|
HC CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,267.32
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$623.59 |
| Max. Negotiated Rate |
$3,267.32 |
| Rate for Payer: Aetna Commercial |
$2,940.59
|
| Rate for Payer: Aetna Medicare |
$1,192.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.42
|
| Rate for Payer: ASR ASR |
$3,169.30
|
| Rate for Payer: BCBS Complete |
$654.83
|
| Rate for Payer: BCBS MAPPO |
$1,192.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,693.91
|
| Rate for Payer: BCN Commercial |
$2,693.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.34
|
| Rate for Payer: Cash Price |
$2,613.86
|
| Rate for Payer: Cash Price |
$2,613.86
|
| Rate for Payer: Cofinity Commercial |
$3,071.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,613.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.34
|
| Rate for Payer: Healthscope Commercial |
$3,169.30
|
| Rate for Payer: Healthscope Whirlpool |
$3,267.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,192.34
|
| Rate for Payer: Mclaren Commercial |
$2,940.59
|
| Rate for Payer: Mclaren Medicaid |
$1,192.34
|
| Rate for Payer: Mclaren Medicare |
$1,192.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.96
|
| Rate for Payer: Meridian Medicaid |
$654.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,371.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,311.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,777.22
|
| Rate for Payer: Nomi Health Commercial |
$2,679.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,450.49
|
| Rate for Payer: PACE Medicare |
$1,132.72
|
| Rate for Payer: PACE SWMI |
$1,192.34
|
| Rate for Payer: PHP Commercial |
$1,311.57
|
| Rate for Payer: PHP Medicaid |
$639.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,862.83
|
| Rate for Payer: Priority Health Medicare |
$1,192.34
|
| Rate for Payer: Priority Health Narrow Network |
$2,290.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,875.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,192.34
|
| Rate for Payer: UHC Exchange |
$1,848.13
|
| Rate for Payer: UHC Medicaid |
$623.59
|
| Rate for Payer: UHCCP DNSP |
$1,192.34
|
| Rate for Payer: UHCCP Medicaid |
$623.59
|
| Rate for Payer: VA VA |
$1,192.34
|
|
|
HC CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Facility
|
IP
|
$3,267.32
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,450.49 |
| Max. Negotiated Rate |
$3,267.32 |
| Rate for Payer: Aetna Commercial |
$2,940.59
|
| Rate for Payer: ASR ASR |
$3,169.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,683.12
|
| Rate for Payer: BCN Commercial |
$2,683.12
|
| Rate for Payer: Cash Price |
$2,613.86
|
| Rate for Payer: Cofinity Commercial |
$3,071.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,613.86
|
| Rate for Payer: Healthscope Commercial |
$3,169.30
|
| Rate for Payer: Healthscope Whirlpool |
$3,267.32
|
| Rate for Payer: Mclaren Commercial |
$2,940.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,777.22
|
| Rate for Payer: Nomi Health Commercial |
$2,679.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,450.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,875.24
|
|
|
HC CHEMODENERVATION TRUNK 6 OR > MUSCLES
|
Facility
|
IP
|
$1,995.07
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
36000374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.30 |
| Max. Negotiated Rate |
$1,995.07 |
| Rate for Payer: Aetna Commercial |
$1,795.56
|
| Rate for Payer: ASR ASR |
$1,935.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,638.35
|
| Rate for Payer: BCN Commercial |
$1,638.35
|
| Rate for Payer: Cash Price |
$1,596.06
|
| Rate for Payer: Cofinity Commercial |
$1,875.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.06
|
| Rate for Payer: Healthscope Commercial |
$1,935.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,995.07
|
| Rate for Payer: Mclaren Commercial |
$1,795.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,695.81
|
| Rate for Payer: Nomi Health Commercial |
$1,635.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,496.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,755.66
|
|
|
HC CHEMODENERVATION TRUNK 6 OR > MUSCLES
|
Facility
|
OP
|
$1,995.07
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
36000374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.45 |
| Max. Negotiated Rate |
$1,995.07 |
| Rate for Payer: Aetna Commercial |
$1,795.56
|
| Rate for Payer: Aetna Medicare |
$703.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: ASR ASR |
$1,935.22
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.94
|
| Rate for Payer: BCN Commercial |
$1,644.94
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$1,596.06
|
| Rate for Payer: Cash Price |
$1,596.06
|
| Rate for Payer: Cofinity Commercial |
$1,875.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$1,935.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,995.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$703.34
|
| Rate for Payer: Mclaren Commercial |
$1,795.56
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| 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 |
$386.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,695.81
|
| Rate for Payer: Nomi Health Commercial |
$1,635.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,496.30
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$773.67
|
| Rate for Payer: PHP Medicaid |
$376.99
|
| 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/Tiered Network |
$446.82
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Narrow Network |
$357.45
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,755.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$1,090.18
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP DNSP |
$703.34
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
IP
|
$393.93
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.45 |
| Max. Negotiated Rate |
$393.93 |
| Rate for Payer: Aetna Commercial |
$354.54
|
| Rate for Payer: ASR ASR |
$382.11
|
| Rate for Payer: BCBS Trust/PPO |
$323.50
|
| Rate for Payer: BCN Commercial |
$323.50
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Commercial |
$370.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Healthscope Commercial |
$382.11
|
| Rate for Payer: Healthscope Whirlpool |
$393.93
|
| Rate for Payer: Mclaren Commercial |
$354.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$323.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.66
|
|
|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
OP
|
$393.93
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$474.07 |
| Rate for Payer: Aetna Commercial |
$354.54
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$382.11
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$324.80
|
| Rate for Payer: BCN Commercial |
$324.80
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Commercial |
$370.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$382.11
|
| Rate for Payer: Healthscope Whirlpool |
$393.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$354.54
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| 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 |
$167.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$323.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| 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/Tiered Network |
$345.16
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$276.14
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC CHEMODNRV EA ADD EXT 1-4 MUSC
|
Facility
|
IP
|
$710.37
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
36100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$532.78 |
| Max. Negotiated Rate |
$710.37 |
| Rate for Payer: Aetna Commercial |
$639.33
|
| Rate for Payer: ASR ASR |
$689.06
|
| Rate for Payer: BCBS Trust/PPO |
$583.36
|
| Rate for Payer: BCN Commercial |
$583.36
|
| Rate for Payer: Cash Price |
$568.30
|
| Rate for Payer: Cofinity Commercial |
$667.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.30
|
| Rate for Payer: Healthscope Commercial |
$689.06
|
| Rate for Payer: Healthscope Whirlpool |
$710.37
|
| Rate for Payer: Mclaren Commercial |
$639.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.81
|
| Rate for Payer: Nomi Health Commercial |
$582.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.13
|
|
|
HC CHEMODNRV EA ADD EXT 1-4 MUSC
|
Facility
|
OP
|
$710.37
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
36100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.84 |
| Max. Negotiated Rate |
$710.37 |
| Rate for Payer: Aetna Commercial |
$639.33
|
| Rate for Payer: Aetna Medicare |
$262.84
|
| Rate for Payer: ASR ASR |
$689.06
|
| Rate for Payer: BCBS Complete |
$284.15
|
| Rate for Payer: BCBS Trust/PPO |
$585.70
|
| Rate for Payer: BCN Commercial |
$585.70
|
| Rate for Payer: Cash Price |
$568.30
|
| Rate for Payer: Cash Price |
$568.30
|
| Rate for Payer: Cofinity Commercial |
$667.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.30
|
| Rate for Payer: Healthscope Commercial |
$689.06
|
| Rate for Payer: Healthscope Whirlpool |
$710.37
|
| Rate for Payer: Mclaren Commercial |
$639.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$568.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.81
|
| Rate for Payer: Nomi Health Commercial |
$582.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$417.13
|
| Rate for Payer: Priority Health Narrow Network |
$333.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.13
|
|
|
HC CHEMODNRV EXT1-4 MUSC
|
Facility
|
IP
|
$684.81
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$513.61 |
| Max. Negotiated Rate |
$684.81 |
| Rate for Payer: Aetna Commercial |
$616.33
|
| Rate for Payer: ASR ASR |
$664.27
|
| Rate for Payer: BCBS Trust/PPO |
$562.37
|
| Rate for Payer: BCN Commercial |
$562.37
|
| Rate for Payer: Cash Price |
$547.85
|
| Rate for Payer: Cofinity Commercial |
$643.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.85
|
| Rate for Payer: Healthscope Commercial |
$664.27
|
| Rate for Payer: Healthscope Whirlpool |
$684.81
|
| Rate for Payer: Mclaren Commercial |
$616.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$582.09
|
| Rate for Payer: Nomi Health Commercial |
$561.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.63
|
|
|
HC CHEMODNRV EXT1-4 MUSC
|
Facility
|
OP
|
$684.81
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.45 |
| Max. Negotiated Rate |
$1,090.18 |
| Rate for Payer: Aetna Commercial |
$616.33
|
| Rate for Payer: Aetna Medicare |
$703.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: ASR ASR |
$664.27
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$564.63
|
| Rate for Payer: BCN Commercial |
$564.63
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$547.85
|
| Rate for Payer: Cash Price |
$547.85
|
| Rate for Payer: Cofinity Commercial |
$643.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$664.27
|
| Rate for Payer: Healthscope Whirlpool |
$684.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$703.34
|
| Rate for Payer: Mclaren Commercial |
$616.33
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| 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 |
$386.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$582.09
|
| Rate for Payer: Nomi Health Commercial |
$561.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.61
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$773.67
|
| Rate for Payer: PHP Medicaid |
$376.99
|
| 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/Tiered Network |
$446.82
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Narrow Network |
$357.45
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$1,090.18
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP DNSP |
$703.34
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC CHEMODNRV EXTREMITY 5/< MUSCLES
|
Facility
|
IP
|
$117.90
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
36100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.42 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Aetna Commercial |
$106.11
|
| Rate for Payer: ASR ASR |
$114.36
|
| Rate for Payer: BCBS Trust/PPO |
$96.82
|
| Rate for Payer: BCN Commercial |
$96.82
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cofinity Commercial |
$110.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.32
|
| Rate for Payer: Healthscope Commercial |
$114.36
|
| Rate for Payer: Healthscope Whirlpool |
$117.90
|
| Rate for Payer: Mclaren Commercial |
$106.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.22
|
| Rate for Payer: Nomi Health Commercial |
$96.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.75
|
|
|
HC CHEMODNRV EXTREMITY 5/< MUSCLES
|
Facility
|
OP
|
$117.90
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
36100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$478.18 |
| Rate for Payer: Aetna Commercial |
$106.11
|
| Rate for Payer: Aetna Medicare |
$43.62
|
| Rate for Payer: ASR ASR |
$114.36
|
| Rate for Payer: BCBS Complete |
$47.16
|
| Rate for Payer: BCBS Trust/PPO |
$97.21
|
| Rate for Payer: BCN Commercial |
$97.21
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cofinity Commercial |
$110.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.32
|
| Rate for Payer: Healthscope Commercial |
$114.36
|
| Rate for Payer: Healthscope Whirlpool |
$117.90
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$96.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$478.18
|
| Rate for Payer: Priority Health Narrow Network |
$382.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.75
|
|
|
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 |
$357.45 |
| Max. Negotiated Rate |
$1,090.18 |
| Rate for Payer: Aetna Commercial |
$484.23
|
| Rate for Payer: Aetna Medicare |
$703.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: ASR ASR |
$521.89
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$443.61
|
| Rate for Payer: BCN Commercial |
$443.61
|
| 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: Cofinity Commercial |
$505.75
|
| 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 |
$521.89
|
| Rate for Payer: Healthscope Whirlpool |
$538.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$703.34
|
| Rate for Payer: Mclaren Commercial |
$484.23
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| 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 |
$386.27
|
| 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 |
$441.18
|
| 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 |
$773.67
|
| Rate for Payer: PHP Medicaid |
$376.99
|
| 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/Tiered Network |
$446.82
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Narrow Network |
$357.45
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$1,090.18
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP DNSP |
$703.34
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
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 |
$403.52 |
| Max. Negotiated Rate |
$538.03 |
| Rate for Payer: Aetna Commercial |
$484.23
|
| Rate for Payer: ASR ASR |
$521.89
|
| Rate for Payer: BCBS Trust/PPO |
$441.83
|
| Rate for Payer: BCN Commercial |
$441.83
|
| Rate for Payer: Cash Price |
$430.42
|
| Rate for Payer: Cofinity Commercial |
$505.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.42
|
| Rate for Payer: Healthscope Commercial |
$521.89
|
| Rate for Payer: Healthscope Whirlpool |
$538.03
|
| Rate for Payer: Mclaren Commercial |
$484.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.33
|
| Rate for Payer: Nomi Health Commercial |
$441.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$403.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.47
|
|
|
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 |
$552.83 |
| Rate for Payer: Aetna Commercial |
$497.55
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$536.25
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$455.81
|
| Rate for Payer: BCN Commercial |
$455.81
|
| 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: Cofinity Commercial |
$519.66
|
| 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 |
$536.25
|
| Rate for Payer: Healthscope Whirlpool |
$552.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$497.55
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| 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 |
$167.97
|
| 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 |
$453.32
|
| 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 |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| 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/Tiered Network |
$484.39
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$387.53
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC CHEMODNRV MUSC FACIAL
|
Facility
|
IP
|
$552.83
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.62 |
| Max. Negotiated Rate |
$552.83 |
| Rate for Payer: Aetna Commercial |
$497.55
|
| Rate for Payer: ASR ASR |
$536.25
|
| Rate for Payer: BCBS Trust/PPO |
$453.98
|
| Rate for Payer: BCN Commercial |
$453.98
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Commercial |
$519.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Healthscope Commercial |
$536.25
|
| Rate for Payer: Healthscope Whirlpool |
$552.83
|
| Rate for Payer: Mclaren Commercial |
$497.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.91
|
| Rate for Payer: Nomi Health Commercial |
$453.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.49
|
|
|
HC CHEMODNRV MUSC FACIAL BIL
|
Facility
|
IP
|
$675.67
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.75 |
| Max. Negotiated Rate |
$675.67 |
| Rate for Payer: Aetna Commercial |
$608.10
|
| Rate for Payer: ASR ASR |
$655.40
|
| Rate for Payer: BCBS Trust/PPO |
$554.86
|
| Rate for Payer: BCN Commercial |
$554.86
|
| Rate for Payer: Cash Price |
$540.54
|
| Rate for Payer: Cofinity Commercial |
$635.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.54
|
| Rate for Payer: Healthscope Commercial |
$655.40
|
| Rate for Payer: Healthscope Whirlpool |
$675.67
|
| Rate for Payer: Mclaren Commercial |
$608.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.32
|
| Rate for Payer: Nomi Health Commercial |
$554.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$506.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.59
|
|
|
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 |
$675.67 |
| Rate for Payer: Aetna Commercial |
$608.10
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$655.40
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$557.09
|
| Rate for Payer: BCN Commercial |
$557.09
|
| 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: Cofinity Commercial |
$635.13
|
| 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 |
$655.40
|
| Rate for Payer: Healthscope Whirlpool |
$675.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$608.10
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| 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 |
$167.97
|
| 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 |
$554.05
|
| 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 |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| 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/Tiered Network |
$592.02
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$473.64
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| 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 |
$183.85 |
| Max. Negotiated Rate |
$245.14 |
| Rate for Payer: Aetna Commercial |
$220.63
|
| Rate for Payer: ASR ASR |
$237.79
|
| Rate for Payer: BCBS Trust/PPO |
$201.31
|
| Rate for Payer: BCN Commercial |
$201.31
|
| Rate for Payer: Cash Price |
$196.11
|
| Rate for Payer: Cofinity Commercial |
$230.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.11
|
| Rate for Payer: Healthscope Commercial |
$237.79
|
| Rate for Payer: Healthscope Whirlpool |
$245.14
|
| Rate for Payer: Mclaren Commercial |
$220.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.37
|
| Rate for Payer: Nomi Health Commercial |
$201.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.72
|
|
|
HC CHEMODNRV MUSC MIGRAINE BIL
|
Facility
|
OP
|
$245.14
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
36100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$474.07 |
| Rate for Payer: Aetna Commercial |
$220.63
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$237.79
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$202.12
|
| Rate for Payer: BCN Commercial |
$202.12
|
| 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: Cofinity Commercial |
$230.43
|
| 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 |
$237.79
|
| Rate for Payer: Healthscope Whirlpool |
$245.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$220.63
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| 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 |
$167.97
|
| 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 |
$201.01
|
| 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 |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| 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/Tiered Network |
$230.50
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$184.40
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| 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 |
$343.04 |
| Max. Negotiated Rate |
$457.39 |
| Rate for Payer: Aetna Commercial |
$411.65
|
| Rate for Payer: ASR ASR |
$443.67
|
| Rate for Payer: BCBS Trust/PPO |
$375.61
|
| Rate for Payer: BCN Commercial |
$375.61
|
| Rate for Payer: Cash Price |
$365.91
|
| Rate for Payer: Cofinity Commercial |
$429.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.91
|
| Rate for Payer: Healthscope Commercial |
$443.67
|
| Rate for Payer: Healthscope Whirlpool |
$457.39
|
| Rate for Payer: Mclaren Commercial |
$411.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.78
|
| Rate for Payer: Nomi Health Commercial |
$375.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$402.50
|
|
|
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 |
$474.07 |
| Rate for Payer: Aetna Commercial |
$411.65
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$443.67
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$377.12
|
| Rate for Payer: BCN Commercial |
$377.12
|
| 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: Cofinity Commercial |
$429.95
|
| 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 |
$443.67
|
| Rate for Payer: Healthscope Whirlpool |
$457.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$411.65
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| 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 |
$167.97
|
| 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 |
$375.06
|
| 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 |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| 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/Tiered Network |
$255.24
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$204.20
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$402.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
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 |
$532.78 |
| Max. Negotiated Rate |
$710.37 |
| Rate for Payer: Aetna Commercial |
$639.33
|
| Rate for Payer: ASR ASR |
$689.06
|
| Rate for Payer: BCBS Trust/PPO |
$583.36
|
| Rate for Payer: BCN Commercial |
$583.36
|
| Rate for Payer: Cash Price |
$568.30
|
| Rate for Payer: Cofinity Commercial |
$667.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.30
|
| Rate for Payer: Healthscope Commercial |
$689.06
|
| Rate for Payer: Healthscope Whirlpool |
$710.37
|
| Rate for Payer: Mclaren Commercial |
$639.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.81
|
| Rate for Payer: Nomi Health Commercial |
$582.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.13
|
|
|
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 |
$357.45 |
| Max. Negotiated Rate |
$1,090.18 |
| Rate for Payer: Aetna Commercial |
$639.33
|
| Rate for Payer: Aetna Medicare |
$703.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: ASR ASR |
$689.06
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$585.70
|
| Rate for Payer: BCN Commercial |
$585.70
|
| 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: Cofinity Commercial |
$667.75
|
| 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 |
$689.06
|
| Rate for Payer: Healthscope Whirlpool |
$710.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$703.34
|
| Rate for Payer: Mclaren Commercial |
$639.33
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| 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 |
$386.27
|
| 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 |
$582.50
|
| 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 |
$773.67
|
| Rate for Payer: PHP Medicaid |
$376.99
|
| 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/Tiered Network |
$446.82
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Narrow Network |
$357.45
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$1,090.18
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP DNSP |
$703.34
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
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 |
$201.63 |
| Rate for Payer: Aetna Commercial |
$181.47
|
| Rate for Payer: Aetna Medicare |
$46.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: ASR ASR |
$195.58
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$166.24
|
| Rate for Payer: BCN Commercial |
$166.24
|
| 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 Commercial |
$189.53
|
| 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 |
$195.58
|
| Rate for Payer: Healthscope Whirlpool |
$201.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.66
|
| Rate for Payer: Mclaren Commercial |
$181.47
|
| Rate for Payer: Mclaren Medicaid |
$46.66
|
| 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 |
$25.63
|
| 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 |
$165.34
|
| 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 |
$51.33
|
| Rate for Payer: PHP Medicaid |
$25.01
|
| 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/Tiered Network |
$176.67
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health Narrow Network |
$141.34
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$72.32
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP DNSP |
$46.66
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
