Rate for Payer: Mclaren Commercial |
$616.45
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$582.20
|
| Rate for Payer: Nomi Health Commercial |
$561.65
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$392.72
|
| Rate for Payer: PHP Medicaid |
$191.36
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$600.14
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health Narrow Network |
$480.14
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$553.38
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP DNSP |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$191.36
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC RO ISODOSE BRACHY CALC COMPLEX
|
Facility
|
IP
|
$684.94
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$445.21 |
| Max. Negotiated Rate |
$684.94 |
| Rate for Payer: Aetna Commercial |
$616.45
|
| Rate for Payer: ASR ASR |
$664.39
|
| Rate for Payer: ASR Commercial |
$664.39
|
| Rate for Payer: BCBS Trust/PPO |
$558.16
|
| Rate for Payer: BCN Commercial |
$531.03
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Cofinity Commercial |
$643.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.95
|
| Rate for Payer: Healthscope Commercial |
$684.94
|
| Rate for Payer: Healthscope Whirlpool |
$664.39
|
| Rate for Payer: Mclaren Commercial |
$616.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$582.20
|
| Rate for Payer: Nomi Health Commercial |
$561.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.75
|
|
|
HC RO ISODOSE BRACHY CALC INTRM
|
Facility
|
IP
|
$622.67
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$404.74 |
| Max. Negotiated Rate |
$622.67 |
| Rate for Payer: Aetna Commercial |
$560.40
|
| Rate for Payer: ASR ASR |
$603.99
|
| Rate for Payer: ASR Commercial |
$603.99
|
| Rate for Payer: BCBS Trust/PPO |
$507.41
|
| Rate for Payer: BCN Commercial |
$482.76
|
| Rate for Payer: Cash Price |
$498.14
|
| Rate for Payer: Cofinity Commercial |
$585.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.14
|
| Rate for Payer: Healthscope Commercial |
$622.67
|
| Rate for Payer: Healthscope Whirlpool |
$603.99
|
| Rate for Payer: Mclaren Commercial |
$560.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.27
|
| Rate for Payer: Nomi Health Commercial |
$510.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.95
|
|
|
HC RO ISODOSE BRACHY CALC INTRM
|
Facility
|
OP
|
$622.67
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$622.67 |
| Rate for Payer: Aetna Commercial |
$560.40
|
| Rate for Payer: Aetna Medicare |
$357.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: ASR ASR |
$603.99
|
| Rate for Payer: ASR Commercial |
$603.99
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCBS Trust/PPO |
$509.90
|
| Rate for Payer: BCN Commercial |
$482.76
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$498.14
|
| Rate for Payer: Cash Price |
$498.14
|
| Rate for Payer: Cofinity Commercial |
$585.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$622.67
|
| Rate for Payer: Healthscope Whirlpool |
$603.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.02
|
| Rate for Payer: Mclaren Commercial |
$560.40
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.27
|
| Rate for Payer: Nomi Health Commercial |
$510.59
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$392.72
|
| Rate for Payer: PHP Medicaid |
$191.36
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$545.58
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health Narrow Network |
$436.49
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$553.38
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP DNSP |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$191.36
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC RO ISODOSE TELETHRPY COMPLEX
|
Facility
|
IP
|
$1,157.97
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$752.68 |
| Max. Negotiated Rate |
$1,157.97 |
| Rate for Payer: Aetna Commercial |
$1,042.17
|
| Rate for Payer: ASR ASR |
$1,123.23
|
| Rate for Payer: ASR Commercial |
$1,123.23
|
| Rate for Payer: BCBS Trust/PPO |
$943.63
|
| Rate for Payer: BCN Commercial |
$897.77
|
| Rate for Payer: Cash Price |
$926.38
|
| Rate for Payer: Cofinity Commercial |
$1,088.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$926.38
|
| Rate for Payer: Healthscope Commercial |
$1,157.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,123.23
|
| Rate for Payer: Mclaren Commercial |
$1,042.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$984.27
|
| Rate for Payer: Nomi Health Commercial |
$949.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,019.01
|
|
|
HC RO ISODOSE TELETHRPY COMPLEX
|
Facility
|
OP
|
$1,157.97
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$1,157.97 |
| Rate for Payer: Aetna Commercial |
$1,042.17
|
| Rate for Payer: Aetna Medicare |
$357.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: ASR ASR |
$1,123.23
|
| Rate for Payer: ASR Commercial |
$1,123.23
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCBS Trust/PPO |
$948.26
|
| Rate for Payer: BCN Commercial |
$897.77
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$926.38
|
| Rate for Payer: Cash Price |
$926.38
|
| Rate for Payer: Cofinity Commercial |
$1,088.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$926.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$1,157.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,123.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.02
|
| Rate for Payer: Mclaren Commercial |
$1,042.17
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$984.27
|
| Rate for Payer: Nomi Health Commercial |
$949.54
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$392.72
|
| Rate for Payer: PHP Medicaid |
$191.36
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,014.61
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health Narrow Network |
$811.74
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,019.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$553.38
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP DNSP |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$191.36
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC RO ISODOSE TELETHRPY SIMPLE
|
Facility
|
OP
|
$252.82
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$164.33 |
| Max. Negotiated Rate |
$553.38 |
| Rate for Payer: Aetna Commercial |
$227.54
|
| Rate for Payer: Aetna Medicare |
$357.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: ASR ASR |
$245.24
|
| Rate for Payer: ASR Commercial |
$245.24
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCBS Trust/PPO |
$207.03
|
| Rate for Payer: BCN Commercial |
$196.01
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cofinity Commercial |
$237.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$252.82
|
| Rate for Payer: Healthscope Whirlpool |
$245.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.02
|
| Rate for Payer: Mclaren Commercial |
$227.54
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.90
|
| Rate for Payer: Nomi Health Commercial |
$207.31
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$392.72
|
| Rate for Payer: PHP Medicaid |
$191.36
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.52
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health Narrow Network |
$177.23
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$553.38
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP DNSP |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$191.36
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC RO ISODOSE TELETHRPY SIMPLE
|
Facility
|
IP
|
$252.82
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$164.33 |
| Max. Negotiated Rate |
$252.82 |
| Rate for Payer: Aetna Commercial |
$227.54
|
| Rate for Payer: ASR ASR |
$245.24
|
| Rate for Payer: ASR Commercial |
$245.24
|
| Rate for Payer: BCBS Trust/PPO |
$206.02
|
| Rate for Payer: BCN Commercial |
$196.01
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cofinity Commercial |
$237.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.26
|
| Rate for Payer: Healthscope Commercial |
$252.82
|
| Rate for Payer: Healthscope Whirlpool |
$245.24
|
| Rate for Payer: Mclaren Commercial |
$227.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.90
|
| Rate for Payer: Nomi Health Commercial |
$207.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.48
|
|
|
HC RO LINAC SBRT PER SESSION
|
Facility
|
OP
|
$3,546.01
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$917.90 |
| Max. Negotiated Rate |
$3,546.01 |
| Rate for Payer: Aetna Commercial |
$3,191.41
|
| Rate for Payer: Aetna Medicare |
$1,712.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,140.62
|
| Rate for Payer: ASR ASR |
$3,439.63
|
| Rate for Payer: ASR Commercial |
$3,439.63
|
| Rate for Payer: BCBS Complete |
$963.79
|
| Rate for Payer: BCBS MAPPO |
$1,712.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,903.83
|
| Rate for Payer: BCN Commercial |
$2,749.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,712.50
|
| Rate for Payer: Cash Price |
$2,836.81
|
| Rate for Payer: Cash Price |
$2,836.81
|
| Rate for Payer: Cofinity Commercial |
$3,333.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,836.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,712.50
|
| Rate for Payer: Healthscope Commercial |
$3,546.01
|
| Rate for Payer: Healthscope Whirlpool |
$3,439.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,712.50
|
| Rate for Payer: Mclaren Commercial |
$3,191.41
|
| Rate for Payer: Mclaren Medicaid |
$917.90
|
| Rate for Payer: Mclaren Medicare |
$1,712.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,798.12
|
| Rate for Payer: Meridian Medicaid |
$963.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,969.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.11
|
| Rate for Payer: Nomi Health Commercial |
$2,907.73
|
| Rate for Payer: PACE Medicare |
$1,626.88
|
| Rate for Payer: PACE SWMI |
$1,712.50
|
| Rate for Payer: PHP Commercial |
$1,883.75
|
| Rate for Payer: PHP Medicaid |
$917.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,712.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$917.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,304.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,107.01
|
| Rate for Payer: Priority Health Medicare |
$1,712.50
|
| Rate for Payer: Priority Health Narrow Network |
$2,485.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,712.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,120.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,712.50
|
| Rate for Payer: UHC Exchange |
$2,654.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,712.50
|
| Rate for Payer: UHCCP DNSP |
$1,712.50
|
| Rate for Payer: UHCCP Medicaid |
$917.90
|
| Rate for Payer: VA VA |
$1,712.50
|
|
|
HC RO LINAC SBRT PER SESSION
|
Facility
|
IP
|
$3,546.01
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,304.91 |
| Max. Negotiated Rate |
$3,546.01 |
| Rate for Payer: Aetna Commercial |
$3,191.41
|
| Rate for Payer: ASR ASR |
$3,439.63
|
| Rate for Payer: ASR Commercial |
$3,439.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,889.64
|
| Rate for Payer: BCN Commercial |
$2,749.22
|
| Rate for Payer: Cash Price |
$2,836.81
|
| Rate for Payer: Cofinity Commercial |
$3,333.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,836.81
|
| Rate for Payer: Healthscope Commercial |
$3,546.01
|
| Rate for Payer: Healthscope Whirlpool |
$3,439.63
|
| Rate for Payer: Mclaren Commercial |
$3,191.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.11
|
| Rate for Payer: Nomi Health Commercial |
$2,907.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,304.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,120.49
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
IP
|
$11.44
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$11.44 |
| Rate for Payer: Aetna Commercial |
$10.30
|
| Rate for Payer: ASR ASR |
$11.10
|
| Rate for Payer: ASR Commercial |
$11.10
|
| Rate for Payer: BCBS Trust/PPO |
$9.32
|
| Rate for Payer: BCN Commercial |
$8.87
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cofinity Commercial |
$10.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.15
|
| Rate for Payer: Healthscope Commercial |
$11.44
|
| Rate for Payer: Healthscope Whirlpool |
$11.10
|
| Rate for Payer: Mclaren Commercial |
$10.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Nomi Health Commercial |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.07
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
OP
|
$11.44
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Aetna Commercial |
$10.30
|
| Rate for Payer: Aetna Medicare |
$12.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.09
|
| Rate for Payer: ASR ASR |
$11.10
|
| Rate for Payer: ASR Commercial |
$11.10
|
| Rate for Payer: BCBS Complete |
$6.79
|
| Rate for Payer: BCBS MAPPO |
$12.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.37
|
| Rate for Payer: BCN Commercial |
$8.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.07
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cofinity Commercial |
$10.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.07
|
| Rate for Payer: Healthscope Commercial |
$11.44
|
| Rate for Payer: Healthscope Whirlpool |
$11.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.07
|
| Rate for Payer: Mclaren Commercial |
$10.30
|
| Rate for Payer: Mclaren Medicaid |
$6.47
|
| Rate for Payer: Mclaren Medicare |
$12.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.67
|
| Rate for Payer: Meridian Medicaid |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Nomi Health Commercial |
$9.38
|
| Rate for Payer: PACE Medicare |
$11.47
|
| Rate for Payer: PACE SWMI |
$12.07
|
| Rate for Payer: PHP Commercial |
$13.28
|
| Rate for Payer: PHP Medicaid |
$6.47
|
| Rate for Payer: PHP Medicare Advantage |
$12.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.02
|
| Rate for Payer: Priority Health Medicare |
$12.07
|
| Rate for Payer: Priority Health Narrow Network |
$8.02
|
| Rate for Payer: Railroad Medicare Medicare |
$12.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.07
|
| Rate for Payer: UHC Exchange |
$18.71
|
| Rate for Payer: UHC Medicare Advantage |
$12.07
|
| Rate for Payer: UHCCP DNSP |
$12.07
|
| Rate for Payer: UHCCP Medicaid |
$6.47
|
| Rate for Payer: VA VA |
$12.07
|
|
|
HC ROOM & BOARD PSYCH
|
Facility
|
IP
|
$1,810.72
|
|
| Hospital Charge Code |
12400001
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,176.97 |
| Max. Negotiated Rate |
$1,810.72 |
| Rate for Payer: Aetna Commercial |
$1,629.65
|
| Rate for Payer: ASR ASR |
$1,756.40
|
| Rate for Payer: ASR Commercial |
$1,756.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,475.56
|
| Rate for Payer: BCN Commercial |
$1,403.85
|
| Rate for Payer: Cash Price |
$1,448.58
|
| Rate for Payer: Cofinity Commercial |
$1,702.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.58
|
| Rate for Payer: Healthscope Commercial |
$1,810.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,756.40
|
| Rate for Payer: Mclaren Commercial |
$1,629.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,539.11
|
| Rate for Payer: Nomi Health Commercial |
$1,484.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,176.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,593.43
|
|
