|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
OP
|
$190.73
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$171.66 |
| Rate for Payer: Aetna Commercial |
$162.12
|
| Rate for Payer: Aetna Medicare |
$43.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.84
|
| Rate for Payer: BCBS Complete |
$24.28
|
| Rate for Payer: BCBS MAPPO |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$83.36
|
| Rate for Payer: BCN Medicare Advantage |
$42.27
|
| Rate for Payer: Cash Price |
$152.58
|
| Rate for Payer: Cash Price |
$152.58
|
| Rate for Payer: Cofinity Commercial |
$164.03
|
| Rate for Payer: Cofinity Commercial |
$133.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.27
|
| Rate for Payer: Healthscope Commercial |
$171.66
|
| Rate for Payer: Mclaren Medicaid |
$23.12
|
| Rate for Payer: Mclaren Medicare |
$42.27
|
| Rate for Payer: Meridian Medicaid |
$24.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.12
|
| Rate for Payer: PACE Medicare |
$40.16
|
| Rate for Payer: PACE SWMI |
$42.27
|
| Rate for Payer: PHP Commercial |
$162.12
|
| Rate for Payer: PHP Medicare Advantage |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.59
|
| Rate for Payer: Priority Health Medicare |
$42.27
|
| Rate for Payer: Priority Health Narrow Network |
$99.67
|
| Rate for Payer: Priority Health SBD |
$120.16
|
| Rate for Payer: Railroad Medicare Medicare |
$42.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.27
|
| Rate for Payer: UHC Exchange |
$19.97
|
| Rate for Payer: UHC Medicare Advantage |
$43.54
|
| Rate for Payer: VA VA |
$42.27
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
OP
|
$524.29
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$636.96 |
| Rate for Payer: Aetna Commercial |
$445.65
|
| Rate for Payer: Aetna Medicare |
$198.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.40
|
| Rate for Payer: BCBS Complete |
$109.55
|
| Rate for Payer: BCBS MAPPO |
$190.72
|
| Rate for Payer: BCBS Trust/PPO |
$260.99
|
| Rate for Payer: BCN Medicare Advantage |
$190.72
|
| Rate for Payer: Cash Price |
$419.43
|
| Rate for Payer: Cash Price |
$419.43
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.72
|
| Rate for Payer: Healthscope Commercial |
$471.86
|
| Rate for Payer: Mclaren Medicaid |
$104.32
|
| Rate for Payer: Mclaren Medicare |
$190.72
|
| Rate for Payer: Meridian Medicaid |
$109.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.65
|
| Rate for Payer: PACE Medicare |
$181.18
|
| Rate for Payer: PACE SWMI |
$190.72
|
| Rate for Payer: PHP Commercial |
$445.65
|
| Rate for Payer: PHP Medicare Advantage |
$190.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$636.96
|
| Rate for Payer: Priority Health Medicare |
$190.72
|
| Rate for Payer: Priority Health Narrow Network |
$509.57
|
| Rate for Payer: Priority Health SBD |
$330.30
|
| Rate for Payer: Railroad Medicare Medicare |
$190.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.72
|
| Rate for Payer: UHC Exchange |
$61.56
|
| Rate for Payer: UHC Medicare Advantage |
$196.44
|
| Rate for Payer: VA VA |
$190.72
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
IP
|
$524.29
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$330.30 |
| Max. Negotiated Rate |
$471.86 |
| Rate for Payer: Aetna Commercial |
$445.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.79
|
| Rate for Payer: Cash Price |
$419.43
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.89
|
| Rate for Payer: Healthscope Commercial |
$471.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.65
|
| Rate for Payer: PHP Commercial |
$445.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health SBD |
$330.30
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
OP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.43
|
| Rate for Payer: BCBS Complete |
$33.50
|
| Rate for Payer: BCBS Trust/PPO |
$7.64
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$58.62
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: Priority Health SBD |
$52.76
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
IP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.76 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.43
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$58.62
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: Priority Health SBD |
$52.76
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
IP
|
$85.72
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$77.15 |
| Rate for Payer: Aetna Commercial |
$72.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.72
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$73.72
|
| Rate for Payer: Healthscope Commercial |
$77.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.86
|
| Rate for Payer: PHP Commercial |
$72.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.00
|
| Rate for Payer: Priority Health SBD |
$54.00
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
OP
|
$85.72
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$77.15 |
| Rate for Payer: Aetna Commercial |
$72.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.72
|
| Rate for Payer: BCBS Complete |
$34.29
|
| Rate for Payer: BCBS Trust/PPO |
$3.98
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$73.72
|
| Rate for Payer: Healthscope Commercial |
$77.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.86
|
| Rate for Payer: PHP Commercial |
$72.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.00
|
| Rate for Payer: Priority Health SBD |
$54.00
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
OP
|
$164.43
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$147.99 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Aetna Medicare |
$43.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.84
|
| Rate for Payer: BCBS Complete |
$24.28
|
| Rate for Payer: BCBS MAPPO |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$62.85
|
| Rate for Payer: BCN Medicare Advantage |
$42.27
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$115.10
|
| Rate for Payer: Cofinity Commercial |
$141.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.27
|
| Rate for Payer: Healthscope Commercial |
$147.99
|
| Rate for Payer: Mclaren Medicaid |
$23.12
|
| Rate for Payer: Mclaren Medicare |
$42.27
|
| Rate for Payer: Meridian Medicaid |
$24.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.77
|
| Rate for Payer: PACE Medicare |
$40.16
|
| Rate for Payer: PACE SWMI |
$42.27
|
| Rate for Payer: PHP Commercial |
$139.77
|
| Rate for Payer: PHP Medicare Advantage |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.59
|
| Rate for Payer: Priority Health Medicare |
$42.27
|
| Rate for Payer: Priority Health Narrow Network |
$99.67
|
| Rate for Payer: Priority Health SBD |
$103.59
|
| Rate for Payer: Railroad Medicare Medicare |
$42.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.27
|
| Rate for Payer: UHC Exchange |
$15.06
|
| Rate for Payer: UHC Medicare Advantage |
$43.54
|
| Rate for Payer: VA VA |
$42.27
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
IP
|
$164.43
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.59 |
| Max. Negotiated Rate |
$147.99 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.88
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$115.10
|
| Rate for Payer: Cofinity Commercial |
$141.41
|
| Rate for Payer: Healthscope Commercial |
$147.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.77
|
| Rate for Payer: PHP Commercial |
$139.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.10
|
| Rate for Payer: Priority Health SBD |
$103.59
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
IP
|
$151.79
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.63 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.66
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.02
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.25
|
| Rate for Payer: Priority Health SBD |
$95.63
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
OP
|
$151.79
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.66
|
| Rate for Payer: BCBS Complete |
$60.72
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.02
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.25
|
| Rate for Payer: Priority Health SBD |
$95.63
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
IP
|
$365.26
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$230.11 |
| Max. Negotiated Rate |
$328.73 |
| Rate for Payer: Aetna Commercial |
$310.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.42
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cofinity Commercial |
$255.68
|
| Rate for Payer: Cofinity Commercial |
$314.12
|
| Rate for Payer: Healthscope Commercial |
$328.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.47
|
| Rate for Payer: PHP Commercial |
$310.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.68
|
| Rate for Payer: Priority Health SBD |
$230.11
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
OP
|
$365.26
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$328.73 |
| Rate for Payer: Aetna Commercial |
$310.47
|
| Rate for Payer: Aetna Medicare |
$65.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.35
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$62.68
|
| Rate for Payer: BCBS Trust/PPO |
$225.46
|
| Rate for Payer: BCN Medicare Advantage |
$62.68
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cofinity Commercial |
$314.12
|
| Rate for Payer: Cofinity Commercial |
$255.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.68
|
| Rate for Payer: Healthscope Commercial |
$328.73
|
| Rate for Payer: Mclaren Medicaid |
$34.29
|
| Rate for Payer: Mclaren Medicare |
$62.68
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.47
|
| Rate for Payer: PACE Medicare |
$59.55
|
| Rate for Payer: PACE SWMI |
$62.68
|
| Rate for Payer: PHP Commercial |
$310.47
|
| Rate for Payer: PHP Medicare Advantage |
$62.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.04
|
| Rate for Payer: Priority Health Medicare |
$62.68
|
| Rate for Payer: Priority Health Narrow Network |
$154.43
|
| Rate for Payer: Priority Health SBD |
$230.11
|
| Rate for Payer: Railroad Medicare Medicare |
$62.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.68
|
| Rate for Payer: UHC Exchange |
$53.37
|
| Rate for Payer: UHC Medicare Advantage |
$64.56
|
| Rate for Payer: VA VA |
$62.68
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
IP
|
$669.39
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$421.72 |
| Max. Negotiated Rate |
$602.45 |
| Rate for Payer: Aetna Commercial |
$568.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.10
|
| Rate for Payer: Cash Price |
$535.51
|
| Rate for Payer: Cofinity Commercial |
$468.57
|
| Rate for Payer: Cofinity Commercial |
$575.68
|
| Rate for Payer: Healthscope Commercial |
$602.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.98
|
| Rate for Payer: PHP Commercial |
$568.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.57
|
| Rate for Payer: Priority Health SBD |
$421.72
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
OP
|
$669.39
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$98.23 |
| Max. Negotiated Rate |
$636.96 |
| Rate for Payer: Aetna Commercial |
$568.98
|
| Rate for Payer: Aetna Medicare |
$313.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.68
|
| Rate for Payer: BCBS Complete |
$173.09
|
| Rate for Payer: BCBS MAPPO |
$301.34
|
| Rate for Payer: BCBS Trust/PPO |
$411.29
|
| Rate for Payer: BCN Medicare Advantage |
$301.34
|
| Rate for Payer: Cash Price |
$535.51
|
| Rate for Payer: Cash Price |
$535.51
|
| Rate for Payer: Cofinity Commercial |
$575.68
|
| Rate for Payer: Cofinity Commercial |
$468.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.34
|
| Rate for Payer: Healthscope Commercial |
$602.45
|
| Rate for Payer: Mclaren Medicaid |
$164.83
|
| Rate for Payer: Mclaren Medicare |
$301.34
|
| Rate for Payer: Meridian Medicaid |
$173.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.98
|
| Rate for Payer: PACE Medicare |
$286.27
|
| Rate for Payer: PACE SWMI |
$301.34
|
| Rate for Payer: PHP Commercial |
$568.98
|
| Rate for Payer: PHP Medicare Advantage |
$301.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$636.96
|
| Rate for Payer: Priority Health Medicare |
$301.34
|
| Rate for Payer: Priority Health Narrow Network |
$509.57
|
| Rate for Payer: Priority Health SBD |
$421.72
|
| Rate for Payer: Railroad Medicare Medicare |
$301.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.34
|
| Rate for Payer: UHC Exchange |
$98.23
|
| Rate for Payer: UHC Medicare Advantage |
$310.38
|
| Rate for Payer: VA VA |
$301.34
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
IP
|
$277.09
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.57 |
| Max. Negotiated Rate |
$249.38 |
| Rate for Payer: Aetna Commercial |
$235.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.11
|
| Rate for Payer: Cash Price |
$221.67
|
| Rate for Payer: Cofinity Commercial |
$193.96
|
| Rate for Payer: Cofinity Commercial |
$238.30
|
| Rate for Payer: Healthscope Commercial |
$249.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.53
|
| Rate for Payer: PHP Commercial |
$235.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.96
|
| Rate for Payer: Priority Health SBD |
$174.57
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
OP
|
$277.09
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$636.96 |
| Rate for Payer: Aetna Commercial |
$235.53
|
| Rate for Payer: Aetna Medicare |
$198.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.40
|
| Rate for Payer: BCBS Complete |
$109.55
|
| Rate for Payer: BCBS MAPPO |
$190.72
|
| Rate for Payer: BCBS Trust/PPO |
$151.67
|
| Rate for Payer: BCN Medicare Advantage |
$190.72
|
| Rate for Payer: Cash Price |
$221.67
|
| Rate for Payer: Cash Price |
$221.67
|
| Rate for Payer: Cofinity Commercial |
$238.30
|
| Rate for Payer: Cofinity Commercial |
$193.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.72
|
| Rate for Payer: Healthscope Commercial |
$249.38
|
| Rate for Payer: Mclaren Medicaid |
$104.32
|
| Rate for Payer: Mclaren Medicare |
$190.72
|
| Rate for Payer: Meridian Medicaid |
$109.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.53
|
| Rate for Payer: PACE Medicare |
$181.18
|
| Rate for Payer: PACE SWMI |
$190.72
|
| Rate for Payer: PHP Commercial |
$235.53
|
| Rate for Payer: PHP Medicare Advantage |
$190.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$636.96
|
| Rate for Payer: Priority Health Medicare |
$190.72
|
| Rate for Payer: Priority Health Narrow Network |
$509.57
|
| Rate for Payer: Priority Health SBD |
$174.57
|
| Rate for Payer: Railroad Medicare Medicare |
$190.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.72
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UHC Medicare Advantage |
$196.44
|
| Rate for Payer: VA VA |
$190.72
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
OP
|
$217.88
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$196.09 |
| Rate for Payer: Aetna Commercial |
$185.20
|
| Rate for Payer: Aetna Medicare |
$65.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.35
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$62.68
|
| Rate for Payer: BCBS Trust/PPO |
$117.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.68
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$187.38
|
| Rate for Payer: Cofinity Commercial |
$152.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.68
|
| Rate for Payer: Healthscope Commercial |
$196.09
|
| Rate for Payer: Mclaren Medicaid |
$34.29
|
| Rate for Payer: Mclaren Medicare |
$62.68
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.20
|
| Rate for Payer: PACE Medicare |
$59.55
|
| Rate for Payer: PACE SWMI |
$62.68
|
| Rate for Payer: PHP Commercial |
$185.20
|
| Rate for Payer: PHP Medicare Advantage |
$62.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.04
|
| Rate for Payer: Priority Health Medicare |
$62.68
|
| Rate for Payer: Priority Health Narrow Network |
$154.43
|
| Rate for Payer: Priority Health SBD |
$137.26
|
| Rate for Payer: Railroad Medicare Medicare |
$62.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.68
|
| Rate for Payer: UHC Exchange |
$27.83
|
| Rate for Payer: UHC Medicare Advantage |
$64.56
|
| Rate for Payer: VA VA |
$62.68
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
IP
|
$217.88
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$137.26 |
| Max. Negotiated Rate |
$196.09 |
| Rate for Payer: Aetna Commercial |
$185.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.62
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$152.52
|
| Rate for Payer: Cofinity Commercial |
$187.38
|
| Rate for Payer: Healthscope Commercial |
$196.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.20
|
| Rate for Payer: PHP Commercial |
$185.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health SBD |
$137.26
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$230.13 |
| Max. Negotiated Rate |
$525.89 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna Medicare |
$437.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$525.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$525.89
|
| Rate for Payer: BCBS Complete |
$241.66
|
| Rate for Payer: BCBS MAPPO |
$420.71
|
| Rate for Payer: BCN Medicare Advantage |
$420.71
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.71
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Mclaren Medicaid |
$230.13
|
| Rate for Payer: Mclaren Medicare |
$420.71
|
| Rate for Payer: Meridian Medicaid |
$241.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Medicare |
$399.67
|
| Rate for Payer: PACE SWMI |
$420.71
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: PHP Medicare Advantage |
$420.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health Medicare |
$420.71
|
| Rate for Payer: Priority Health SBD |
$330.30
|
| Rate for Payer: Railroad Medicare Medicare |
$420.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.71
|
| Rate for Payer: UHC Medicare Advantage |
$433.33
|
| Rate for Payer: VA VA |
$420.71
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$330.30 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health SBD |
$330.30
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$330.30 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health SBD |
$330.30
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$230.13 |
| Max. Negotiated Rate |
$525.89 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna Medicare |
$437.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$525.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$525.89
|
| Rate for Payer: BCBS Complete |
$241.66
|
| Rate for Payer: BCBS MAPPO |
$420.71
|
| Rate for Payer: BCN Medicare Advantage |
$420.71
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.71
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Mclaren Medicaid |
$230.13
|
| Rate for Payer: Mclaren Medicare |
$420.71
|
| Rate for Payer: Meridian Medicaid |
$241.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Medicare |
$399.67
|
| Rate for Payer: PACE SWMI |
$420.71
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: PHP Medicare Advantage |
$420.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health Medicare |
$420.71
|
| Rate for Payer: Priority Health SBD |
$330.30
|
| Rate for Payer: Railroad Medicare Medicare |
$420.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.71
|
| Rate for Payer: UHC Medicare Advantage |
$433.33
|
| Rate for Payer: VA VA |
$420.71
|
|
|
HC IVUS CATHETER
|
Facility
|
IP
|
$2,685.65
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,691.96 |
| Max. Negotiated Rate |
$2,417.08 |
| Rate for Payer: Aetna Commercial |
$2,282.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,745.67
|
| Rate for Payer: Cash Price |
$2,148.52
|
| Rate for Payer: Cofinity Commercial |
$1,879.96
|
| Rate for Payer: Cofinity Commercial |
$2,309.66
|
| Rate for Payer: Healthscope Commercial |
$2,417.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,282.80
|
| Rate for Payer: PHP Commercial |
$2,282.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.96
|
| Rate for Payer: Priority Health SBD |
$1,691.96
|
|
|
HC IVUS CATHETER
|
Facility
|
OP
|
$2,685.65
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,074.26 |
| Max. Negotiated Rate |
$2,417.08 |
| Rate for Payer: Aetna Commercial |
$2,282.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,745.67
|
| Rate for Payer: BCBS Complete |
$1,074.26
|
| Rate for Payer: Cash Price |
$2,148.52
|
| Rate for Payer: Cofinity Commercial |
$1,879.96
|
| Rate for Payer: Cofinity Commercial |
$2,309.66
|
| Rate for Payer: Healthscope Commercial |
$2,417.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,282.80
|
| Rate for Payer: PHP Commercial |
$2,282.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.96
|
| Rate for Payer: Priority Health SBD |
$1,691.96
|
|
