|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
IP
|
$378.64
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.54 |
| Max. Negotiated Rate |
$340.78 |
| Rate for Payer: Aetna Commercial |
$321.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.12
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$265.05
|
| Rate for Payer: Cofinity Commercial |
$325.63
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PHP Commercial |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health SBD |
$238.54
|
|
|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
OP
|
$378.64
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.34 |
| Max. Negotiated Rate |
$813.49 |
| Rate for Payer: Aetna Commercial |
$321.84
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$51.34
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$265.05
|
| Rate for Payer: Cofinity Commercial |
$325.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$321.84
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.49
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health Narrow Network |
$650.79
|
| Rate for Payer: Priority Health SBD |
$238.54
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$112.31
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
HC CHEMODNRV EA ADD EXT 1-4 MUSC
|
Facility
|
OP
|
$682.78
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
36100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.44 |
| Max. Negotiated Rate |
$614.50 |
| Rate for Payer: Aetna Commercial |
$580.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.81
|
| Rate for Payer: BCBS Complete |
$273.11
|
| Rate for Payer: BCBS Trust/PPO |
$543.52
|
| Rate for Payer: Cash Price |
$546.22
|
| Rate for Payer: Cash Price |
$546.22
|
| Rate for Payer: Cofinity Commercial |
$587.19
|
| Rate for Payer: Cofinity Commercial |
$477.95
|
| Rate for Payer: Healthscope Commercial |
$614.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$580.36
|
| Rate for Payer: PHP Commercial |
$580.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.95
|
| Rate for Payer: Priority Health SBD |
$430.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.28
|
| Rate for Payer: UHC Exchange |
$68.44
|
|
|
HC CHEMODNRV EA ADD EXT 1-4 MUSC
|
Facility
|
IP
|
$682.78
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
36100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.15 |
| Max. Negotiated Rate |
$614.50 |
| Rate for Payer: Aetna Commercial |
$580.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.81
|
| Rate for Payer: Cash Price |
$546.22
|
| Rate for Payer: Cofinity Commercial |
$587.19
|
| Rate for Payer: Cofinity Commercial |
$477.95
|
| Rate for Payer: Healthscope Commercial |
$614.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$580.36
|
| Rate for Payer: PHP Commercial |
$580.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.95
|
| Rate for Payer: Priority Health SBD |
$430.15
|
|
|
HC CHEMODNRV EXT1-4 MUSC
|
Facility
|
OP
|
$658.22
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.44 |
| Max. Negotiated Rate |
$1,977.15 |
| Rate for Payer: Aetna Commercial |
$559.49
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$402.78
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$526.58
|
| Rate for Payer: Cash Price |
$526.58
|
| Rate for Payer: Cofinity Commercial |
$566.07
|
| Rate for Payer: Cofinity Commercial |
$460.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$592.40
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$559.49
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$559.49
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,977.15
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,581.72
|
| Rate for Payer: Priority Health SBD |
$414.68
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$105.44
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
HC CHEMODNRV EXT1-4 MUSC
|
Facility
|
IP
|
$658.22
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.68 |
| Max. Negotiated Rate |
$592.40 |
| Rate for Payer: Aetna Commercial |
$559.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.84
|
| Rate for Payer: Cash Price |
$526.58
|
| Rate for Payer: Cofinity Commercial |
$460.75
|
| Rate for Payer: Cofinity Commercial |
$566.07
|
| Rate for Payer: Healthscope Commercial |
$592.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$559.49
|
| Rate for Payer: PHP Commercial |
$559.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.75
|
| Rate for Payer: Priority Health SBD |
$414.68
|
|
|
HC CHEMODNRV EXTREMITY 5/< MUSCLES
|
Facility
|
IP
|
$113.32
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
36100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$101.99 |
| Rate for Payer: Aetna Commercial |
$96.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.66
|
| Rate for Payer: Cash Price |
$90.66
|
| Rate for Payer: Cofinity Commercial |
$79.32
|
| Rate for Payer: Cofinity Commercial |
$97.46
|
| Rate for Payer: Healthscope Commercial |
$101.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.32
|
| Rate for Payer: PHP Commercial |
$96.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.32
|
| Rate for Payer: Priority Health SBD |
$71.39
|
|
|
HC CHEMODNRV EXTREMITY 5/< MUSCLES
|
Facility
|
OP
|
$113.32
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
36100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.33 |
| Max. Negotiated Rate |
$672.71 |
| Rate for Payer: Aetna Commercial |
$96.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.66
|
| Rate for Payer: BCBS Complete |
$45.33
|
| Rate for Payer: BCBS Trust/PPO |
$672.71
|
| Rate for Payer: Cash Price |
$90.66
|
| Rate for Payer: Cash Price |
$90.66
|
| Rate for Payer: Cofinity Commercial |
$97.46
|
| Rate for Payer: Cofinity Commercial |
$79.32
|
| Rate for Payer: Healthscope Commercial |
$101.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.32
|
| Rate for Payer: PHP Commercial |
$96.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.32
|
| Rate for Payer: Priority Health SBD |
$71.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.53
|
| Rate for Payer: UHC Exchange |
$79.57
|
|
|
HC CHEMODNRV EXTREMITY 5 OR MORE MUSCLES
|
Facility
|
OP
|
$517.14
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
36100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.95 |
| Max. Negotiated Rate |
$1,977.15 |
| Rate for Payer: Aetna Commercial |
$439.57
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$402.78
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$413.71
|
| Rate for Payer: Cash Price |
$413.71
|
| Rate for Payer: Cofinity Commercial |
$362.00
|
| Rate for Payer: Cofinity Commercial |
$444.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$465.43
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$439.57
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$439.57
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,977.15
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,581.72
|
| Rate for Payer: Priority Health SBD |
$325.80
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$113.95
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
HC CHEMODNRV EXTREMITY 5 OR MORE MUSCLES
|
Facility
|
IP
|
$517.14
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
36100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.80 |
| Max. Negotiated Rate |
$465.43 |
| Rate for Payer: Aetna Commercial |
$439.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.14
|
| Rate for Payer: Cash Price |
$413.71
|
| Rate for Payer: Cofinity Commercial |
$444.74
|
| Rate for Payer: Cofinity Commercial |
$362.00
|
| Rate for Payer: Healthscope Commercial |
$465.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$439.57
|
| Rate for Payer: PHP Commercial |
$439.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.00
|
| Rate for Payer: Priority Health SBD |
$325.80
|
|
|
HC CHEMODNRV MUSC FACIAL
|
Facility
|
IP
|
$531.36
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.76 |
| Max. Negotiated Rate |
$478.22 |
| Rate for Payer: Aetna Commercial |
$451.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.38
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cofinity Commercial |
$371.95
|
| Rate for Payer: Cofinity Commercial |
$456.97
|
| Rate for Payer: Healthscope Commercial |
$478.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.66
|
| Rate for Payer: PHP Commercial |
$451.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.95
|
| Rate for Payer: Priority Health SBD |
$334.76
|
|
|
HC CHEMODNRV MUSC FACIAL
|
Facility
|
OP
|
$531.36
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$813.49 |
| Rate for Payer: Aetna Commercial |
$451.66
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cofinity Commercial |
$456.97
|
| Rate for Payer: Cofinity Commercial |
$371.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$478.22
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.66
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$451.66
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.49
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health Narrow Network |
$650.79
|
| Rate for Payer: Priority Health SBD |
$334.76
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$117.88
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
HC CHEMODNRV MUSC FACIAL BIL
|
Facility
|
IP
|
$649.43
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.14 |
| Max. Negotiated Rate |
$584.49 |
| Rate for Payer: Aetna Commercial |
$552.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.13
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$454.60
|
| Rate for Payer: Cofinity Commercial |
$558.51
|
| Rate for Payer: Healthscope Commercial |
$584.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.02
|
| Rate for Payer: PHP Commercial |
$552.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.60
|
| Rate for Payer: Priority Health SBD |
$409.14
|
|
|
HC CHEMODNRV MUSC FACIAL BIL
|
Facility
|
OP
|
$649.43
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$813.49 |
| Rate for Payer: Aetna Commercial |
$552.02
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$558.51
|
| Rate for Payer: Cofinity Commercial |
$454.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$584.49
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.02
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$552.02
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.49
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health Narrow Network |
$650.79
|
| Rate for Payer: Priority Health SBD |
$409.14
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$117.88
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
HC CHEMODNRV MUSC MIGRAINE BIL
|
Facility
|
OP
|
$235.62
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
36100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.15 |
| Max. Negotiated Rate |
$813.49 |
| Rate for Payer: Aetna Commercial |
$200.28
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cofinity Commercial |
$164.93
|
| Rate for Payer: Cofinity Commercial |
$202.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$212.06
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.28
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$200.28
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.49
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health Narrow Network |
$650.79
|
| Rate for Payer: Priority Health SBD |
$148.44
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$121.15
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
HC CHEMODNRV MUSC MIGRAINE BIL
|
Facility
|
IP
|
$235.62
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
36100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.44 |
| Max. Negotiated Rate |
$212.06 |
| Rate for Payer: Aetna Commercial |
$200.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.15
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cofinity Commercial |
$164.93
|
| Rate for Payer: Cofinity Commercial |
$202.63
|
| Rate for Payer: Healthscope Commercial |
$212.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.28
|
| Rate for Payer: PHP Commercial |
$200.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.93
|
| Rate for Payer: Priority Health SBD |
$148.44
|
|
|
HC CHEMODNRV MUSC NECK
|
Facility
|
OP
|
$439.63
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
36100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.38 |
| Max. Negotiated Rate |
$813.49 |
| Rate for Payer: Aetna Commercial |
$373.69
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$351.70
|
| Rate for Payer: Cash Price |
$351.70
|
| Rate for Payer: Cofinity Commercial |
$378.08
|
| Rate for Payer: Cofinity Commercial |
$307.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$395.67
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.69
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$373.69
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.49
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health Narrow Network |
$650.79
|
| Rate for Payer: Priority Health SBD |
$276.97
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$108.38
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
HC CHEMODNRV MUSC NECK
|
Facility
|
IP
|
$439.63
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
36100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.97 |
| Max. Negotiated Rate |
$395.67 |
| Rate for Payer: Aetna Commercial |
$373.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.76
|
| Rate for Payer: Cash Price |
$351.70
|
| Rate for Payer: Cofinity Commercial |
$378.08
|
| Rate for Payer: Cofinity Commercial |
$307.74
|
| Rate for Payer: Healthscope Commercial |
$395.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.69
|
| Rate for Payer: PHP Commercial |
$373.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.74
|
| Rate for Payer: Priority Health SBD |
$276.97
|
|
|
HC CHEMODNRV TRUNK MUSC 1-5 MUSC
|
Facility
|
IP
|
$682.78
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
36100453
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$430.15 |
| Max. Negotiated Rate |
$614.50 |
| Rate for Payer: Aetna Commercial |
$580.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.81
|
| Rate for Payer: Cash Price |
$546.22
|
| Rate for Payer: Cofinity Commercial |
$477.95
|
| Rate for Payer: Cofinity Commercial |
$587.19
|
| Rate for Payer: Healthscope Commercial |
$614.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$580.36
|
| Rate for Payer: PHP Commercial |
$580.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.95
|
| Rate for Payer: Priority Health SBD |
$430.15
|
|
|
HC CHEMODNRV TRUNK MUSC 1-5 MUSC
|
Facility
|
OP
|
$682.78
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
36100453
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.28 |
| Max. Negotiated Rate |
$1,977.15 |
| Rate for Payer: Aetna Commercial |
$580.36
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$402.78
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$546.22
|
| Rate for Payer: Cash Price |
$546.22
|
| Rate for Payer: Cofinity Commercial |
$477.95
|
| Rate for Payer: Cofinity Commercial |
$587.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$614.50
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$580.36
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$580.36
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,977.15
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,581.72
|
| Rate for Payer: Priority Health SBD |
$430.15
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.71
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$114.28
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
HC CHEMO INFUSION CONCURRENT
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
33500011
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$122.09 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.73
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.66
|
| Rate for Payer: Priority Health SBD |
$122.09
|
|
|
HC CHEMO INFUSION CONCURRENT
|
Facility
|
OP
|
$193.80
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
33500011
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$23.12 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna Medicare |
$43.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.84
|
| Rate for Payer: BCBS Complete |
$24.28
|
| Rate for Payer: BCBS MAPPO |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$109.59
|
| Rate for Payer: BCN Medicare Advantage |
$42.27
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Commercial |
$135.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.27
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Mclaren Medicaid |
$23.12
|
| Rate for Payer: Mclaren Medicare |
$42.27
|
| Rate for Payer: Meridian Medicaid |
$24.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.73
|
| Rate for Payer: PACE Medicare |
$40.16
|
| Rate for Payer: PACE SWMI |
$42.27
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: PHP Medicare Advantage |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.59
|
| Rate for Payer: Priority Health Medicare |
$42.27
|
| Rate for Payer: Priority Health Narrow Network |
$99.67
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: Railroad Medicare Medicare |
$42.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.27
|
| Rate for Payer: UHC Medicare Advantage |
$43.54
|
| Rate for Payer: VA VA |
$42.27
|
|
|
HC CHEMO INFUSION EACH ADDL HR
|
Facility
|
OP
|
$238.30
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
33500002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$214.47 |
| Rate for Payer: Aetna Commercial |
$202.56
|
| Rate for Payer: Aetna Medicare |
$65.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.35
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$62.68
|
| Rate for Payer: BCBS Trust/PPO |
$114.78
|
| Rate for Payer: BCN Medicare Advantage |
$62.68
|
| Rate for Payer: Cash Price |
$190.64
|
| Rate for Payer: Cash Price |
$190.64
|
| Rate for Payer: Cofinity Commercial |
$204.94
|
| Rate for Payer: Cofinity Commercial |
$166.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.68
|
| Rate for Payer: Healthscope Commercial |
$214.47
|
| Rate for Payer: Mclaren Medicaid |
$34.29
|
| Rate for Payer: Mclaren Medicare |
$62.68
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.56
|
| Rate for Payer: PACE Medicare |
$59.55
|
| Rate for Payer: PACE SWMI |
$62.68
|
| Rate for Payer: PHP Commercial |
$202.56
|
| Rate for Payer: PHP Medicare Advantage |
$62.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.04
|
| Rate for Payer: Priority Health Medicare |
$62.68
|
| Rate for Payer: Priority Health Narrow Network |
$154.43
|
| Rate for Payer: Priority Health SBD |
$150.13
|
| Rate for Payer: Railroad Medicare Medicare |
$62.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.68
|
| Rate for Payer: UHC Exchange |
$27.18
|
| Rate for Payer: UHC Medicare Advantage |
$64.56
|
| Rate for Payer: VA VA |
$62.68
|
|
|
HC CHEMO INFUSION EACH ADDL HR
|
Facility
|
IP
|
$238.30
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
33500002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$214.47 |
| Rate for Payer: Aetna Commercial |
$202.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.90
|
| Rate for Payer: Cash Price |
$190.64
|
| Rate for Payer: Cofinity Commercial |
$166.81
|
| Rate for Payer: Cofinity Commercial |
$204.94
|
| Rate for Payer: Healthscope Commercial |
$214.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.56
|
| Rate for Payer: PHP Commercial |
$202.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.81
|
| Rate for Payer: Priority Health SBD |
$150.13
|
|
|
HC CHEMO INFUSION FIRST HR
|
Facility
|
IP
|
$885.43
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
33500001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$557.82 |
| Max. Negotiated Rate |
$796.89 |
| Rate for Payer: Aetna Commercial |
$752.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.53
|
| Rate for Payer: Cash Price |
$708.34
|
| Rate for Payer: Cofinity Commercial |
$619.80
|
| Rate for Payer: Cofinity Commercial |
$761.47
|
| Rate for Payer: Healthscope Commercial |
$796.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$752.62
|
| Rate for Payer: PHP Commercial |
$752.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.80
|
| Rate for Payer: Priority Health SBD |
$557.82
|
|
