|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
IP
|
$207.64
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$130.81 |
| Max. Negotiated Rate |
$186.88 |
| Rate for Payer: Aetna Commercial |
$176.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.97
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cofinity Advantage |
$145.35
|
| Rate for Payer: Cofinity Commercial |
$178.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.11
|
| Rate for Payer: Healthscope Commercial |
$186.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.73
|
| Rate for Payer: PHP Commercial |
$176.49
|
| Rate for Payer: Priority Health SBD |
$130.81
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
OP
|
$207.64
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$186.88 |
| Rate for Payer: Aetna Commercial |
$176.49
|
| Rate for Payer: Aetna Medicare |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$47.20
|
| Rate for Payer: BCN Commercial |
$47.20
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cofinity Advantage |
$145.35
|
| Rate for Payer: Cofinity Commercial |
$178.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$186.88
|
| Rate for Payer: Mclaren Medicaid |
$24.40
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$48.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.49
|
| Rate for Payer: Nomi Health Commercial |
$139.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.73
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$176.49
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.88
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health SBD |
$130.81
|
| Rate for Payer: Priority Health Tiered Network |
$120.70
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.97
|
| Rate for Payer: UHC Core |
$108.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$81.60
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
OP
|
$520.44
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$685.39 |
| Rate for Payer: Aetna Commercial |
$442.37
|
| Rate for Payer: Aetna Medicare |
$220.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$121.96
|
| Rate for Payer: BCN Commercial |
$121.96
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$416.35
|
| Rate for Payer: Cash Price |
$416.35
|
| Rate for Payer: Cofinity Advantage |
$364.31
|
| Rate for Payer: Cofinity Commercial |
$447.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$468.40
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$222.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.37
|
| Rate for Payer: Nomi Health Commercial |
$635.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.33
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$442.37
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$685.39
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health SBD |
$327.88
|
| Rate for Payer: Priority Health Tiered Network |
$548.31
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.29
|
| Rate for Payer: UHC Core |
$271.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$204.53
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
IP
|
$520.44
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$327.88 |
| Max. Negotiated Rate |
$468.40 |
| Rate for Payer: Aetna Commercial |
$442.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.29
|
| Rate for Payer: Cash Price |
$416.35
|
| Rate for Payer: Cofinity Advantage |
$364.31
|
| Rate for Payer: Cofinity Commercial |
$447.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.35
|
| Rate for Payer: Healthscope Commercial |
$468.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.33
|
| Rate for Payer: PHP Commercial |
$442.37
|
| Rate for Payer: Priority Health SBD |
$327.88
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$47.20
|
| Rate for Payer: BCN Commercial |
$47.20
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Mclaren Medicaid |
$24.40
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$48.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Nomi Health Commercial |
$139.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.88
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: Priority Health Tiered Network |
$120.70
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.54
|
| Rate for Payer: UHC Core |
$68.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$51.72
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$82.91 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
IP
|
$276.35
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$174.10 |
| Max. Negotiated Rate |
$248.72 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.63
|
| Rate for Payer: Cash Price |
$221.08
|
| Rate for Payer: Cofinity Advantage |
$193.44
|
| Rate for Payer: Cofinity Commercial |
$237.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.08
|
| Rate for Payer: Healthscope Commercial |
$248.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.26
|
| Rate for Payer: PHP Commercial |
$234.90
|
| Rate for Payer: Priority Health SBD |
$174.10
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
OP
|
$276.35
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.61 |
| Max. Negotiated Rate |
$685.39 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Medicare |
$220.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$121.96
|
| Rate for Payer: BCN Commercial |
$121.96
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$221.08
|
| Rate for Payer: Cash Price |
$221.08
|
| Rate for Payer: Cofinity Advantage |
$193.44
|
| Rate for Payer: Cofinity Commercial |
$237.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$248.72
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$222.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.90
|
| Rate for Payer: Nomi Health Commercial |
$635.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.26
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$234.90
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$685.39
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health SBD |
$174.10
|
| Rate for Payer: Priority Health Tiered Network |
$548.31
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.63
|
| Rate for Payer: UHC Core |
$143.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$108.61
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
OP
|
$701.93
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$685.39 |
| Rate for Payer: Aetna Commercial |
$596.64
|
| Rate for Payer: Aetna Medicare |
$220.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$234.77
|
| Rate for Payer: BCN Commercial |
$234.77
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$561.54
|
| Rate for Payer: Cash Price |
$561.54
|
| Rate for Payer: Cofinity Advantage |
$491.35
|
| Rate for Payer: Cofinity Commercial |
$603.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$631.74
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$222.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.64
|
| Rate for Payer: Nomi Health Commercial |
$635.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.45
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$596.64
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$685.39
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health SBD |
$442.22
|
| Rate for Payer: Priority Health Tiered Network |
$548.31
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.25
|
| Rate for Payer: UHC Core |
$365.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$275.86
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
IP
|
$701.93
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$442.22 |
| Max. Negotiated Rate |
$631.74 |
| Rate for Payer: Aetna Commercial |
$596.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.25
|
| Rate for Payer: Cash Price |
$561.54
|
| Rate for Payer: Cofinity Advantage |
$491.35
|
| Rate for Payer: Cofinity Commercial |
$603.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.54
|
| Rate for Payer: Healthscope Commercial |
$631.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.45
|
| Rate for Payer: PHP Commercial |
$596.64
|
| Rate for Payer: Priority Health SBD |
$442.22
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$214.37 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna Medicare |
$272.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.56
|
| Rate for Payer: BCBS Complete |
$218.19
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Advantage |
$381.83
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$436.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: Priority Health SBD |
$343.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.56
|
| Rate for Payer: UHC Core |
$284.19
|
| Rate for Payer: UHC Exchange |
$214.37
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$343.65 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.56
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Advantage |
$381.83
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: Priority Health SBD |
$343.65
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$214.37 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna Medicare |
$272.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.56
|
| Rate for Payer: BCBS Complete |
$218.19
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Advantage |
$381.83
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$436.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: Priority Health SBD |
$343.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.56
|
| Rate for Payer: UHC Core |
$284.19
|
| Rate for Payer: UHC Exchange |
$214.37
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$343.65 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.56
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Advantage |
$381.83
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: Priority Health SBD |
$343.65
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
OP
|
$177.14
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$69.62 |
| Max. Negotiated Rate |
$159.43 |
| Rate for Payer: Aetna Commercial |
$150.57
|
| Rate for Payer: Aetna Medicare |
$88.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.14
|
| Rate for Payer: BCBS Complete |
$70.86
|
| Rate for Payer: BCBS Trust/PPO |
$74.76
|
| Rate for Payer: BCN Commercial |
$74.76
|
| Rate for Payer: Cash Price |
$141.71
|
| Rate for Payer: Cash Price |
$141.71
|
| Rate for Payer: Cofinity Advantage |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$152.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.71
|
| Rate for Payer: Healthscope Commercial |
$159.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.85
|
| Rate for Payer: PHP Commercial |
$150.57
|
| Rate for Payer: Priority Health SBD |
$111.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.14
|
| Rate for Payer: UHC Core |
$92.29
|
| Rate for Payer: UHC Exchange |
$69.62
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
IP
|
$177.14
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$159.43 |
| Rate for Payer: Aetna Commercial |
$150.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.14
|
| Rate for Payer: Cash Price |
$141.71
|
| Rate for Payer: Cofinity Advantage |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$152.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.71
|
| Rate for Payer: Healthscope Commercial |
$159.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.85
|
| Rate for Payer: PHP Commercial |
$150.57
|
| Rate for Payer: Priority Health SBD |
$111.60
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
IP
|
$198.43
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$125.01 |
| Max. Negotiated Rate |
$178.59 |
| Rate for Payer: Aetna Commercial |
$168.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.98
|
| Rate for Payer: Cash Price |
$158.74
|
| Rate for Payer: Cofinity Advantage |
$138.90
|
| Rate for Payer: Cofinity Commercial |
$170.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.74
|
| Rate for Payer: Healthscope Commercial |
$178.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.82
|
| Rate for Payer: PHP Commercial |
$168.67
|
| Rate for Payer: Priority Health SBD |
$125.01
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
OP
|
$198.43
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$178.59 |
| Rate for Payer: Aetna Commercial |
$168.67
|
| Rate for Payer: Aetna Medicare |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$78.70
|
| Rate for Payer: BCN Commercial |
$78.70
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$158.74
|
| Rate for Payer: Cash Price |
$158.74
|
| Rate for Payer: Cofinity Advantage |
$138.90
|
| Rate for Payer: Cofinity Commercial |
$170.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$178.59
|
| Rate for Payer: Mclaren Medicaid |
$24.40
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$48.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.67
|
| Rate for Payer: Nomi Health Commercial |
$139.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.82
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$168.67
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.88
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health SBD |
$125.01
|
| Rate for Payer: Priority Health Tiered Network |
$120.70
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.98
|
| Rate for Payer: UHC Core |
$103.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$77.98
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
OP
|
$545.48
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$685.39 |
| Rate for Payer: Aetna Commercial |
$463.66
|
| Rate for Payer: Aetna Medicare |
$220.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$234.77
|
| Rate for Payer: BCN Commercial |
$234.77
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Advantage |
$381.84
|
| Rate for Payer: Cofinity Commercial |
$469.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$490.93
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$222.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.66
|
| Rate for Payer: Nomi Health Commercial |
$635.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.11
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$463.66
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$685.39
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health SBD |
$343.65
|
| Rate for Payer: Priority Health Tiered Network |
$548.31
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.56
|
| Rate for Payer: UHC Core |
$284.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$214.37
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
IP
|
$545.48
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$343.65 |
| Max. Negotiated Rate |
$490.93 |
| Rate for Payer: Aetna Commercial |
$463.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.56
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Advantage |
$381.84
|
| Rate for Payer: Cofinity Commercial |
$469.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.11
|
| Rate for Payer: PHP Commercial |
$463.66
|
| Rate for Payer: Priority Health SBD |
$343.65
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
OP
|
$85.41
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$76.87 |
| Rate for Payer: Aetna Commercial |
$72.60
|
| Rate for Payer: Aetna Medicare |
$42.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.52
|
| Rate for Payer: BCBS Complete |
$34.16
|
| Rate for Payer: BCBS Trust/PPO |
$5.96
|
| Rate for Payer: BCN Commercial |
$5.96
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cofinity Advantage |
$59.79
|
| Rate for Payer: Cofinity Commercial |
$73.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$76.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.06
|
| Rate for Payer: PHP Commercial |
$72.60
|
| Rate for Payer: Priority Health SBD |
$53.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.52
|
| Rate for Payer: UHC Core |
$44.50
|
| Rate for Payer: UHC Exchange |
$33.57
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
IP
|
$85.41
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.81 |
| Max. Negotiated Rate |
$76.87 |
| Rate for Payer: Aetna Commercial |
$72.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.52
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cofinity Advantage |
$59.79
|
| Rate for Payer: Cofinity Commercial |
$73.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$76.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.06
|
| Rate for Payer: PHP Commercial |
$72.60
|
| Rate for Payer: Priority Health SBD |
$53.81
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
OP
|
$87.43
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$78.69 |
| Rate for Payer: Aetna Commercial |
$74.32
|
| Rate for Payer: Aetna Medicare |
$43.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.83
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS Trust/PPO |
$3.23
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$69.94
|
| Rate for Payer: Cash Price |
$69.94
|
| Rate for Payer: Cofinity Advantage |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$75.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.94
|
| Rate for Payer: Healthscope Commercial |
$78.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.57
|
| Rate for Payer: PHP Commercial |
$74.32
|
| Rate for Payer: Priority Health SBD |
$55.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.13
|
| Rate for Payer: UHC Core |
$2.13
|
| Rate for Payer: UHC Exchange |
$2.13
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
IP
|
$87.43
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$78.69 |
| Rate for Payer: Aetna Commercial |
$74.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.83
|
| Rate for Payer: Cash Price |
$69.94
|
| Rate for Payer: Cofinity Advantage |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$75.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.94
|
| Rate for Payer: Healthscope Commercial |
$78.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.57
|
| Rate for Payer: PHP Commercial |
$74.32
|
| Rate for Payer: Priority Health SBD |
$55.08
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
IP
|
$171.07
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.77 |
| Max. Negotiated Rate |
$153.96 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.20
|
| Rate for Payer: Cash Price |
$136.86
|
| Rate for Payer: Cofinity Advantage |
$119.75
|
| Rate for Payer: Cofinity Commercial |
$147.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.86
|
| Rate for Payer: Healthscope Commercial |
$153.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.30
|
| Rate for Payer: PHP Commercial |
$145.41
|
| Rate for Payer: Priority Health SBD |
$107.77
|
|
