|
HC CERV OR VAG CA SCREEN PELVIC/BREAST EXAM
|
Facility
|
OP
|
$143.60
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
77000001
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$122.06
|
| Rate for Payer: Aetna Medicare |
$105.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.53
|
| Rate for Payer: BCBS Complete |
$55.59
|
| Rate for Payer: BCBS MAPPO |
$101.22
|
| Rate for Payer: BCBS Trust/PPO |
$97.71
|
| Rate for Payer: BCN Commercial |
$97.71
|
| Rate for Payer: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$114.88
|
| Rate for Payer: Cash Price |
$114.88
|
| Rate for Payer: Cofinity Advantage |
$100.52
|
| Rate for Payer: Cofinity Commercial |
$123.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$129.24
|
| Rate for Payer: Mclaren Medicaid |
$52.94
|
| Rate for Payer: Mclaren Medicare |
$101.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.28
|
| Rate for Payer: Meridian Medicaid |
$106.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.06
|
| Rate for Payer: Nomi Health Commercial |
$303.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.70
|
| Rate for Payer: PACE Medicare |
$96.16
|
| Rate for Payer: PACE SWMI |
$101.22
|
| Rate for Payer: PHP Commercial |
$122.06
|
| Rate for Payer: PHP Medicare Advantage |
$101.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$327.36
|
| Rate for Payer: Priority Health Medicare |
$101.22
|
| Rate for Payer: Priority Health SBD |
$90.47
|
| Rate for Payer: Priority Health Tiered Network |
$261.89
|
| Rate for Payer: Railroad Medicare Medicare |
$101.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.34
|
| Rate for Payer: UHC Core |
$74.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.22
|
| Rate for Payer: UHC Exchange |
$56.43
|
| Rate for Payer: UHC Medicaid |
$52.94
|
| Rate for Payer: UHCCP Medicaid |
$52.94
|
| Rate for Payer: VA VA |
$101.22
|
|
|
HC CERV OR VAG CA SCREEN PELVIC/BREAST EXAM
|
Facility
|
IP
|
$143.60
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
77000001
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$90.47 |
| Max. Negotiated Rate |
$129.24 |
| Rate for Payer: Aetna Commercial |
$122.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.34
|
| Rate for Payer: Cash Price |
$114.88
|
| Rate for Payer: Cofinity Advantage |
$100.52
|
| Rate for Payer: Cofinity Commercial |
$123.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.88
|
| Rate for Payer: Healthscope Commercial |
$129.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.70
|
| Rate for Payer: PHP Commercial |
$122.06
|
| Rate for Payer: Priority Health SBD |
$90.47
|
|
|
HC CESIUM 137 PER SOURCE
|
Facility
|
IP
|
$793.26
|
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$499.75 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.62
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Advantage |
$555.28
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: Priority Health SBD |
$499.75
|
|
|
HC CESIUM 137 PER SOURCE
|
Facility
|
OP
|
$793.26
|
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$311.75 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna Medicare |
$396.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.62
|
| Rate for Payer: BCBS Complete |
$317.30
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Advantage |
$555.28
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$634.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: Priority Health SBD |
$499.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.62
|
| Rate for Payer: UHC Core |
$413.29
|
| Rate for Payer: UHC Exchange |
$311.75
|
|
|
HC CHAMBER HOLDING OPTI CHAMBER
|
Facility
|
IP
|
$22.77
|
|
| Hospital Charge Code |
27000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$20.49 |
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.80
|
| Rate for Payer: Cash Price |
$18.22
|
| Rate for Payer: Cofinity Advantage |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$19.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.22
|
| Rate for Payer: Healthscope Commercial |
$20.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.08
|
| Rate for Payer: PHP Commercial |
$19.35
|
| Rate for Payer: Priority Health SBD |
$14.35
|
|
|
HC CHAMBER HOLDING OPTI CHAMBER
|
Facility
|
OP
|
$22.77
|
|
| Hospital Charge Code |
27000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$20.49 |
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.80
|
| Rate for Payer: BCBS Complete |
$9.11
|
| Rate for Payer: Cash Price |
$18.22
|
| Rate for Payer: Cofinity Advantage |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$19.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.22
|
| Rate for Payer: Healthscope Commercial |
$20.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.08
|
| Rate for Payer: PHP Commercial |
$19.35
|
| Rate for Payer: Priority Health SBD |
$14.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.80
|
| Rate for Payer: UHC Core |
$11.86
|
| Rate for Payer: UHC Exchange |
$8.95
|
|
|
HC CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
IP
|
$1,036.80
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$653.18 |
| Max. Negotiated Rate |
$933.12 |
| Rate for Payer: Aetna Commercial |
$881.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.92
|
| Rate for Payer: Cash Price |
$829.44
|
| Rate for Payer: Cofinity Advantage |
$725.76
|
| Rate for Payer: Cofinity Commercial |
$891.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.44
|
| Rate for Payer: Healthscope Commercial |
$933.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$777.60
|
| Rate for Payer: PHP Commercial |
$881.28
|
| Rate for Payer: Priority Health SBD |
$653.18
|
|
|
HC CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
OP
|
$1,036.80
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.38 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna Commercial |
$881.28
|
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$396.60
|
| Rate for Payer: BCN Commercial |
$396.60
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$829.44
|
| Rate for Payer: Cash Price |
$829.44
|
| Rate for Payer: Cash Price |
$829.44
|
| Rate for Payer: Cofinity Advantage |
$725.76
|
| Rate for Payer: Cofinity Commercial |
$891.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$933.12
|
| Rate for Payer: Mclaren Medicaid |
$363.38
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.28
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$777.60
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$881.28
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health SBD |
$653.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$673.92
|
| Rate for Payer: UHC Core |
$540.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Exchange |
$407.46
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
HC CHANNEL RFA ENDO CATHETER
|
Facility
|
IP
|
$3,796.01
|
|
| Hospital Charge Code |
27200289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,391.49 |
| Max. Negotiated Rate |
$3,416.41 |
| Rate for Payer: Aetna Commercial |
$3,226.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,467.41
|
| Rate for Payer: Cash Price |
$3,036.81
|
| Rate for Payer: Cofinity Advantage |
$2,657.21
|
| Rate for Payer: Cofinity Commercial |
$3,264.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,036.81
|
| Rate for Payer: Healthscope Commercial |
$3,416.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,226.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,847.01
|
| Rate for Payer: PHP Commercial |
$3,226.61
|
| Rate for Payer: Priority Health SBD |
$2,391.49
|
|
|
HC CHANNEL RFA ENDO CATHETER
|
Facility
|
OP
|
$3,796.01
|
|
| Hospital Charge Code |
27200289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,491.83 |
| Max. Negotiated Rate |
$3,416.41 |
| Rate for Payer: Aetna Commercial |
$3,226.61
|
| Rate for Payer: Aetna Medicare |
$1,898.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,467.41
|
| Rate for Payer: BCBS Complete |
$1,518.40
|
| Rate for Payer: Cash Price |
$3,036.81
|
| Rate for Payer: Cofinity Advantage |
$2,657.21
|
| Rate for Payer: Cofinity Commercial |
$3,264.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,036.81
|
| Rate for Payer: Healthscope Commercial |
$3,416.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,036.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,226.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,847.01
|
| Rate for Payer: PHP Commercial |
$3,226.61
|
| Rate for Payer: Priority Health SBD |
$2,391.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,467.41
|
| Rate for Payer: UHC Core |
$1,977.72
|
| Rate for Payer: UHC Exchange |
$1,491.83
|
|
|
HC CHEM CAUTERY GRANULATION TISSUE
|
Facility
|
IP
|
$302.67
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.68 |
| Max. Negotiated Rate |
$272.40 |
| Rate for Payer: Aetna Commercial |
$257.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.74
|
| Rate for Payer: Cash Price |
$242.14
|
| Rate for Payer: Cofinity Advantage |
$211.87
|
| Rate for Payer: Cofinity Commercial |
$260.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.14
|
| Rate for Payer: Healthscope Commercial |
$272.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.00
|
| Rate for Payer: PHP Commercial |
$257.27
|
| Rate for Payer: Priority Health SBD |
$190.68
|
|
|
HC CHEM CAUTERY GRANULATION TISSUE
|
Facility
|
OP
|
$302.67
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.92 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$257.27
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$94.92
|
| Rate for Payer: BCN Commercial |
$94.92
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$242.14
|
| Rate for Payer: Cash Price |
$242.14
|
| Rate for Payer: Cash Price |
$242.14
|
| Rate for Payer: Cofinity Advantage |
$211.87
|
| Rate for Payer: Cofinity Commercial |
$260.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$272.40
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.27
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.00
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$257.27
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$190.68
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.74
|
| Rate for Payer: UHC Core |
$157.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$118.95
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC CHEMO ADMIN INTO CNS
|
Facility
|
OP
|
$1,148.54
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$1,064.33 |
| Rate for Payer: Aetna Commercial |
$976.26
|
| Rate for Payer: Aetna Medicare |
$342.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$746.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$624.27
|
| Rate for Payer: BCN Commercial |
$624.27
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$918.83
|
| Rate for Payer: Cash Price |
$918.83
|
| Rate for Payer: Cofinity Advantage |
$803.98
|
| Rate for Payer: Cofinity Commercial |
$987.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$918.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$1,033.69
|
| Rate for Payer: Mclaren Medicaid |
$172.13
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$345.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$976.26
|
| Rate for Payer: Nomi Health Commercial |
$987.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$861.40
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$976.26
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,064.33
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health SBD |
$723.58
|
| Rate for Payer: Priority Health Tiered Network |
$851.46
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$746.55
|
| Rate for Payer: UHC Core |
$598.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$451.38
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC CHEMO ADMIN INTO CNS
|
Facility
|
IP
|
$1,148.54
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$723.58 |
| Max. Negotiated Rate |
$1,033.69 |
| Rate for Payer: Aetna Commercial |
$976.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$746.55
|
| Rate for Payer: Cash Price |
$918.83
|
| Rate for Payer: Cofinity Advantage |
$803.98
|
| Rate for Payer: Cofinity Commercial |
$987.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$918.83
|
| Rate for Payer: Healthscope Commercial |
$1,033.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$976.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$861.40
|
| Rate for Payer: PHP Commercial |
$976.26
|
| Rate for Payer: Priority Health SBD |
$723.58
|
|
|
HC CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,267.32
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$623.59 |
| Max. Negotiated Rate |
$3,855.91 |
| Rate for Payer: Aetna Commercial |
$2,777.22
|
| Rate for Payer: Aetna Medicare |
$1,240.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,123.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.42
|
| Rate for Payer: BCBS Complete |
$654.83
|
| Rate for Payer: BCBS MAPPO |
$1,192.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,536.77
|
| Rate for Payer: BCN Commercial |
$1,536.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.34
|
| Rate for Payer: Cash Price |
$2,613.86
|
| Rate for Payer: Cash Price |
$2,613.86
|
| Rate for Payer: Cash Price |
$2,613.86
|
| Rate for Payer: Cofinity Advantage |
$2,287.12
|
| Rate for Payer: Cofinity Commercial |
$2,809.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,613.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.34
|
| Rate for Payer: Healthscope Commercial |
$2,940.59
|
| Rate for Payer: Mclaren Medicaid |
$623.59
|
| Rate for Payer: Mclaren Medicare |
$1,192.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.96
|
| Rate for Payer: Meridian Medicaid |
$1,251.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,371.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,311.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,777.22
|
| Rate for Payer: Nomi Health Commercial |
$3,577.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,450.49
|
| Rate for Payer: PACE Medicare |
$1,132.72
|
| Rate for Payer: PACE SWMI |
$1,192.34
|
| Rate for Payer: PHP Commercial |
$2,777.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,855.91
|
| Rate for Payer: Priority Health Medicare |
$1,192.34
|
| Rate for Payer: Priority Health SBD |
$2,058.41
|
| Rate for Payer: Priority Health Tiered Network |
$3,084.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,123.76
|
| Rate for Payer: UHC Core |
$1,702.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,192.34
|
| Rate for Payer: UHC Exchange |
$1,284.06
|
| Rate for Payer: UHC Medicaid |
$623.59
|
| Rate for Payer: UHCCP Medicaid |
$623.59
|
| Rate for Payer: VA VA |
$1,192.34
|
|
|
HC CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Facility
|
IP
|
$3,267.32
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,058.41 |
| Max. Negotiated Rate |
$2,940.59 |
| Rate for Payer: Aetna Commercial |
$2,777.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,123.76
|
| Rate for Payer: Cash Price |
$2,613.86
|
| Rate for Payer: Cofinity Advantage |
$2,287.12
|
| Rate for Payer: Cofinity Commercial |
$2,809.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,613.86
|
| Rate for Payer: Healthscope Commercial |
$2,940.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,777.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,450.49
|
| Rate for Payer: PHP Commercial |
$2,777.22
|
| Rate for Payer: Priority Health SBD |
$2,058.41
|
|
|
HC CHEMODENERVATION TRUNK 6 OR > MUSCLES
|
Facility
|
OP
|
$1,995.07
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
36000374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$1,695.81
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,296.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$83.43
|
| Rate for Payer: BCN Commercial |
$83.43
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$1,596.06
|
| Rate for Payer: Cash Price |
$1,596.06
|
| Rate for Payer: Cash Price |
$1,596.06
|
| Rate for Payer: Cofinity Advantage |
$1,396.55
|
| Rate for Payer: Cofinity Commercial |
$1,715.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$1,795.56
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,695.81
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,496.30
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$1,695.81
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$1,256.89
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC CHEMODENERVATION TRUNK 6 OR > MUSCLES
|
Facility
|
IP
|
$1,995.07
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
36000374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,256.89 |
| Max. Negotiated Rate |
$1,795.56 |
| Rate for Payer: Aetna Commercial |
$1,695.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,296.80
|
| Rate for Payer: Cash Price |
$1,596.06
|
| Rate for Payer: Cofinity Advantage |
$1,396.55
|
| Rate for Payer: Cofinity Commercial |
$1,715.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.06
|
| Rate for Payer: Healthscope Commercial |
$1,795.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,695.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,496.30
|
| Rate for Payer: PHP Commercial |
$1,695.81
|
| Rate for Payer: Priority Health SBD |
$1,256.89
|
|
|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
OP
|
$393.93
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.72 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$334.84
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$67.72
|
| Rate for Payer: BCN Commercial |
$67.72
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Advantage |
$275.75
|
| Rate for Payer: Cofinity Commercial |
$338.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$354.54
|
| Rate for Payer: Mclaren Medicaid |
$159.96
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$334.84
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health SBD |
$248.18
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.05
|
| Rate for Payer: UHC Core |
$205.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$154.81
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
IP
|
$393.93
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.18 |
| Max. Negotiated Rate |
$354.54 |
| Rate for Payer: Aetna Commercial |
$334.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.05
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Advantage |
$275.75
|
| Rate for Payer: Cofinity Commercial |
$338.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Healthscope Commercial |
$354.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PHP Commercial |
$334.84
|
| Rate for Payer: Priority Health SBD |
$248.18
|
|
|
HC CHEMODNRV EA ADD EXT 1-4 MUSC
|
Facility
|
OP
|
$710.37
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
36100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.18 |
| Max. Negotiated Rate |
$716.89 |
| Rate for Payer: Aetna Commercial |
$603.81
|
| Rate for Payer: Aetna Medicare |
$355.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.74
|
| Rate for Payer: BCBS Complete |
$284.15
|
| Rate for Payer: BCBS Trust/PPO |
$716.89
|
| Rate for Payer: BCN Commercial |
$716.89
|
| Rate for Payer: Cash Price |
$568.30
|
| Rate for Payer: Cash Price |
$568.30
|
| Rate for Payer: Cofinity Advantage |
$497.26
|
| Rate for Payer: Cofinity Commercial |
$610.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.30
|
| Rate for Payer: Healthscope Commercial |
$639.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$568.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.78
|
| Rate for Payer: PHP Commercial |
$603.81
|
| Rate for Payer: Priority Health SBD |
$447.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.74
|
| Rate for Payer: UHC Core |
$370.10
|
| Rate for Payer: UHC Exchange |
$279.18
|
|
|
HC CHEMODNRV EA ADD EXT 1-4 MUSC
|
Facility
|
IP
|
$710.37
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
36100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.53 |
| Max. Negotiated Rate |
$639.33 |
| Rate for Payer: Aetna Commercial |
$603.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.74
|
| Rate for Payer: Cash Price |
$568.30
|
| Rate for Payer: Cofinity Advantage |
$497.26
|
| Rate for Payer: Cofinity Commercial |
$610.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.30
|
| Rate for Payer: Healthscope Commercial |
$639.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.78
|
| Rate for Payer: PHP Commercial |
$603.81
|
| Rate for Payer: Priority Health SBD |
$447.53
|
|
|
HC CHEMODNRV EXT1-4 MUSC
|
Facility
|
IP
|
$684.81
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.43 |
| Max. Negotiated Rate |
$616.33 |
| Rate for Payer: Aetna Commercial |
$582.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.13
|
| Rate for Payer: Cash Price |
$547.85
|
| Rate for Payer: Cofinity Advantage |
$479.37
|
| Rate for Payer: Cofinity Commercial |
$588.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.85
|
| Rate for Payer: Healthscope Commercial |
$616.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$582.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.61
|
| Rate for Payer: PHP Commercial |
$582.09
|
| Rate for Payer: Priority Health SBD |
$431.43
|
|
|
HC CHEMODNRV EXT1-4 MUSC
|
Facility
|
OP
|
$684.81
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.13 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$582.09
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$531.26
|
| Rate for Payer: BCN Commercial |
$531.26
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$547.85
|
| Rate for Payer: Cash Price |
$547.85
|
| Rate for Payer: Cash Price |
$547.85
|
| Rate for Payer: Cofinity Advantage |
$479.37
|
| Rate for Payer: Cofinity Commercial |
$588.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$616.33
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$582.09
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.61
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$582.09
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$431.43
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$445.13
|
| Rate for Payer: UHC Core |
$356.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$269.13
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC CHEMODNRV EXTREMITY 5/< MUSCLES
|
Facility
|
IP
|
$117.90
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
36100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.28 |
| Max. Negotiated Rate |
$106.11 |
| Rate for Payer: Aetna Commercial |
$100.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.64
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cofinity Advantage |
$82.53
|
| Rate for Payer: Cofinity Commercial |
$101.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.32
|
| Rate for Payer: Healthscope Commercial |
$106.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.42
|
| Rate for Payer: PHP Commercial |
$100.22
|
| Rate for Payer: Priority Health SBD |
$74.28
|
|
