|
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 |
$22.32 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: Aetna Medicare |
$11.16
|
| Rate for Payer: ASR ASR |
$21.65
|
| Rate for Payer: ASR Commercial |
$21.65
|
| Rate for Payer: BCBS Complete |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$18.28
|
| Rate for Payer: BCN Commercial |
$17.30
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$20.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.86
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Healthscope Whirlpool |
$21.65
|
| Rate for Payer: Mclaren Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.97
|
| Rate for Payer: Nomi Health Commercial |
$18.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.56
|
| Rate for Payer: Priority Health Narrow Network |
$15.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.64
|
|
|
HC CHAMBER HOLDING OPTI CHAMBER
|
Facility
|
IP
|
$22.32
|
|
| Hospital Charge Code |
27000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.51 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: ASR ASR |
$21.65
|
| Rate for Payer: ASR Commercial |
$21.65
|
| Rate for Payer: BCBS Trust/PPO |
$18.19
|
| Rate for Payer: BCN Commercial |
$17.30
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$20.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.86
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Healthscope Whirlpool |
$21.65
|
| Rate for Payer: Mclaren Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.97
|
| Rate for Payer: Nomi Health Commercial |
$18.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.64
|
|
|
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 |
$660.71 |
| Max. Negotiated Rate |
$1,016.47 |
| Rate for Payer: Aetna Commercial |
$914.82
|
| Rate for Payer: ASR ASR |
$985.98
|
| Rate for Payer: ASR Commercial |
$985.98
|
| Rate for Payer: BCBS Trust/PPO |
$828.32
|
| Rate for Payer: BCN Commercial |
$788.07
|
| Rate for Payer: Cash Price |
$813.18
|
| Rate for Payer: Cofinity Commercial |
$955.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.18
|
| Rate for Payer: Healthscope Commercial |
$1,016.47
|
| Rate for Payer: Healthscope Whirlpool |
$985.98
|
| Rate for Payer: Mclaren Commercial |
$914.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$864.00
|
| Rate for Payer: Nomi Health Commercial |
$833.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$894.49
|
|
|
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 |
$348.92 |
| Max. Negotiated Rate |
$1,016.47 |
| Rate for Payer: Aetna Commercial |
$914.82
|
| Rate for Payer: Aetna Medicare |
$650.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: ASR ASR |
$985.98
|
| Rate for Payer: ASR Commercial |
$985.98
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCBS Trust/PPO |
$832.39
|
| Rate for Payer: BCN Commercial |
$788.07
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$813.18
|
| Rate for Payer: Cash Price |
$813.18
|
| Rate for Payer: Cofinity Commercial |
$955.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$1,016.47
|
| Rate for Payer: Healthscope Whirlpool |
$985.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$650.97
|
| Rate for Payer: Mclaren Commercial |
$914.82
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$864.00
|
| Rate for Payer: Nomi Health Commercial |
$833.51
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$716.07
|
| Rate for Payer: PHP Medicaid |
$348.92
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$890.63
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health Narrow Network |
$712.55
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$894.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Exchange |
$1,009.00
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP DNSP |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$348.92
|
| Rate for Payer: VA VA |
$650.97
|
|
|
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 |
$3,721.58 |
| Rate for Payer: Aetna Commercial |
$3,349.42
|
| Rate for Payer: Aetna Medicare |
$1,860.79
|
| Rate for Payer: ASR ASR |
$3,609.93
|
| Rate for Payer: ASR Commercial |
$3,609.93
|
| Rate for Payer: BCBS Complete |
$1,488.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,047.60
|
| Rate for Payer: BCN Commercial |
$2,885.34
|
| Rate for Payer: Cash Price |
$2,977.26
|
| Rate for Payer: Cofinity Commercial |
$3,498.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,977.26
|
| Rate for Payer: Healthscope Commercial |
$3,721.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,609.93
|
| Rate for Payer: Mclaren Commercial |
$3,349.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,163.34
|
| Rate for Payer: Nomi Health Commercial |
$3,051.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,419.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,260.85
|
| Rate for Payer: Priority Health Narrow Network |
$2,608.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,274.99
|
|
|
HC CHANNEL RFA ENDO CATHETER
|
Facility
|
IP
|
$3,721.58
|
|
| Hospital Charge Code |
27200289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,419.03 |
| Max. Negotiated Rate |
$3,721.58 |
| Rate for Payer: Aetna Commercial |
$3,349.42
|
| Rate for Payer: ASR ASR |
$3,609.93
|
| Rate for Payer: ASR Commercial |
$3,609.93
|
| Rate for Payer: BCBS Trust/PPO |
$3,032.72
|
| Rate for Payer: BCN Commercial |
$2,885.34
|
| Rate for Payer: Cash Price |
$2,977.26
|
| Rate for Payer: Cofinity Commercial |
$3,498.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,977.26
|
| Rate for Payer: Healthscope Commercial |
$3,721.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,609.93
|
| Rate for Payer: Mclaren Commercial |
$3,349.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,163.34
|
| Rate for Payer: Nomi Health Commercial |
$3,051.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,419.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,274.99
|
|
|
HC CHEM CAUTERY GRANULATION TISSUE
|
Facility
|
IP
|
$296.74
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.88 |
| Max. Negotiated Rate |
$296.74 |
| Rate for Payer: Aetna Commercial |
$267.07
|
| Rate for Payer: ASR ASR |
$287.84
|
| Rate for Payer: ASR Commercial |
$287.84
|
| Rate for Payer: BCBS Trust/PPO |
$241.81
|
| Rate for Payer: BCN Commercial |
$230.06
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cofinity Commercial |
$278.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.39
|
| Rate for Payer: Healthscope Commercial |
$296.74
|
| Rate for Payer: Healthscope Whirlpool |
$287.84
|
| Rate for Payer: Mclaren Commercial |
$267.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.23
|
| Rate for Payer: Nomi Health Commercial |
$243.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.13
|
|
|
HC CHEM CAUTERY GRANULATION TISSUE
|
Facility
|
OP
|
$296.74
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$300.37 |
| Rate for Payer: Aetna Commercial |
$267.07
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$287.84
|
| Rate for Payer: ASR Commercial |
$287.84
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$243.00
|
| Rate for Payer: BCN Commercial |
$230.06
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cofinity Commercial |
$278.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$296.74
|
| Rate for Payer: Healthscope Whirlpool |
$287.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$267.07
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.23
|
| Rate for Payer: Nomi Health Commercial |
$243.33
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.00
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$208.01
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
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 |
$731.91 |
| Max. Negotiated Rate |
$1,126.02 |
| Rate for Payer: Aetna Commercial |
$1,013.42
|
| Rate for Payer: ASR ASR |
$1,092.24
|
| Rate for Payer: ASR Commercial |
$1,092.24
|
| Rate for Payer: BCBS Trust/PPO |
$917.59
|
| Rate for Payer: BCN Commercial |
$873.00
|
| Rate for Payer: Cash Price |
$900.82
|
| Rate for Payer: Cofinity Commercial |
$1,058.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.82
|
| Rate for Payer: Healthscope Commercial |
$1,126.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,092.24
|
| Rate for Payer: Mclaren Commercial |
$1,013.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$957.12
|
| Rate for Payer: Nomi Health Commercial |
$923.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.90
|
|
|
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 |
$173.39 |
| Max. Negotiated Rate |
$1,126.02 |
| Rate for Payer: Aetna Commercial |
$1,013.42
|
| Rate for Payer: Aetna Medicare |
$323.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.36
|
| Rate for Payer: ASR ASR |
$1,092.24
|
| Rate for Payer: ASR Commercial |
$1,092.24
|
| Rate for Payer: BCBS Complete |
$182.06
|
| Rate for Payer: BCBS MAPPO |
$323.49
|
| Rate for Payer: BCBS Trust/PPO |
$922.10
|
| Rate for Payer: BCN Commercial |
$873.00
|
| Rate for Payer: BCN Medicare Advantage |
$323.49
|
| Rate for Payer: Cash Price |
$900.82
|
| Rate for Payer: Cash Price |
$900.82
|
| Rate for Payer: Cofinity Commercial |
$1,058.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.49
|
| Rate for Payer: Healthscope Commercial |
$1,126.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,092.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$323.49
|
| Rate for Payer: Mclaren Commercial |
$1,013.42
|
| Rate for Payer: Mclaren Medicaid |
$173.39
|
| Rate for Payer: Mclaren Medicare |
$323.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.66
|
| Rate for Payer: Meridian Medicaid |
$182.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$957.12
|
| Rate for Payer: Nomi Health Commercial |
$923.34
|
| Rate for Payer: PACE Medicare |
$307.32
|
| Rate for Payer: PACE SWMI |
$323.49
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: PHP Medicaid |
$173.39
|
| Rate for Payer: PHP Medicare Advantage |
$323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$986.62
|
| Rate for Payer: Priority Health Medicare |
$323.49
|
| Rate for Payer: Priority Health Narrow Network |
$789.34
|
| Rate for Payer: Railroad Medicare Medicare |
$323.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.49
|
| Rate for Payer: UHC Exchange |
$501.41
|
| Rate for Payer: UHC Medicare Advantage |
$323.49
|
| Rate for Payer: UHCCP DNSP |
$323.49
|
| Rate for Payer: UHCCP Medicaid |
$173.39
|
| Rate for Payer: VA VA |
$323.49
|
|
|
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 |
$616.36 |
| Max. Negotiated Rate |
$3,203.25 |
| Rate for Payer: Aetna Commercial |
$2,882.93
|
| Rate for Payer: Aetna Medicare |
$1,149.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: ASR ASR |
$3,107.15
|
| Rate for Payer: ASR Commercial |
$3,107.15
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,623.14
|
| Rate for Payer: BCN Commercial |
$2,483.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cofinity Commercial |
$3,011.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,562.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Healthscope Commercial |
$3,203.25
|
| Rate for Payer: Healthscope Whirlpool |
$3,107.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,149.93
|
| Rate for Payer: Mclaren Commercial |
$2,882.93
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,722.76
|
| Rate for Payer: Nomi Health Commercial |
$2,626.66
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Commercial |
$1,264.92
|
| Rate for Payer: PHP Medicaid |
$616.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,082.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,806.69
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,245.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,818.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$1,782.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP DNSP |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
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 |
$2,082.11 |
| Max. Negotiated Rate |
$3,203.25 |
| Rate for Payer: Aetna Commercial |
$2,882.93
|
| Rate for Payer: ASR ASR |
$3,107.15
|
| Rate for Payer: ASR Commercial |
$3,107.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,610.33
|
| Rate for Payer: BCN Commercial |
$2,483.48
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cofinity Commercial |
$3,011.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,562.60
|
| Rate for Payer: Healthscope Commercial |
$3,203.25
|
| Rate for Payer: Healthscope Whirlpool |
$3,107.15
|
| Rate for Payer: Mclaren Commercial |
$2,882.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,722.76
|
| Rate for Payer: Nomi Health Commercial |
$2,626.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,082.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,818.86
|
|
|
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 |
$362.01 |
| Max. Negotiated Rate |
$1,955.95 |
| Rate for Payer: Aetna Commercial |
$1,760.36
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$1,897.27
|
| Rate for Payer: ASR Commercial |
$1,897.27
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,601.73
|
| Rate for Payer: BCN Commercial |
$1,516.45
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cofinity Commercial |
$1,838.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,564.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$1,955.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,897.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$1,760.36
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,662.56
|
| Rate for Payer: Nomi Health Commercial |
$1,603.88
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,271.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,713.80
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,371.12
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,721.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
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 |
$1,271.37 |
| Max. Negotiated Rate |
$1,955.95 |
| Rate for Payer: Aetna Commercial |
$1,760.36
|
| Rate for Payer: ASR ASR |
$1,897.27
|
| Rate for Payer: ASR Commercial |
$1,897.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.90
|
| Rate for Payer: BCN Commercial |
$1,516.45
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cofinity Commercial |
$1,838.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,564.76
|
| Rate for Payer: Healthscope Commercial |
$1,955.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,897.27
|
| Rate for Payer: Mclaren Commercial |
$1,760.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,662.56
|
| Rate for Payer: Nomi Health Commercial |
$1,603.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,271.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,721.24
|
|
|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
IP
|
$386.21
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.04 |
| Max. Negotiated Rate |
$386.21 |
| Rate for Payer: Aetna Commercial |
$347.59
|
| Rate for Payer: ASR ASR |
$374.62
|
| Rate for Payer: ASR Commercial |
$374.62
|
| Rate for Payer: BCBS Trust/PPO |
$314.72
|
| Rate for Payer: BCN Commercial |
$299.43
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$363.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Healthscope Commercial |
$386.21
|
| Rate for Payer: Healthscope Whirlpool |
$374.62
|
| Rate for Payer: Mclaren Commercial |
$347.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$316.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.86
|
|
|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
OP
|
$386.21
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$446.23 |
| Rate for Payer: Aetna Commercial |
$347.59
|
| Rate for Payer: Aetna Medicare |
$287.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: ASR ASR |
$374.62
|
| Rate for Payer: ASR Commercial |
$374.62
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCBS Trust/PPO |
$316.27
|
| Rate for Payer: BCN Commercial |
$299.43
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$363.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$386.21
|
| Rate for Payer: Healthscope Whirlpool |
$374.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$287.89
|
| Rate for Payer: Mclaren Commercial |
$347.59
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$316.69
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$316.68
|
| Rate for Payer: PHP Medicaid |
$154.31
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.40
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health Narrow Network |
$270.73
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$446.23
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP DNSP |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: VA VA |
$287.89
|
|
|
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 |
$278.58 |
| Max. Negotiated Rate |
$696.44 |
| Rate for Payer: Aetna Commercial |
$626.80
|
| Rate for Payer: Aetna Medicare |
$348.22
|
| Rate for Payer: ASR ASR |
$675.55
|
| Rate for Payer: ASR Commercial |
$675.55
|
| Rate for Payer: BCBS Complete |
$278.58
|
| Rate for Payer: BCBS Trust/PPO |
$570.31
|
| Rate for Payer: BCN Commercial |
$539.95
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Cofinity Commercial |
$654.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.15
|
| Rate for Payer: Healthscope Commercial |
$696.44
|
| Rate for Payer: Healthscope Whirlpool |
$675.55
|
| Rate for Payer: Mclaren Commercial |
$626.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$591.97
|
| Rate for Payer: Nomi Health Commercial |
$571.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$610.22
|
| Rate for Payer: Priority Health Narrow Network |
$488.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$612.87
|
|
|
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 |
$452.69 |
| Max. Negotiated Rate |
$696.44 |
| Rate for Payer: Aetna Commercial |
$626.80
|
| Rate for Payer: ASR ASR |
$675.55
|
| Rate for Payer: ASR Commercial |
$675.55
|
| Rate for Payer: BCBS Trust/PPO |
$567.53
|
| Rate for Payer: BCN Commercial |
$539.95
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Cofinity Commercial |
$654.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.15
|
| Rate for Payer: Healthscope Commercial |
$696.44
|
| Rate for Payer: Healthscope Whirlpool |
$675.55
|
| Rate for Payer: Mclaren Commercial |
$626.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$591.97
|
| Rate for Payer: Nomi Health Commercial |
$571.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$612.87
|
|
|
HC CHEMODNRV EXT1-4 MUSC
|
Facility
|
IP
|
$671.38
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$436.40 |
| Max. Negotiated Rate |
$671.38 |
| Rate for Payer: Aetna Commercial |
$604.24
|
| Rate for Payer: ASR ASR |
$651.24
|
| Rate for Payer: ASR Commercial |
$651.24
|
| Rate for Payer: BCBS Trust/PPO |
$547.11
|
| Rate for Payer: BCN Commercial |
$520.52
|
| Rate for Payer: Cash Price |
$537.10
|
| Rate for Payer: Cofinity Commercial |
$631.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.10
|
| Rate for Payer: Healthscope Commercial |
$671.38
|
| Rate for Payer: Healthscope Whirlpool |
$651.24
|
| Rate for Payer: Mclaren Commercial |
$604.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.67
|
| Rate for Payer: Nomi Health Commercial |
$550.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$590.81
|
|
|
HC CHEMODNRV EXT1-4 MUSC
|
Facility
|
OP
|
$671.38
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.01 |
| Max. Negotiated Rate |
$1,046.87 |
| Rate for Payer: Aetna Commercial |
$604.24
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$651.24
|
| Rate for Payer: ASR Commercial |
$651.24
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$549.79
|
| Rate for Payer: BCN Commercial |
$520.52
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$537.10
|
| Rate for Payer: Cash Price |
$537.10
|
| Rate for Payer: Cofinity Commercial |
$631.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$671.38
|
| Rate for Payer: Healthscope Whirlpool |
$651.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$604.24
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.67
|
| Rate for Payer: Nomi Health Commercial |
$550.53
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$588.26
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$470.64
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$590.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
HC CHEMODNRV EXTREMITY 5/< MUSCLES
|
Facility
|
IP
|
$115.59
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
36100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$115.59 |
| Rate for Payer: Aetna Commercial |
$104.03
|
| Rate for Payer: ASR ASR |
$112.12
|
| Rate for Payer: ASR Commercial |
$112.12
|
| Rate for Payer: BCBS Trust/PPO |
$94.19
|
| Rate for Payer: BCN Commercial |
$89.62
|
| Rate for Payer: Cash Price |
$92.47
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.47
|
| Rate for Payer: Healthscope Commercial |
$115.59
|
| Rate for Payer: Healthscope Whirlpool |
$112.12
|
| Rate for Payer: Mclaren Commercial |
$104.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.25
|
| Rate for Payer: Nomi Health Commercial |
$94.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.72
|
|
|
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 |
$115.59 |
| Rate for Payer: Aetna Commercial |
$104.03
|
| Rate for Payer: Aetna Medicare |
$57.80
|
| Rate for Payer: ASR ASR |
$112.12
|
| Rate for Payer: ASR Commercial |
$112.12
|
| Rate for Payer: BCBS Complete |
$46.24
|
| Rate for Payer: BCBS Trust/PPO |
$94.66
|
| Rate for Payer: BCN Commercial |
$89.62
|
| Rate for Payer: Cash Price |
$92.47
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.47
|
| Rate for Payer: Healthscope Commercial |
$115.59
|
| Rate for Payer: Healthscope Whirlpool |
$112.12
|
| Rate for Payer: Mclaren Commercial |
$104.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.25
|
| Rate for Payer: Nomi Health Commercial |
$94.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.28
|
| Rate for Payer: Priority Health Narrow Network |
$81.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.72
|
|
|
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 |
$342.86 |
| Max. Negotiated Rate |
$1,046.87 |
| Rate for Payer: Aetna Commercial |
$474.73
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$511.66
|
| Rate for Payer: ASR Commercial |
$511.66
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$431.95
|
| Rate for Payer: BCN Commercial |
$408.96
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$495.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$527.48
|
| Rate for Payer: Healthscope Whirlpool |
$511.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$474.73
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: Nomi Health Commercial |
$432.53
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$462.18
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$369.76
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
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 |
$342.86 |
| Max. Negotiated Rate |
$527.48 |
| Rate for Payer: Aetna Commercial |
$474.73
|
| Rate for Payer: ASR ASR |
$511.66
|
| Rate for Payer: ASR Commercial |
$511.66
|
| Rate for Payer: BCBS Trust/PPO |
$429.84
|
| Rate for Payer: BCN Commercial |
$408.96
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$495.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Healthscope Commercial |
$527.48
|
| Rate for Payer: Healthscope Whirlpool |
$511.66
|
| Rate for Payer: Mclaren Commercial |
$474.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: Nomi Health Commercial |
$432.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.18
|
|
|
HC CHEMODNRV MUSC FACIAL
|
Facility
|
IP
|
$541.99
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.29 |
| Max. Negotiated Rate |
$541.99 |
| Rate for Payer: Aetna Commercial |
$487.79
|
| Rate for Payer: ASR ASR |
$525.73
|
| Rate for Payer: ASR Commercial |
$525.73
|
| Rate for Payer: BCBS Trust/PPO |
$441.67
|
| Rate for Payer: BCN Commercial |
$420.20
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cofinity Commercial |
$509.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.59
|
| Rate for Payer: Healthscope Commercial |
$541.99
|
| Rate for Payer: Healthscope Whirlpool |
$525.73
|
| Rate for Payer: Mclaren Commercial |
$487.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.69
|
| Rate for Payer: Nomi Health Commercial |
$444.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.95
|
|
