|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
OP
|
$386.21
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Aetna Commercial |
$347.59
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$374.62
|
| Rate for Payer: ASR Commercial |
$374.62
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$316.27
|
| Rate for Payer: BCN Commercial |
$299.43
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$363.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$386.21
|
| Rate for Payer: Healthscope Whirlpool |
$374.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$347.59
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$316.69
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.40
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$270.73
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
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: 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 |
$378.35
|
| Rate for Payer: Priority Health Narrow Network |
$302.68
|
| 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
|
OP
|
$671.38
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.22 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$604.24
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$651.24
|
| Rate for Payer: ASR Commercial |
$651.24
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$549.79
|
| Rate for Payer: BCN Commercial |
$520.52
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$537.10
|
| Rate for Payer: Cash Price |
$537.10
|
| Rate for Payer: Cofinity Commercial |
$631.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$671.38
|
| Rate for Payer: Healthscope Whirlpool |
$651.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$604.24
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.67
|
| Rate for Payer: Nomi Health Commercial |
$550.53
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$405.28
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$324.22
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$590.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
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 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 |
$433.72 |
| 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: 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 |
$433.72
|
| Rate for Payer: Priority Health Narrow Network |
$346.98
|
| 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 |
$324.22 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$474.73
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$511.66
|
| Rate for Payer: ASR Commercial |
$511.66
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$431.95
|
| Rate for Payer: BCN Commercial |
$408.96
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$495.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$527.48
|
| Rate for Payer: Healthscope Whirlpool |
$511.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$474.73
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: Nomi Health Commercial |
$432.53
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$405.28
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$324.22
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
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
|
|
|
HC CHEMODNRV MUSC FACIAL
|
Facility
|
OP
|
$541.99
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$541.99 |
| Rate for Payer: Aetna Commercial |
$487.79
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$525.73
|
| Rate for Payer: ASR Commercial |
$525.73
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$443.84
|
| Rate for Payer: BCN Commercial |
$420.20
|
| 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: Cofinity Commercial |
$509.47
|
| 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 |
$541.99
|
| Rate for Payer: Healthscope Whirlpool |
$525.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren 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 |
$444.43
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| 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 |
$474.89
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$379.93
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC CHEMODNRV MUSC FACIAL BIL
|
Facility
|
IP
|
$662.42
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.57 |
| Max. Negotiated Rate |
$662.42 |
| Rate for Payer: Aetna Commercial |
$596.18
|
| Rate for Payer: ASR ASR |
$642.55
|
| Rate for Payer: ASR Commercial |
$642.55
|
| Rate for Payer: BCBS Trust/PPO |
$539.81
|
| Rate for Payer: BCN Commercial |
$513.57
|
| Rate for Payer: Cash Price |
$529.94
|
| Rate for Payer: Cofinity Commercial |
$622.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.94
|
| Rate for Payer: Healthscope Commercial |
$662.42
|
| Rate for Payer: Healthscope Whirlpool |
$642.55
|
| Rate for Payer: Mclaren Commercial |
$596.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.06
|
| Rate for Payer: Nomi Health Commercial |
$543.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$582.93
|
|
|
HC CHEMODNRV MUSC FACIAL BIL
|
Facility
|
OP
|
$662.42
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$662.42 |
| Rate for Payer: Aetna Commercial |
$596.18
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$642.55
|
| Rate for Payer: ASR Commercial |
$642.55
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$542.46
|
| Rate for Payer: BCN Commercial |
$513.57
|
| 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: Cofinity Commercial |
$622.67
|
| 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 |
$662.42
|
| Rate for Payer: Healthscope Whirlpool |
$642.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren 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 |
$543.18
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| 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 |
$580.41
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$464.36
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$582.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| 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 |
$156.21 |
| Max. Negotiated Rate |
$240.33 |
| Rate for Payer: Aetna Commercial |
$216.30
|
| Rate for Payer: ASR ASR |
$233.12
|
| Rate for Payer: ASR Commercial |
$233.12
|
| Rate for Payer: BCBS Trust/PPO |
$195.84
|
| Rate for Payer: BCN Commercial |
$186.33
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cofinity Commercial |
$225.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.26
|
| Rate for Payer: Healthscope Commercial |
$240.33
|
| Rate for Payer: Healthscope Whirlpool |
$233.12
|
| Rate for Payer: Mclaren Commercial |
$216.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.28
|
| Rate for Payer: Nomi Health Commercial |
$197.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.49
|
|
|
HC CHEMODNRV MUSC MIGRAINE BIL
|
Facility
|
OP
|
$240.33
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
36100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Aetna Commercial |
$216.30
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$233.12
|
| Rate for Payer: ASR Commercial |
$233.12
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$196.81
|
| Rate for Payer: BCN Commercial |
$186.33
|
| 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: Cofinity Commercial |
$225.91
|
| 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 |
$240.33
|
| Rate for Payer: Healthscope Whirlpool |
$233.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren 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 |
$197.07
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| 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 |
$209.07
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$167.26
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| 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 |
$291.47 |
| Max. Negotiated Rate |
$448.42 |
| Rate for Payer: Aetna Commercial |
$403.58
|
| Rate for Payer: ASR ASR |
$434.97
|
| Rate for Payer: ASR Commercial |
$434.97
|
| Rate for Payer: BCBS Trust/PPO |
$365.42
|
| Rate for Payer: BCN Commercial |
$347.66
|
| Rate for Payer: Cash Price |
$358.74
|
| Rate for Payer: Cofinity Commercial |
$421.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.74
|
| Rate for Payer: Healthscope Commercial |
$448.42
|
| Rate for Payer: Healthscope Whirlpool |
$434.97
|
| Rate for Payer: Mclaren Commercial |
$403.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.16
|
| Rate for Payer: Nomi Health Commercial |
$367.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$394.61
|
|
|
HC CHEMODNRV MUSC NECK
|
Facility
|
OP
|
$448.42
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
36100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$448.42 |
| Rate for Payer: Aetna Commercial |
$403.58
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$434.97
|
| Rate for Payer: ASR Commercial |
$434.97
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$367.21
|
| Rate for Payer: BCN Commercial |
$347.66
|
| 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: Cofinity Commercial |
$421.51
|
| 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 |
$448.42
|
| Rate for Payer: Healthscope Whirlpool |
$434.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren 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 |
$367.70
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| 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 |
$231.51
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$185.21
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$394.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
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 |
$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 TRUNK MUSC 1-5 MUSC
|
Facility
|
OP
|
$696.44
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
36100453
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$324.22 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$626.80
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$675.55
|
| Rate for Payer: ASR Commercial |
$675.55
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$570.31
|
| Rate for Payer: BCN Commercial |
$539.95
|
| 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: Cofinity Commercial |
$654.65
|
| 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 |
$696.44
|
| Rate for Payer: Healthscope Whirlpool |
$675.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren 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 |
$571.08
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| 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 |
$405.28
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$324.22
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$612.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| 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 |
$197.68 |
| Rate for Payer: Aetna Commercial |
$177.91
|
| Rate for Payer: Aetna Medicare |
$45.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: ASR ASR |
$191.75
|
| Rate for Payer: ASR Commercial |
$191.75
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$161.88
|
| Rate for Payer: BCN Commercial |
$153.26
|
| 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 |
$185.82
|
| 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 |
$197.68
|
| Rate for Payer: Healthscope Whirlpool |
$191.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.21
|
| Rate for Payer: Mclaren 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 |
$162.10
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$49.73
|
| Rate for Payer: PHP Medicaid |
$24.23
|
| 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 |
$173.21
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$138.57
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$70.08
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP DNSP |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$24.23
|
| 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 |
$128.49 |
| Max. Negotiated Rate |
$197.68 |
| Rate for Payer: Aetna Commercial |
$177.91
|
| Rate for Payer: ASR ASR |
$191.75
|
| Rate for Payer: ASR Commercial |
$191.75
|
| Rate for Payer: BCBS Trust/PPO |
$161.09
|
| Rate for Payer: BCN Commercial |
$153.26
|
| Rate for Payer: Cash Price |
$158.14
|
| Rate for Payer: Cofinity Commercial |
$185.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.14
|
| Rate for Payer: Healthscope Commercial |
$197.68
|
| Rate for Payer: Healthscope Whirlpool |
$191.75
|
| Rate for Payer: Mclaren Commercial |
$177.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.03
|
| Rate for Payer: Nomi Health Commercial |
$162.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.96
|
|
|
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 |
$170.38 |
| Max. Negotiated Rate |
$262.13 |
| Rate for Payer: Aetna Commercial |
$235.92
|
| Rate for Payer: ASR ASR |
$254.27
|
| Rate for Payer: ASR Commercial |
$254.27
|
| Rate for Payer: BCBS Trust/PPO |
$213.61
|
| Rate for Payer: BCN Commercial |
$203.23
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cofinity Commercial |
$246.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.70
|
| Rate for Payer: Healthscope Commercial |
$262.13
|
| Rate for Payer: Healthscope Whirlpool |
$254.27
|
| Rate for Payer: Mclaren Commercial |
$235.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.81
|
| Rate for Payer: Nomi Health Commercial |
$214.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.67
|
|
|
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 |
$37.38 |
| Max. Negotiated Rate |
$262.13 |
| Rate for Payer: Aetna Commercial |
$235.92
|
| Rate for Payer: Aetna Medicare |
$69.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: ASR ASR |
$254.27
|
| Rate for Payer: ASR Commercial |
$254.27
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$214.66
|
| Rate for Payer: BCN Commercial |
$203.23
|
| 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 |
$246.40
|
| 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 |
$262.13
|
| Rate for Payer: Healthscope Whirlpool |
$254.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$69.73
|
| Rate for Payer: Mclaren 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 |
$214.95
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: PHP Medicaid |
$37.38
|
| 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 |
$109.79
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$87.83
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$108.08
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP DNSP |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$37.38
|
| 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 |
$633.08 |
| Max. Negotiated Rate |
$973.97 |
| Rate for Payer: Aetna Commercial |
$876.57
|
| Rate for Payer: ASR ASR |
$944.75
|
| Rate for Payer: ASR Commercial |
$944.75
|
| Rate for Payer: BCBS Trust/PPO |
$793.69
|
| Rate for Payer: BCN Commercial |
$755.12
|
| Rate for Payer: Cash Price |
$779.18
|
| Rate for Payer: Cofinity Commercial |
$915.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.18
|
| Rate for Payer: Healthscope Commercial |
$973.97
|
| Rate for Payer: Healthscope Whirlpool |
$944.75
|
| Rate for Payer: Mclaren Commercial |
$876.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$827.87
|
| Rate for Payer: Nomi Health Commercial |
$798.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$857.09
|
|
|
HC CHEMO INFUSION FIRST HR
|
Facility
|
OP
|
$973.97
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
33500001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$174.19 |
| Max. Negotiated Rate |
$973.97 |
| Rate for Payer: Aetna Commercial |
$876.57
|
| Rate for Payer: Aetna Medicare |
$324.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: ASR ASR |
$944.75
|
| Rate for Payer: ASR Commercial |
$944.75
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$797.58
|
| Rate for Payer: BCN Commercial |
$755.12
|
| 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 |
$915.53
|
| 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 |
$973.97
|
| Rate for Payer: Healthscope Whirlpool |
$944.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$324.98
|
| Rate for Payer: Mclaren 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 |
$798.66
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Commercial |
$357.48
|
| Rate for Payer: PHP Medicaid |
$174.19
|
| 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 |
$483.13
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$386.50
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$857.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$503.72
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP DNSP |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$174.19
|
| Rate for Payer: VA VA |
$324.98
|
|
