|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
OP
|
$171.07
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$153.96 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Aetna Medicare |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.20
|
| 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 |
$57.69
|
| Rate for Payer: BCN Commercial |
$57.69
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$136.86
|
| 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: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$153.96
|
| 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 |
$145.41
|
| Rate for Payer: Nomi Health Commercial |
$139.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.30
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$145.41
|
| 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 |
$107.77
|
| 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) |
$111.20
|
| Rate for Payer: UHC Core |
$89.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$67.23
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
OP
|
$157.93
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$142.14 |
| Rate for Payer: Aetna Commercial |
$134.24
|
| Rate for Payer: Aetna Medicare |
$78.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.65
|
| Rate for Payer: BCBS Complete |
$63.17
|
| Rate for Payer: BCBS Trust/PPO |
$29.99
|
| Rate for Payer: BCN Commercial |
$29.99
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Advantage |
$110.55
|
| Rate for Payer: Cofinity Commercial |
$135.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Healthscope Commercial |
$142.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: PHP Commercial |
$134.24
|
| Rate for Payer: Priority Health SBD |
$99.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.65
|
| Rate for Payer: UHC Core |
$82.28
|
| Rate for Payer: UHC Exchange |
$62.07
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
IP
|
$157.93
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.50 |
| Max. Negotiated Rate |
$142.14 |
| Rate for Payer: Aetna Commercial |
$134.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.65
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Advantage |
$110.55
|
| Rate for Payer: Cofinity Commercial |
$135.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Healthscope Commercial |
$142.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: PHP Commercial |
$134.24
|
| Rate for Payer: Priority Health SBD |
$99.50
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
IP
|
$409.83
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$258.19 |
| Max. Negotiated Rate |
$368.85 |
| Rate for Payer: Aetna Commercial |
$348.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.39
|
| Rate for Payer: Cash Price |
$327.86
|
| Rate for Payer: Cofinity Advantage |
$286.88
|
| Rate for Payer: Cofinity Commercial |
$352.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.86
|
| Rate for Payer: Healthscope Commercial |
$368.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.37
|
| Rate for Payer: PHP Commercial |
$348.36
|
| Rate for Payer: Priority Health SBD |
$258.19
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
OP
|
$409.83
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$368.85 |
| Rate for Payer: Aetna Commercial |
$348.36
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$205.91
|
| Rate for Payer: BCN Commercial |
$205.91
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$327.86
|
| Rate for Payer: Cash Price |
$327.86
|
| Rate for Payer: Cofinity Advantage |
$286.88
|
| Rate for Payer: Cofinity Commercial |
$352.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$368.85
|
| Rate for Payer: Mclaren Medicaid |
$37.52
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$75.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.36
|
| Rate for Payer: Nomi Health Commercial |
$215.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.37
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$348.36
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.01
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health SBD |
$258.19
|
| Rate for Payer: Priority Health Tiered Network |
$185.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.39
|
| Rate for Payer: UHC Core |
$213.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$161.06
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
IP
|
$710.44
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$447.58 |
| Max. Negotiated Rate |
$639.40 |
| Rate for Payer: Aetna Commercial |
$603.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.79
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cofinity Advantage |
$497.31
|
| Rate for Payer: Cofinity Commercial |
$610.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.35
|
| Rate for Payer: Healthscope Commercial |
$639.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.83
|
| Rate for Payer: PHP Commercial |
$603.87
|
| Rate for Payer: Priority Health SBD |
$447.58
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
OP
|
$710.44
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$1,064.33 |
| Rate for Payer: Aetna Commercial |
$603.87
|
| Rate for Payer: Aetna Medicare |
$342.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$375.07
|
| Rate for Payer: BCN Commercial |
$375.07
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cofinity Advantage |
$497.31
|
| Rate for Payer: Cofinity Commercial |
$610.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$639.40
|
| Rate for Payer: Mclaren Medicaid |
$172.13
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$345.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.87
|
| Rate for Payer: Nomi Health Commercial |
$987.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.83
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$603.87
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,064.33
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health SBD |
$447.58
|
| Rate for Payer: Priority Health Tiered Network |
$851.46
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.79
|
| Rate for Payer: UHC Core |
$370.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$279.20
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
IP
|
$288.28
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.62 |
| Max. Negotiated Rate |
$259.45 |
| Rate for Payer: Aetna Commercial |
$245.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.38
|
| Rate for Payer: Cash Price |
$230.62
|
| Rate for Payer: Cofinity Advantage |
$201.80
|
| Rate for Payer: Cofinity Commercial |
$247.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.62
|
| Rate for Payer: Healthscope Commercial |
$259.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.21
|
| Rate for Payer: PHP Commercial |
$245.04
|
| Rate for Payer: Priority Health SBD |
$181.62
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
OP
|
$288.28
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$685.39 |
| Rate for Payer: Aetna Commercial |
$245.04
|
| Rate for Payer: Aetna Medicare |
$220.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.38
|
| 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 |
$137.70
|
| Rate for Payer: BCN Commercial |
$137.70
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$230.62
|
| Rate for Payer: Cash Price |
$230.62
|
| Rate for Payer: Cofinity Advantage |
$201.80
|
| Rate for Payer: Cofinity Commercial |
$247.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$259.45
|
| 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 |
$245.04
|
| Rate for Payer: Nomi Health Commercial |
$635.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.21
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$245.04
|
| 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 |
$181.62
|
| 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) |
$187.38
|
| Rate for Payer: UHC Core |
$150.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$113.29
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
OP
|
$226.68
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$232.01 |
| Rate for Payer: Aetna Commercial |
$192.68
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$107.53
|
| Rate for Payer: BCN Commercial |
$107.53
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$181.34
|
| Rate for Payer: Cash Price |
$181.34
|
| Rate for Payer: Cofinity Advantage |
$158.68
|
| Rate for Payer: Cofinity Commercial |
$194.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$204.01
|
| Rate for Payer: Mclaren Medicaid |
$37.52
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$75.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.68
|
| Rate for Payer: Nomi Health Commercial |
$215.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.01
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$192.68
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.01
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health SBD |
$142.81
|
| Rate for Payer: Priority Health Tiered Network |
$185.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.34
|
| Rate for Payer: UHC Core |
$118.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$89.09
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
IP
|
$226.68
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$142.81 |
| Max. Negotiated Rate |
$204.01 |
| Rate for Payer: Aetna Commercial |
$192.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.34
|
| Rate for Payer: Cash Price |
$181.34
|
| Rate for Payer: Cofinity Advantage |
$158.68
|
| Rate for Payer: Cofinity Commercial |
$194.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.34
|
| Rate for Payer: Healthscope Commercial |
$204.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.01
|
| Rate for Payer: PHP Commercial |
$192.68
|
| Rate for Payer: Priority Health SBD |
$142.81
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
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 IVUS CATHETER
|
Facility
|
OP
|
$2,794.15
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,098.10 |
| Max. Negotiated Rate |
$2,514.74 |
| Rate for Payer: Aetna Commercial |
$2,375.03
|
| Rate for Payer: Aetna Medicare |
$1,397.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,816.20
|
| Rate for Payer: BCBS Complete |
$1,117.66
|
| Rate for Payer: Cash Price |
$2,235.32
|
| Rate for Payer: Cofinity Advantage |
$1,955.90
|
| Rate for Payer: Cofinity Commercial |
$2,402.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,235.32
|
| Rate for Payer: Healthscope Commercial |
$2,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,235.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,375.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,095.61
|
| Rate for Payer: PHP Commercial |
$2,375.03
|
| Rate for Payer: Priority Health SBD |
$1,760.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,816.20
|
| Rate for Payer: UHC Core |
$1,455.75
|
| Rate for Payer: UHC Exchange |
$1,098.10
|
|
|
HC IVUS CATHETER
|
Facility
|
IP
|
$2,794.15
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,760.31 |
| Max. Negotiated Rate |
$2,514.74 |
| Rate for Payer: Aetna Commercial |
$2,375.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,816.20
|
| Rate for Payer: Cash Price |
$2,235.32
|
| Rate for Payer: Cofinity Advantage |
$1,955.90
|
| Rate for Payer: Cofinity Commercial |
$2,402.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,235.32
|
| Rate for Payer: Healthscope Commercial |
$2,514.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,375.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,095.61
|
| Rate for Payer: PHP Commercial |
$2,375.03
|
| Rate for Payer: Priority Health SBD |
$1,760.31
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
IP
|
$1,351.34
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$851.34 |
| Max. Negotiated Rate |
$1,216.21 |
| Rate for Payer: Aetna Commercial |
$1,148.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$878.37
|
| Rate for Payer: Cash Price |
$1,081.07
|
| Rate for Payer: Cofinity Advantage |
$945.94
|
| Rate for Payer: Cofinity Commercial |
$1,162.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,081.07
|
| Rate for Payer: Healthscope Commercial |
$1,216.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,148.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,013.50
|
| Rate for Payer: PHP Commercial |
$1,148.64
|
| Rate for Payer: Priority Health SBD |
$851.34
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
OP
|
$1,351.34
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$540.54 |
| Max. Negotiated Rate |
$1,216.21 |
| Rate for Payer: Aetna Commercial |
$1,148.64
|
| Rate for Payer: Aetna Medicare |
$675.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$878.37
|
| Rate for Payer: BCBS Complete |
$540.54
|
| Rate for Payer: BCBS Trust/PPO |
$546.12
|
| Rate for Payer: BCN Commercial |
$546.12
|
| Rate for Payer: Cash Price |
$1,081.07
|
| Rate for Payer: Cash Price |
$1,081.07
|
| Rate for Payer: Cofinity Advantage |
$945.94
|
| Rate for Payer: Cofinity Commercial |
$1,162.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,081.07
|
| Rate for Payer: Healthscope Commercial |
$1,216.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,081.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,148.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,013.50
|
| Rate for Payer: PHP Commercial |
$1,148.64
|
| Rate for Payer: Priority Health SBD |
$851.34
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
IP
|
$8,224.18
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,181.23 |
| Max. Negotiated Rate |
$7,401.76 |
| Rate for Payer: Aetna Commercial |
$6,990.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,345.72
|
| Rate for Payer: Cash Price |
$6,579.34
|
| Rate for Payer: Cofinity Advantage |
$5,756.93
|
| Rate for Payer: Cofinity Commercial |
$7,072.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,579.34
|
| Rate for Payer: Healthscope Commercial |
$7,401.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,990.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,168.14
|
| Rate for Payer: PHP Commercial |
$6,990.55
|
| Rate for Payer: Priority Health SBD |
$5,181.23
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
OP
|
$8,224.18
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,289.67 |
| Max. Negotiated Rate |
$7,401.76 |
| Rate for Payer: Aetna Commercial |
$6,990.55
|
| Rate for Payer: Aetna Medicare |
$4,112.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,345.72
|
| Rate for Payer: BCBS Complete |
$3,289.67
|
| Rate for Payer: BCBS Trust/PPO |
$3,701.30
|
| Rate for Payer: BCN Commercial |
$3,701.30
|
| Rate for Payer: Cash Price |
$6,579.34
|
| Rate for Payer: Cash Price |
$6,579.34
|
| Rate for Payer: Cofinity Advantage |
$5,756.93
|
| Rate for Payer: Cofinity Commercial |
$7,072.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,579.34
|
| Rate for Payer: Healthscope Commercial |
$7,401.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,579.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,990.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,168.14
|
| Rate for Payer: PHP Commercial |
$6,990.55
|
| Rate for Payer: Priority Health SBD |
$5,181.23
|
|
|
HC IVUS OR OCT EACH ADDL VESSEL
|
Facility
|
IP
|
$1,562.84
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
48100107
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$984.59 |
| Max. Negotiated Rate |
$1,406.56 |
| Rate for Payer: Aetna Commercial |
$1,328.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.85
|
| Rate for Payer: Cash Price |
$1,250.27
|
| Rate for Payer: Cofinity Advantage |
$1,093.99
|
| Rate for Payer: Cofinity Commercial |
$1,344.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,250.27
|
| Rate for Payer: Healthscope Commercial |
$1,406.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,328.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,172.13
|
| Rate for Payer: PHP Commercial |
$1,328.41
|
| Rate for Payer: Priority Health SBD |
$984.59
|
|
|
HC IVUS OR OCT EACH ADDL VESSEL
|
Facility
|
OP
|
$1,562.84
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
48100107
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$400.63 |
| Max. Negotiated Rate |
$1,406.56 |
| Rate for Payer: Aetna Commercial |
$1,328.41
|
| Rate for Payer: Aetna Medicare |
$781.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.85
|
| Rate for Payer: BCBS Complete |
$625.14
|
| Rate for Payer: BCBS Trust/PPO |
$400.63
|
| Rate for Payer: BCN Commercial |
$400.63
|
| Rate for Payer: Cash Price |
$1,250.27
|
| Rate for Payer: Cash Price |
$1,250.27
|
| Rate for Payer: Cofinity Advantage |
$1,093.99
|
| Rate for Payer: Cofinity Commercial |
$1,344.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,250.27
|
| Rate for Payer: Healthscope Commercial |
$1,406.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,250.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,328.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,172.13
|
| Rate for Payer: PHP Commercial |
$1,328.41
|
| Rate for Payer: Priority Health SBD |
$984.59
|
|
|
HC IVUS OR OCT INITIAL VESSEL
|
Facility
|
OP
|
$3,767.76
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
48100106
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$666.06 |
| Max. Negotiated Rate |
$3,390.98 |
| Rate for Payer: Aetna Commercial |
$3,202.60
|
| Rate for Payer: Aetna Medicare |
$1,883.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,449.04
|
| Rate for Payer: BCBS Complete |
$1,507.10
|
| Rate for Payer: BCBS Trust/PPO |
$666.06
|
| Rate for Payer: BCN Commercial |
$666.06
|
| Rate for Payer: Cash Price |
$3,014.21
|
| Rate for Payer: Cash Price |
$3,014.21
|
| Rate for Payer: Cofinity Advantage |
$2,637.43
|
| Rate for Payer: Cofinity Commercial |
$3,240.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,014.21
|
| Rate for Payer: Healthscope Commercial |
$3,390.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,014.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,825.82
|
| Rate for Payer: PHP Commercial |
$3,202.60
|
| Rate for Payer: Priority Health SBD |
$2,373.69
|
|
|
HC IVUS OR OCT INITIAL VESSEL
|
Facility
|
IP
|
$3,767.76
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
48100106
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,373.69 |
| Max. Negotiated Rate |
$3,390.98 |
| Rate for Payer: Aetna Commercial |
$3,202.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,449.04
|
| Rate for Payer: Cash Price |
$3,014.21
|
| Rate for Payer: Cofinity Advantage |
$2,637.43
|
| Rate for Payer: Cofinity Commercial |
$3,240.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,014.21
|
| Rate for Payer: Healthscope Commercial |
$3,390.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,825.82
|
| Rate for Payer: PHP Commercial |
$3,202.60
|
| Rate for Payer: Priority Health SBD |
$2,373.69
|
|
