|
HC CESIUM 137 PER SOURCE
|
Facility
|
IP
|
$777.71
|
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$489.96 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.51
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$544.40
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health SBD |
$489.96
|
|
|
HC CESIUM 137 PER SOURCE
|
Facility
|
OP
|
$777.71
|
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$311.08 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna Medicare |
$388.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.51
|
| Rate for Payer: BCBS Complete |
$311.08
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$544.40
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health SBD |
$489.96
|
| Rate for Payer: UHC Core |
$575.51
|
| Rate for Payer: UHC Exchange |
$575.51
|
|
|
HC CHAMBER HOLDING OPTI CHAMBER
|
Facility
|
OP
|
$22.32
|
|
| Hospital Charge Code |
27000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$18.97
|
| Rate for Payer: Aetna Medicare |
$11.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.51
|
| Rate for Payer: BCBS Complete |
$8.93
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$19.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.86
|
| Rate for Payer: Healthscope Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.97
|
| Rate for Payer: PHP Commercial |
$18.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.51
|
| Rate for Payer: Priority Health SBD |
$14.06
|
|
|
HC CHAMBER HOLDING OPTI CHAMBER
|
Facility
|
IP
|
$22.32
|
|
| Hospital Charge Code |
27000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$18.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.51
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$19.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.86
|
| Rate for Payer: Healthscope Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.97
|
| Rate for Payer: PHP Commercial |
$18.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.51
|
| Rate for Payer: Priority Health SBD |
$14.06
|
|
|
HC CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
IP
|
$1,016.47
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$640.38 |
| Max. Negotiated Rate |
$914.82 |
| Rate for Payer: Aetna Commercial |
$864.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.71
|
| Rate for Payer: Cash Price |
$813.18
|
| Rate for Payer: Cofinity Commercial |
$711.53
|
| Rate for Payer: Cofinity Commercial |
$874.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$711.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.18
|
| Rate for Payer: Healthscope Commercial |
$914.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$864.00
|
| Rate for Payer: PHP Commercial |
$864.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.71
|
| Rate for Payer: Priority Health SBD |
$640.38
|
|
|
HC CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
OP
|
$1,016.47
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.36 |
| Max. Negotiated Rate |
$2,055.42 |
| Rate for Payer: Aetna Commercial |
$864.00
|
| Rate for Payer: Aetna Medicare |
$680.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$309.63
|
| Rate for Payer: BCN Commercial |
$309.63
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Cash Price |
$813.18
|
| Rate for Payer: Cash Price |
$813.18
|
| Rate for Payer: Cash Price |
$813.18
|
| Rate for Payer: Cofinity Commercial |
$874.16
|
| Rate for Payer: Cofinity Commercial |
$711.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$711.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.97
|
| Rate for Payer: Healthscope Commercial |
$914.82
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$864.00
|
| Rate for Payer: Nomi Health Commercial |
$1,373.34
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Commercial |
$864.00
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,055.42
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,644.34
|
| Rate for Payer: Priority Health SBD |
$640.38
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.36
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$368.19
|
| Rate for Payer: VA VA |
$653.97
|
|
|
HC CHANNEL RFA ENDO CATHETER
|
Facility
|
IP
|
$3,721.58
|
|
| Hospital Charge Code |
27200289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,344.60 |
| Max. Negotiated Rate |
$3,349.42 |
| Rate for Payer: Aetna Commercial |
$3,163.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,419.03
|
| Rate for Payer: Cash Price |
$2,977.26
|
| Rate for Payer: Cofinity Commercial |
$2,605.11
|
| Rate for Payer: Cofinity Commercial |
$3,200.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,605.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,977.26
|
| Rate for Payer: Healthscope Commercial |
$3,349.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,163.34
|
| Rate for Payer: PHP Commercial |
$3,163.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,419.03
|
| Rate for Payer: Priority Health SBD |
$2,344.60
|
|
|
HC CHANNEL RFA ENDO CATHETER
|
Facility
|
OP
|
$3,721.58
|
|
| Hospital Charge Code |
27200289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,488.63 |
| Max. Negotiated Rate |
$3,349.42 |
| Rate for Payer: Aetna Commercial |
$3,163.34
|
| Rate for Payer: Aetna Medicare |
$1,860.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,419.03
|
| Rate for Payer: BCBS Complete |
$1,488.63
|
| Rate for Payer: Cash Price |
$2,977.26
|
| Rate for Payer: Cofinity Commercial |
$2,605.11
|
| Rate for Payer: Cofinity Commercial |
$3,200.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,605.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,977.26
|
| Rate for Payer: Healthscope Commercial |
$3,349.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,163.34
|
| Rate for Payer: PHP Commercial |
$3,163.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,419.03
|
| Rate for Payer: Priority Health SBD |
$2,344.60
|
|
|
HC CHEM CAUTERY GRANULATION TISSUE
|
Facility
|
IP
|
$296.74
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.95 |
| Max. Negotiated Rate |
$267.07 |
| Rate for Payer: Aetna Commercial |
$252.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.88
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cofinity Commercial |
$207.72
|
| Rate for Payer: Cofinity Commercial |
$255.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.39
|
| Rate for Payer: Healthscope Commercial |
$267.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.23
|
| Rate for Payer: PHP Commercial |
$252.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.88
|
| Rate for Payer: Priority Health SBD |
$186.95
|
|
|
HC CHEM CAUTERY GRANULATION TISSUE
|
Facility
|
OP
|
$296.74
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.44 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$252.23
|
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$74.10
|
| Rate for Payer: BCN Commercial |
$74.10
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cofinity Commercial |
$207.72
|
| Rate for Payer: Cofinity Commercial |
$255.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$267.07
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.23
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$252.23
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Priority Health SBD |
$186.95
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.44
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$109.60
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC CHEMO ADMIN INTO CNS
|
Facility
|
IP
|
$1,126.02
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$709.39 |
| Max. Negotiated Rate |
$1,013.42 |
| Rate for Payer: Aetna Commercial |
$957.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$731.91
|
| Rate for Payer: Cash Price |
$900.82
|
| Rate for Payer: Cofinity Commercial |
$788.21
|
| Rate for Payer: Cofinity Commercial |
$968.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$788.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.82
|
| Rate for Payer: Healthscope Commercial |
$1,013.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$957.12
|
| Rate for Payer: PHP Commercial |
$957.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.91
|
| Rate for Payer: Priority Health SBD |
$709.39
|
|
|
HC CHEMO ADMIN INTO CNS
|
Facility
|
OP
|
$1,126.02
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$80.39 |
| Max. Negotiated Rate |
$1,021.42 |
| Rate for Payer: Aetna Commercial |
$957.12
|
| Rate for Payer: Aetna Medicare |
$337.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$731.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$649.34
|
| Rate for Payer: BCN Commercial |
$649.34
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$900.82
|
| Rate for Payer: Cash Price |
$900.82
|
| Rate for Payer: Cofinity Commercial |
$968.38
|
| Rate for Payer: Cofinity Commercial |
$788.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$788.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$1,013.42
|
| Rate for Payer: Mclaren Medicaid |
$174.19
|
| Rate for Payer: Mclaren Medicare |
$324.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.23
|
| Rate for Payer: Meridian Medicaid |
$182.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$957.12
|
| Rate for Payer: Nomi Health Commercial |
$974.94
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Commercial |
$957.12
|
| Rate for Payer: PHP Medicare Advantage |
$324.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.42
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$817.14
|
| Rate for Payer: Priority Health SBD |
$709.39
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$833.25
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$182.96
|
| Rate for Payer: VA VA |
$324.98
|
|
|
HC CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Facility
|
IP
|
$3,203.25
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,018.05 |
| Max. Negotiated Rate |
$2,882.92 |
| Rate for Payer: Aetna Commercial |
$2,722.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,082.11
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cofinity Commercial |
$2,242.28
|
| Rate for Payer: Cofinity Commercial |
$2,754.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,242.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,562.60
|
| Rate for Payer: Healthscope Commercial |
$2,882.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,722.76
|
| Rate for Payer: PHP Commercial |
$2,722.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,082.11
|
| Rate for Payer: Priority Health SBD |
$2,018.05
|
|
|
HC CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,203.25
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.03 |
| Max. Negotiated Rate |
$3,630.90 |
| Rate for Payer: Aetna Commercial |
$2,722.76
|
| Rate for Payer: Aetna Medicare |
$1,201.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,082.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,199.78
|
| Rate for Payer: BCN Commercial |
$1,199.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cofinity Commercial |
$2,754.80
|
| Rate for Payer: Cofinity Commercial |
$2,242.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,242.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,562.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Healthscope Commercial |
$2,882.92
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,722.76
|
| Rate for Payer: Nomi Health Commercial |
$2,426.00
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Commercial |
$2,722.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,082.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,630.90
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,904.72
|
| Rate for Payer: Priority Health SBD |
$2,018.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.03
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$650.40
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
HC CHEMODENERVATION TRUNK 6 OR > MUSCLES
|
Facility
|
IP
|
$1,955.95
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
36000374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,232.25 |
| Max. Negotiated Rate |
$1,760.36 |
| Rate for Payer: Aetna Commercial |
$1,662.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,271.37
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cofinity Commercial |
$1,369.16
|
| Rate for Payer: Cofinity Commercial |
$1,682.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,369.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,564.76
|
| Rate for Payer: Healthscope Commercial |
$1,760.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,662.56
|
| Rate for Payer: PHP Commercial |
$1,662.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,271.37
|
| Rate for Payer: Priority Health SBD |
$1,232.25
|
|
|
HC CHEMODENERVATION TRUNK 6 OR > MUSCLES
|
Facility
|
OP
|
$1,955.95
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
36000374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$1,662.56
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,271.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$65.14
|
| Rate for Payer: BCN Commercial |
$65.14
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cofinity Commercial |
$1,369.16
|
| Rate for Payer: Cofinity Commercial |
$1,682.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,369.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,564.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$1,760.36
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,662.56
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$1,662.56
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,271.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$1,232.25
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.24
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
OP
|
$386.21
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.87 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$52.87
|
| Rate for Payer: BCN Commercial |
$52.87
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Cofinity Commercial |
$270.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$607.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.03
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$727.22
|
| Rate for Payer: Priority Health SBD |
$243.31
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.62
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$162.83
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
IP
|
$386.21
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.31 |
| Max. Negotiated Rate |
$347.59 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.04
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$270.35
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health SBD |
$243.31
|
|
|
HC CHEMODNRV EA ADD EXT 1-4 MUSC
|
Facility
|
IP
|
$696.44
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
36100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.76 |
| Max. Negotiated Rate |
$626.80 |
| Rate for Payer: Aetna Commercial |
$591.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.69
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Cofinity Commercial |
$487.51
|
| Rate for Payer: Cofinity Commercial |
$598.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$487.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.15
|
| Rate for Payer: Healthscope Commercial |
$626.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$591.97
|
| Rate for Payer: PHP Commercial |
$591.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.69
|
| Rate for Payer: Priority Health SBD |
$438.76
|
|
|
HC CHEMODNRV EA ADD EXT 1-4 MUSC
|
Facility
|
OP
|
$696.44
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
36100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$591.97
|
| Rate for Payer: Aetna Medicare |
$348.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.69
|
| Rate for Payer: BCBS Complete |
$278.58
|
| Rate for Payer: BCBS Trust/PPO |
$559.69
|
| Rate for Payer: BCN Commercial |
$559.69
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Cofinity Commercial |
$487.51
|
| Rate for Payer: Cofinity Commercial |
$598.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$487.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.15
|
| Rate for Payer: Healthscope Commercial |
$626.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$591.97
|
| Rate for Payer: PHP Commercial |
$591.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.69
|
| Rate for Payer: Priority Health SBD |
$438.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.76
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC CHEMODNRV EXT1-4 MUSC
|
Facility
|
IP
|
$671.38
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$422.97 |
| Max. Negotiated Rate |
$604.24 |
| Rate for Payer: Aetna Commercial |
$570.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.40
|
| Rate for Payer: Cash Price |
$537.10
|
| Rate for Payer: Cofinity Commercial |
$469.97
|
| Rate for Payer: Cofinity Commercial |
$577.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$469.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.10
|
| Rate for Payer: Healthscope Commercial |
$604.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.67
|
| Rate for Payer: PHP Commercial |
$570.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.40
|
| Rate for Payer: Priority Health SBD |
$422.97
|
|
|
HC CHEMODNRV EXT1-4 MUSC
|
Facility
|
OP
|
$671.38
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$570.67
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$414.76
|
| Rate for Payer: BCN Commercial |
$414.76
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$537.10
|
| Rate for Payer: Cash Price |
$537.10
|
| Rate for Payer: Cash Price |
$537.10
|
| Rate for Payer: Cofinity Commercial |
$577.39
|
| Rate for Payer: Cofinity Commercial |
$469.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$469.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$604.24
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.67
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$570.67
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$422.97
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.72
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC CHEMODNRV EXTREMITY 5/< MUSCLES
|
Facility
|
IP
|
$115.59
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
36100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.82 |
| Max. Negotiated Rate |
$104.03 |
| Rate for Payer: Aetna Commercial |
$98.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.13
|
| Rate for Payer: Cash Price |
$92.47
|
| Rate for Payer: Cofinity Commercial |
$80.91
|
| Rate for Payer: Cofinity Commercial |
$99.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.47
|
| Rate for Payer: Healthscope Commercial |
$104.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.25
|
| Rate for Payer: PHP Commercial |
$98.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.13
|
| Rate for Payer: Priority Health SBD |
$72.82
|
|
|
HC CHEMODNRV EXTREMITY 5/< MUSCLES
|
Facility
|
OP
|
$115.59
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
36100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$98.25
|
| Rate for Payer: Aetna Medicare |
$57.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.13
|
| Rate for Payer: BCBS Complete |
$46.24
|
| Rate for Payer: BCBS Trust/PPO |
$692.72
|
| Rate for Payer: BCN Commercial |
$692.72
|
| Rate for Payer: Cash Price |
$92.47
|
| Rate for Payer: Cash Price |
$92.47
|
| Rate for Payer: Cash Price |
$92.47
|
| Rate for Payer: Cofinity Commercial |
$80.91
|
| Rate for Payer: Cofinity Commercial |
$99.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.47
|
| Rate for Payer: Healthscope Commercial |
$104.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.25
|
| Rate for Payer: PHP Commercial |
$98.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.13
|
| Rate for Payer: Priority Health SBD |
$72.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.31
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC CHEMODNRV EXTREMITY 5 OR MORE MUSCLES
|
Facility
|
OP
|
$527.48
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
36100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.79 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$448.36
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$414.76
|
| Rate for Payer: BCN Commercial |
$414.76
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$453.63
|
| Rate for Payer: Cofinity Commercial |
$369.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$369.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$474.73
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$448.36
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$332.31
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.79
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
