|
HC CHEMODNRV EXTREMITY 5 OR MORE MUSCLES
|
Facility
|
IP
|
$527.48
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
36100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.31 |
| Max. Negotiated Rate |
$474.73 |
| Rate for Payer: Aetna Commercial |
$448.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.86
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$369.24
|
| Rate for Payer: Cofinity Commercial |
$453.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$369.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Healthscope Commercial |
$474.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: PHP Commercial |
$448.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: Priority Health SBD |
$332.31
|
|
|
HC CHEMODNRV MUSC FACIAL
|
Facility
|
OP
|
$541.99
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.48 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$460.69
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.29
|
| 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 |
$175.02
|
| Rate for Payer: BCN Commercial |
$175.02
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cofinity Commercial |
$466.11
|
| Rate for Payer: Cofinity Commercial |
$379.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$379.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$487.79
|
| 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 |
$460.69
|
| 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 |
$460.69
|
| 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 |
$352.29
|
| 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 |
$341.45
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.48
|
| 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 CHEMODNRV MUSC FACIAL
|
Facility
|
IP
|
$541.99
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.45 |
| Max. Negotiated Rate |
$487.79 |
| Rate for Payer: Aetna Commercial |
$460.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.29
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cofinity Commercial |
$379.39
|
| Rate for Payer: Cofinity Commercial |
$466.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$379.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.59
|
| Rate for Payer: Healthscope Commercial |
$487.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.69
|
| Rate for Payer: PHP Commercial |
$460.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.29
|
| Rate for Payer: Priority Health SBD |
$341.45
|
|
|
HC CHEMODNRV MUSC FACIAL BIL
|
Facility
|
IP
|
$662.42
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.32 |
| Max. Negotiated Rate |
$596.18 |
| Rate for Payer: Aetna Commercial |
$563.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.57
|
| Rate for Payer: Cash Price |
$529.94
|
| Rate for Payer: Cofinity Commercial |
$463.69
|
| Rate for Payer: Cofinity Commercial |
$569.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$463.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.94
|
| Rate for Payer: Healthscope Commercial |
$596.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.06
|
| Rate for Payer: PHP Commercial |
$563.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health SBD |
$417.32
|
|
|
HC CHEMODNRV MUSC FACIAL BIL
|
Facility
|
OP
|
$662.42
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.48 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$563.06
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.57
|
| 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 |
$175.02
|
| Rate for Payer: BCN Commercial |
$175.02
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$529.94
|
| Rate for Payer: Cash Price |
$529.94
|
| Rate for Payer: Cash Price |
$529.94
|
| Rate for Payer: Cofinity Commercial |
$569.68
|
| Rate for Payer: Cofinity Commercial |
$463.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$463.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$596.18
|
| 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 |
$563.06
|
| 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 |
$563.06
|
| 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 |
$430.57
|
| 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 |
$417.32
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.48
|
| 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 CHEMODNRV MUSC MIGRAINE BIL
|
Facility
|
OP
|
$240.33
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
36100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.29 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$204.28
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.21
|
| 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 |
$175.02
|
| Rate for Payer: BCN Commercial |
$175.02
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cofinity Commercial |
$206.68
|
| Rate for Payer: Cofinity Commercial |
$168.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$216.30
|
| 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 |
$204.28
|
| 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 |
$204.28
|
| 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 |
$156.21
|
| 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 |
$151.41
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.29
|
| 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 CHEMODNRV MUSC MIGRAINE BIL
|
Facility
|
IP
|
$240.33
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
36100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.41 |
| Max. Negotiated Rate |
$216.30 |
| Rate for Payer: Aetna Commercial |
$204.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.21
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cofinity Commercial |
$168.23
|
| Rate for Payer: Cofinity Commercial |
$206.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.26
|
| Rate for Payer: Healthscope Commercial |
$216.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.28
|
| Rate for Payer: PHP Commercial |
$204.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.21
|
| Rate for Payer: Priority Health SBD |
$151.41
|
|
|
HC CHEMODNRV MUSC NECK
|
Facility
|
OP
|
$448.42
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
36100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$381.16
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.47
|
| 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 |
$175.02
|
| Rate for Payer: BCN Commercial |
$175.02
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$358.74
|
| Rate for Payer: Cash Price |
$358.74
|
| Rate for Payer: Cash Price |
$358.74
|
| Rate for Payer: Cofinity Commercial |
$385.64
|
| Rate for Payer: Cofinity Commercial |
$313.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$403.58
|
| 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 |
$381.16
|
| 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 |
$381.16
|
| 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 |
$291.47
|
| 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 |
$282.50
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.43
|
| 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 CHEMODNRV MUSC NECK
|
Facility
|
IP
|
$448.42
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
36100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.50 |
| Max. Negotiated Rate |
$403.58 |
| Rate for Payer: Aetna Commercial |
$381.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.47
|
| Rate for Payer: Cash Price |
$358.74
|
| Rate for Payer: Cofinity Commercial |
$313.89
|
| Rate for Payer: Cofinity Commercial |
$385.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.74
|
| Rate for Payer: Healthscope Commercial |
$403.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.16
|
| Rate for Payer: PHP Commercial |
$381.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.47
|
| Rate for Payer: Priority Health SBD |
$282.50
|
|
|
HC CHEMODNRV TRUNK MUSC 1-5 MUSC
|
Facility
|
IP
|
$696.44
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
36100453
|
|
Hospital Revenue Code
|
361
|
| 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 TRUNK MUSC 1-5 MUSC
|
Facility
|
OP
|
$696.44
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
36100453
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.92 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$591.97
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.69
|
| 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 |
$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: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$626.80
|
| 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 |
$591.97
|
| 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 |
$591.97
|
| 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 |
$452.69
|
| 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 |
$438.76
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.92
|
| 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 CHEMO INFUSION CONCURRENT
|
Facility
|
OP
|
$197.68
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
33500011
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$177.91 |
| Rate for Payer: Aetna Commercial |
$168.03
|
| Rate for Payer: Aetna Medicare |
$47.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$113.77
|
| Rate for Payer: BCN Commercial |
$113.77
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| Rate for Payer: Cash Price |
$158.14
|
| Rate for Payer: Cash Price |
$158.14
|
| Rate for Payer: Cofinity Commercial |
$170.00
|
| Rate for Payer: Cofinity Commercial |
$138.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$177.91
|
| Rate for Payer: Mclaren Medicaid |
$24.23
|
| Rate for Payer: Mclaren Medicare |
$45.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.47
|
| Rate for Payer: Meridian Medicaid |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.03
|
| Rate for Payer: Nomi Health Commercial |
$135.63
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$168.03
|
| Rate for Payer: PHP Medicare Advantage |
$45.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.07
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$113.66
|
| Rate for Payer: Priority Health SBD |
$124.54
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$146.28
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$25.45
|
| Rate for Payer: VA VA |
$45.21
|
|
|
HC CHEMO INFUSION CONCURRENT
|
Facility
|
IP
|
$197.68
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
33500011
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$177.91 |
| Rate for Payer: Aetna Commercial |
$168.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.49
|
| Rate for Payer: Cash Price |
$158.14
|
| Rate for Payer: Cofinity Commercial |
$138.38
|
| Rate for Payer: Cofinity Commercial |
$170.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.14
|
| Rate for Payer: Healthscope Commercial |
$177.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.03
|
| Rate for Payer: PHP Commercial |
$168.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.49
|
| Rate for Payer: Priority Health SBD |
$124.54
|
|
|
HC CHEMO INFUSION EACH ADDL HR
|
Facility
|
IP
|
$262.13
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
33500002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$165.14 |
| Max. Negotiated Rate |
$235.92 |
| Rate for Payer: Aetna Commercial |
$222.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.38
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cofinity Commercial |
$183.49
|
| Rate for Payer: Cofinity Commercial |
$225.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.70
|
| Rate for Payer: Healthscope Commercial |
$235.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.81
|
| Rate for Payer: PHP Commercial |
$222.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.38
|
| Rate for Payer: Priority Health SBD |
$165.14
|
|
|
HC CHEMO INFUSION EACH ADDL HR
|
Facility
|
OP
|
$262.13
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
33500002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$235.92 |
| Rate for Payer: Aetna Commercial |
$222.81
|
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$111.14
|
| Rate for Payer: BCN Commercial |
$111.14
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cofinity Commercial |
$225.43
|
| Rate for Payer: Cofinity Commercial |
$183.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$235.92
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.81
|
| Rate for Payer: Nomi Health Commercial |
$209.19
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$222.81
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.18
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$175.34
|
| Rate for Payer: Priority Health SBD |
$165.14
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$193.98
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$39.26
|
| Rate for Payer: VA VA |
$69.73
|
|
|
HC CHEMO INFUSION FIRST HR
|
Facility
|
IP
|
$973.97
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
33500001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$876.57 |
| Rate for Payer: Aetna Commercial |
$827.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.08
|
| Rate for Payer: Cash Price |
$779.18
|
| Rate for Payer: Cofinity Commercial |
$681.78
|
| Rate for Payer: Cofinity Commercial |
$837.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$681.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.18
|
| Rate for Payer: Healthscope Commercial |
$876.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$827.87
|
| Rate for Payer: PHP Commercial |
$827.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.08
|
| Rate for Payer: Priority Health SBD |
$613.60
|
|
|
HC CHEMO INFUSION FIRST HR
|
Facility
|
OP
|
$973.97
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
33500001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$128.88 |
| Max. Negotiated Rate |
$1,021.42 |
| Rate for Payer: Aetna Commercial |
$827.87
|
| Rate for Payer: Aetna Medicare |
$337.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.08
|
| 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 |
$519.48
|
| Rate for Payer: BCN Commercial |
$519.48
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$779.18
|
| Rate for Payer: Cash Price |
$779.18
|
| Rate for Payer: Cofinity Commercial |
$837.61
|
| Rate for Payer: Cofinity Commercial |
$681.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$681.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$876.57
|
| 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 |
$827.87
|
| 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 |
$827.87
|
| 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 |
$633.08
|
| 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 |
$613.60
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$720.74
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$182.96
|
| Rate for Payer: VA VA |
$324.98
|
|
|
HC CHEMO INFUSION VIA PUMP
|
Facility
|
IP
|
$882.55
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
33500003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$556.01 |
| Max. Negotiated Rate |
$794.30 |
| Rate for Payer: Aetna Commercial |
$750.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.66
|
| Rate for Payer: Cash Price |
$706.04
|
| Rate for Payer: Cofinity Commercial |
$617.78
|
| Rate for Payer: Cofinity Commercial |
$758.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$617.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$706.04
|
| Rate for Payer: Healthscope Commercial |
$794.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$750.17
|
| Rate for Payer: PHP Commercial |
$750.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.66
|
| Rate for Payer: Priority Health SBD |
$556.01
|
|
|
HC CHEMO INFUSION VIA PUMP
|
Facility
|
OP
|
$882.55
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
33500003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$126.68 |
| Max. Negotiated Rate |
$1,021.42 |
| Rate for Payer: Aetna Commercial |
$750.17
|
| Rate for Payer: Aetna Medicare |
$337.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.66
|
| 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 |
$511.43
|
| Rate for Payer: BCN Commercial |
$511.43
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$706.04
|
| Rate for Payer: Cash Price |
$706.04
|
| Rate for Payer: Cofinity Commercial |
$758.99
|
| Rate for Payer: Cofinity Commercial |
$617.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$617.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$706.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$794.30
|
| 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 |
$750.17
|
| 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 |
$750.17
|
| 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 |
$573.66
|
| 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 |
$556.01
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$653.09
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$182.96
|
| Rate for Payer: VA VA |
$324.98
|
|
|
HC CHEMO INFUS SEQUENTIAL UP TO 1 HR
|
Facility
|
IP
|
$440.24
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
33500004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$277.35 |
| Max. Negotiated Rate |
$396.22 |
| Rate for Payer: Aetna Commercial |
$374.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.16
|
| Rate for Payer: Cash Price |
$352.19
|
| Rate for Payer: Cofinity Commercial |
$308.17
|
| Rate for Payer: Cofinity Commercial |
$378.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$308.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.19
|
| Rate for Payer: Healthscope Commercial |
$396.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.20
|
| Rate for Payer: PHP Commercial |
$374.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.16
|
| Rate for Payer: Priority Health SBD |
$277.35
|
|
|
HC CHEMO INFUS SEQUENTIAL UP TO 1 HR
|
Facility
|
OP
|
$440.24
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
33500004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$396.22 |
| Rate for Payer: Aetna Commercial |
$374.20
|
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$255.73
|
| Rate for Payer: BCN Commercial |
$255.73
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$352.19
|
| Rate for Payer: Cash Price |
$352.19
|
| Rate for Payer: Cofinity Commercial |
$378.61
|
| Rate for Payer: Cofinity Commercial |
$308.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$308.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$396.22
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.20
|
| Rate for Payer: Nomi Health Commercial |
$209.19
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$374.20
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.18
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$175.34
|
| Rate for Payer: Priority Health SBD |
$277.35
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$325.78
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$39.26
|
| Rate for Payer: VA VA |
$69.73
|
|
|
HC CHEMO INTO PERITONEAL CAVITY VIA PORT
|
Facility
|
OP
|
$438.65
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
33500007
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$1,021.42 |
| Rate for Payer: Aetna Commercial |
$372.85
|
| Rate for Payer: Aetna Medicare |
$337.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.12
|
| 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 |
$641.32
|
| Rate for Payer: BCN Commercial |
$641.32
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cofinity Commercial |
$377.24
|
| Rate for Payer: Cofinity Commercial |
$307.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$394.78
|
| 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 |
$372.85
|
| 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 |
$372.85
|
| 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 |
$285.12
|
| 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 |
$276.35
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$324.60
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$182.96
|
| Rate for Payer: VA VA |
$324.98
|
|
|
HC CHEMO INTO PERITONEAL CAVITY VIA PORT
|
Facility
|
IP
|
$438.65
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
33500007
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$276.35 |
| Max. Negotiated Rate |
$394.78 |
| Rate for Payer: Aetna Commercial |
$372.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.12
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cofinity Commercial |
$307.06
|
| Rate for Payer: Cofinity Commercial |
$377.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.92
|
| Rate for Payer: Healthscope Commercial |
$394.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.85
|
| Rate for Payer: PHP Commercial |
$372.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.12
|
| Rate for Payer: Priority Health SBD |
$276.35
|
|
|
HC CHEMO INTO PLEURA W THORACENTESIS
|
Facility
|
IP
|
$438.65
|
|
|
Service Code
|
CPT 96440
|
| Hospital Charge Code |
33500006
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$276.35 |
| Max. Negotiated Rate |
$394.78 |
| Rate for Payer: Aetna Commercial |
$372.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.12
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cofinity Commercial |
$307.06
|
| Rate for Payer: Cofinity Commercial |
$377.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.92
|
| Rate for Payer: Healthscope Commercial |
$394.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.85
|
| Rate for Payer: PHP Commercial |
$372.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.12
|
| Rate for Payer: Priority Health SBD |
$276.35
|
|
|
HC CHEMO INTO PLEURA W THORACENTESIS
|
Facility
|
OP
|
$438.65
|
|
|
Service Code
|
CPT 96440
|
| Hospital Charge Code |
33500006
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$139.70 |
| Max. Negotiated Rate |
$2,996.35 |
| Rate for Payer: Aetna Commercial |
$372.85
|
| Rate for Payer: Aetna Medicare |
$337.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.12
|
| 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 |
$2,996.35
|
| Rate for Payer: BCN Commercial |
$2,996.35
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cofinity Commercial |
$377.24
|
| Rate for Payer: Cofinity Commercial |
$307.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$394.78
|
| 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 |
$372.85
|
| 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 |
$372.85
|
| 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 |
$285.12
|
| 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 |
$276.35
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$324.60
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$182.96
|
| Rate for Payer: VA VA |
$324.98
|
|
