|
HC CHEMODNRV EXTREMITY 5/< MUSCLES
|
Facility
|
OP
|
$117.90
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
36100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.33 |
| Max. Negotiated Rate |
$887.29 |
| Rate for Payer: Aetna Commercial |
$100.22
|
| Rate for Payer: Aetna Medicare |
$58.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.64
|
| Rate for Payer: BCBS Complete |
$47.16
|
| Rate for Payer: BCBS Trust/PPO |
$887.29
|
| Rate for Payer: BCN Commercial |
$887.29
|
| Rate for Payer: Cash Price |
$94.32
|
| 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: MI Amish Medical Board Commercial |
$94.32
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.64
|
| Rate for Payer: UHC Core |
$61.43
|
| Rate for Payer: UHC Exchange |
$46.33
|
|
|
HC CHEMODNRV EXTREMITY 5 OR MORE MUSCLES
|
Facility
|
IP
|
$538.03
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
36100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.96 |
| Max. Negotiated Rate |
$484.23 |
| Rate for Payer: Aetna Commercial |
$457.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.72
|
| Rate for Payer: Cash Price |
$430.42
|
| Rate for Payer: Cofinity Advantage |
$376.62
|
| Rate for Payer: Cofinity Commercial |
$462.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.42
|
| Rate for Payer: Healthscope Commercial |
$484.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$403.52
|
| Rate for Payer: PHP Commercial |
$457.33
|
| Rate for Payer: Priority Health SBD |
$338.96
|
|
|
HC CHEMODNRV EXTREMITY 5 OR MORE MUSCLES
|
Facility
|
OP
|
$538.03
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
36100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.45 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$457.33
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.72
|
| 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 |
$430.42
|
| Rate for Payer: Cash Price |
$430.42
|
| Rate for Payer: Cash Price |
$430.42
|
| Rate for Payer: Cofinity Advantage |
$376.62
|
| Rate for Payer: Cofinity Commercial |
$462.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$484.23
|
| 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 |
$457.33
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$403.52
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$457.33
|
| 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 |
$338.96
|
| 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) |
$349.72
|
| Rate for Payer: UHC Core |
$280.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$211.45
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC CHEMODNRV MUSC FACIAL
|
Facility
|
IP
|
$552.83
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.28 |
| Max. Negotiated Rate |
$497.55 |
| Rate for Payer: Aetna Commercial |
$469.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.34
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Advantage |
$386.98
|
| Rate for Payer: Cofinity Commercial |
$475.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Healthscope Commercial |
$497.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: PHP Commercial |
$469.91
|
| Rate for Payer: Priority Health SBD |
$348.28
|
|
|
HC CHEMODNRV MUSC FACIAL
|
Facility
|
OP
|
$552.83
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$469.91
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.34
|
| 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 |
$224.17
|
| Rate for Payer: BCN Commercial |
$224.17
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Advantage |
$386.98
|
| Rate for Payer: Cofinity Commercial |
$475.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$497.55
|
| 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 |
$469.91
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$469.91
|
| 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 |
$348.28
|
| 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) |
$359.34
|
| Rate for Payer: UHC Core |
$288.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$217.26
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC CHEMODNRV MUSC FACIAL BIL
|
Facility
|
OP
|
$675.67
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$574.32
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.19
|
| 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 |
$224.17
|
| Rate for Payer: BCN Commercial |
$224.17
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$540.54
|
| Rate for Payer: Cash Price |
$540.54
|
| Rate for Payer: Cash Price |
$540.54
|
| Rate for Payer: Cofinity Advantage |
$472.97
|
| Rate for Payer: Cofinity Commercial |
$581.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$608.10
|
| 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 |
$574.32
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$506.75
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$574.32
|
| 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 |
$425.67
|
| 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) |
$439.19
|
| Rate for Payer: UHC Core |
$352.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$265.54
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC CHEMODNRV MUSC FACIAL BIL
|
Facility
|
IP
|
$675.67
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.67 |
| Max. Negotiated Rate |
$608.10 |
| Rate for Payer: Aetna Commercial |
$574.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.19
|
| Rate for Payer: Cash Price |
$540.54
|
| Rate for Payer: Cofinity Advantage |
$472.97
|
| Rate for Payer: Cofinity Commercial |
$581.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.54
|
| Rate for Payer: Healthscope Commercial |
$608.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$506.75
|
| Rate for Payer: PHP Commercial |
$574.32
|
| Rate for Payer: Priority Health SBD |
$425.67
|
|
|
HC CHEMODNRV MUSC MIGRAINE BIL
|
Facility
|
OP
|
$245.14
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
36100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.34 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$208.37
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.34
|
| 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 |
$224.17
|
| Rate for Payer: BCN Commercial |
$224.17
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$196.11
|
| Rate for Payer: Cash Price |
$196.11
|
| Rate for Payer: Cash Price |
$196.11
|
| Rate for Payer: Cofinity Advantage |
$171.60
|
| Rate for Payer: Cofinity Commercial |
$210.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$220.63
|
| 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 |
$208.37
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.85
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$208.37
|
| 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 |
$154.44
|
| 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) |
$159.34
|
| Rate for Payer: UHC Core |
$127.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$96.34
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC CHEMODNRV MUSC MIGRAINE BIL
|
Facility
|
IP
|
$245.14
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
36100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.44 |
| Max. Negotiated Rate |
$220.63 |
| Rate for Payer: Aetna Commercial |
$208.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.34
|
| Rate for Payer: Cash Price |
$196.11
|
| Rate for Payer: Cofinity Advantage |
$171.60
|
| Rate for Payer: Cofinity Commercial |
$210.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.11
|
| Rate for Payer: Healthscope Commercial |
$220.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.85
|
| Rate for Payer: PHP Commercial |
$208.37
|
| Rate for Payer: Priority Health SBD |
$154.44
|
|
|
HC CHEMODNRV MUSC NECK
|
Facility
|
OP
|
$457.39
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
36100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$388.78
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.30
|
| 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 |
$224.17
|
| Rate for Payer: BCN Commercial |
$224.17
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$365.91
|
| Rate for Payer: Cash Price |
$365.91
|
| Rate for Payer: Cash Price |
$365.91
|
| Rate for Payer: Cofinity Advantage |
$320.17
|
| Rate for Payer: Cofinity Commercial |
$393.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$411.65
|
| 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 |
$388.78
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.04
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$388.78
|
| 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 |
$288.16
|
| 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) |
$297.30
|
| Rate for Payer: UHC Core |
$238.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$179.75
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC CHEMODNRV MUSC NECK
|
Facility
|
IP
|
$457.39
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
36100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.16 |
| Max. Negotiated Rate |
$411.65 |
| Rate for Payer: Aetna Commercial |
$388.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.30
|
| Rate for Payer: Cash Price |
$365.91
|
| Rate for Payer: Cofinity Advantage |
$320.17
|
| Rate for Payer: Cofinity Commercial |
$393.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.91
|
| Rate for Payer: Healthscope Commercial |
$411.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.04
|
| Rate for Payer: PHP Commercial |
$388.78
|
| Rate for Payer: Priority Health SBD |
$288.16
|
|
|
HC CHEMODNRV TRUNK MUSC 1-5 MUSC
|
Facility
|
OP
|
$710.37
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
36100453
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$603.81
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.74
|
| 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 |
$568.30
|
| 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: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$639.33
|
| 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 |
$603.81
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.78
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$603.81
|
| 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 |
$447.53
|
| 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 CHEMODNRV TRUNK MUSC 1-5 MUSC
|
Facility
|
IP
|
$710.37
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
36100453
|
|
Hospital Revenue Code
|
361
|
| 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 CHEMO INFUSION CONCURRENT
|
Facility
|
OP
|
$201.63
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
33500011
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$181.47 |
| Rate for Payer: Aetna Commercial |
$171.39
|
| Rate for Payer: Aetna Medicare |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$113.62
|
| Rate for Payer: BCN Commercial |
$113.62
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$161.30
|
| Rate for Payer: Cash Price |
$161.30
|
| Rate for Payer: Cofinity Advantage |
$141.14
|
| Rate for Payer: Cofinity Commercial |
$173.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$181.47
|
| Rate for Payer: Mclaren Medicaid |
$24.40
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$48.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.39
|
| Rate for Payer: Nomi Health Commercial |
$139.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.22
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$171.39
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.88
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health SBD |
$127.03
|
| Rate for Payer: Priority Health Tiered Network |
$120.70
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.06
|
| Rate for Payer: UHC Core |
$105.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$79.24
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC CHEMO INFUSION CONCURRENT
|
Facility
|
IP
|
$201.63
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
33500011
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$127.03 |
| Max. Negotiated Rate |
$181.47 |
| Rate for Payer: Aetna Commercial |
$171.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.06
|
| Rate for Payer: Cash Price |
$161.30
|
| Rate for Payer: Cofinity Advantage |
$141.14
|
| Rate for Payer: Cofinity Commercial |
$173.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.30
|
| Rate for Payer: Healthscope Commercial |
$181.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.22
|
| Rate for Payer: PHP Commercial |
$171.39
|
| Rate for Payer: Priority Health SBD |
$127.03
|
|
|
HC CHEMO INFUSION EACH ADDL HR
|
Facility
|
OP
|
$267.37
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
33500002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$240.63 |
| Rate for Payer: Aetna Commercial |
$227.26
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$103.62
|
| Rate for Payer: BCN Commercial |
$103.62
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Advantage |
$187.16
|
| Rate for Payer: Cofinity Commercial |
$229.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$240.63
|
| Rate for Payer: Mclaren Medicaid |
$37.52
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$75.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.26
|
| Rate for Payer: Nomi Health Commercial |
$215.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.53
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$227.26
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.01
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health SBD |
$168.44
|
| Rate for Payer: Priority Health Tiered Network |
$185.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.79
|
| Rate for Payer: UHC Core |
$139.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$105.08
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC CHEMO INFUSION EACH ADDL HR
|
Facility
|
IP
|
$267.37
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
33500002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$168.44 |
| Max. Negotiated Rate |
$240.63 |
| Rate for Payer: Aetna Commercial |
$227.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.79
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Advantage |
$187.16
|
| Rate for Payer: Cofinity Commercial |
$229.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$240.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.53
|
| Rate for Payer: PHP Commercial |
$227.26
|
| Rate for Payer: Priority Health SBD |
$168.44
|
|
|
HC CHEMO INFUSION FIRST HR
|
Facility
|
OP
|
$993.45
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
33500001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$1,064.33 |
| Rate for Payer: Aetna Commercial |
$844.43
|
| Rate for Payer: Aetna Medicare |
$342.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$645.74
|
| 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 |
$483.94
|
| Rate for Payer: BCN Commercial |
$483.94
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$794.76
|
| Rate for Payer: Cash Price |
$794.76
|
| Rate for Payer: Cofinity Advantage |
$695.41
|
| Rate for Payer: Cofinity Commercial |
$854.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$794.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$894.11
|
| 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 |
$844.43
|
| Rate for Payer: Nomi Health Commercial |
$987.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$745.09
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$844.43
|
| 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 |
$625.87
|
| 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) |
$645.74
|
| Rate for Payer: UHC Core |
$517.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$390.43
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC CHEMO INFUSION FIRST HR
|
Facility
|
IP
|
$993.45
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
33500001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$625.87 |
| Max. Negotiated Rate |
$894.11 |
| Rate for Payer: Aetna Commercial |
$844.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$645.74
|
| Rate for Payer: Cash Price |
$794.76
|
| Rate for Payer: Cofinity Advantage |
$695.41
|
| Rate for Payer: Cofinity Commercial |
$854.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$794.76
|
| Rate for Payer: Healthscope Commercial |
$894.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$745.09
|
| Rate for Payer: PHP Commercial |
$844.43
|
| Rate for Payer: Priority Health SBD |
$625.87
|
|
|
HC CHEMO INFUSION VIA PUMP
|
Facility
|
IP
|
$900.20
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
33500003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$567.13 |
| Max. Negotiated Rate |
$810.18 |
| Rate for Payer: Aetna Commercial |
$765.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.13
|
| Rate for Payer: Cash Price |
$720.16
|
| Rate for Payer: Cofinity Advantage |
$630.14
|
| Rate for Payer: Cofinity Commercial |
$774.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.16
|
| Rate for Payer: Healthscope Commercial |
$810.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$675.15
|
| Rate for Payer: PHP Commercial |
$765.17
|
| Rate for Payer: Priority Health SBD |
$567.13
|
|
|
HC CHEMO INFUSION VIA PUMP
|
Facility
|
OP
|
$900.20
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
33500003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$1,064.33 |
| Rate for Payer: Aetna Commercial |
$765.17
|
| Rate for Payer: Aetna Medicare |
$342.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.13
|
| 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 |
$476.06
|
| Rate for Payer: BCN Commercial |
$476.06
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$720.16
|
| Rate for Payer: Cash Price |
$720.16
|
| Rate for Payer: Cofinity Advantage |
$630.14
|
| Rate for Payer: Cofinity Commercial |
$774.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$810.18
|
| 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 |
$765.17
|
| Rate for Payer: Nomi Health Commercial |
$987.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$675.15
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$765.17
|
| 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 |
$567.13
|
| 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) |
$585.13
|
| Rate for Payer: UHC Core |
$469.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$353.78
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC CHEMO INFUS SEQUENTIAL UP TO 1 HR
|
Facility
|
OP
|
$449.04
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
33500004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$404.14 |
| Rate for Payer: Aetna Commercial |
$381.68
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$238.68
|
| Rate for Payer: BCN Commercial |
$238.68
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$359.23
|
| Rate for Payer: Cash Price |
$359.23
|
| Rate for Payer: Cofinity Advantage |
$314.33
|
| Rate for Payer: Cofinity Commercial |
$386.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$404.14
|
| Rate for Payer: Mclaren Medicaid |
$37.52
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$75.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.68
|
| Rate for Payer: Nomi Health Commercial |
$215.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.78
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$381.68
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.01
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health SBD |
$282.90
|
| Rate for Payer: Priority Health Tiered Network |
$185.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.88
|
| Rate for Payer: UHC Core |
$233.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$176.47
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC CHEMO INFUS SEQUENTIAL UP TO 1 HR
|
Facility
|
IP
|
$449.04
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
33500004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$282.90 |
| Max. Negotiated Rate |
$404.14 |
| Rate for Payer: Aetna Commercial |
$381.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.88
|
| Rate for Payer: Cash Price |
$359.23
|
| Rate for Payer: Cofinity Advantage |
$314.33
|
| Rate for Payer: Cofinity Commercial |
$386.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.23
|
| Rate for Payer: Healthscope Commercial |
$404.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.78
|
| Rate for Payer: PHP Commercial |
$381.68
|
| Rate for Payer: Priority Health SBD |
$282.90
|
|
|
HC CHEMO INTO PERITONEAL CAVITY VIA PORT
|
Facility
|
IP
|
$447.42
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
33500007
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$281.87 |
| Max. Negotiated Rate |
$402.68 |
| Rate for Payer: Aetna Commercial |
$380.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.82
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cofinity Advantage |
$313.19
|
| Rate for Payer: Cofinity Commercial |
$384.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.94
|
| Rate for Payer: Healthscope Commercial |
$402.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.56
|
| Rate for Payer: PHP Commercial |
$380.31
|
| Rate for Payer: Priority Health SBD |
$281.87
|
|
|
HC CHEMO INTO PERITONEAL CAVITY VIA PORT
|
Facility
|
OP
|
$447.42
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
33500007
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$1,064.33 |
| Rate for Payer: Aetna Commercial |
$380.31
|
| Rate for Payer: Aetna Medicare |
$342.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.82
|
| 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 |
$596.71
|
| Rate for Payer: BCN Commercial |
$596.71
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cofinity Advantage |
$313.19
|
| Rate for Payer: Cofinity Commercial |
$384.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$402.68
|
| 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 |
$380.31
|
| Rate for Payer: Nomi Health Commercial |
$987.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.56
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$380.31
|
| 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 |
$281.87
|
| 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) |
$290.82
|
| Rate for Payer: UHC Core |
$233.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$175.84
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
