|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$213.91 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$267.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: BCBS Complete |
$213.91
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$374.34
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health SBD |
$336.91
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$336.91 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$374.34
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health SBD |
$336.91
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$213.91 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$267.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: BCBS Complete |
$213.91
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$374.34
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health SBD |
$336.91
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
OP
|
$173.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$69.47 |
| Max. Negotiated Rate |
$156.30 |
| Rate for Payer: Aetna Commercial |
$147.62
|
| Rate for Payer: Aetna Medicare |
$86.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.89
|
| Rate for Payer: BCBS Complete |
$69.47
|
| Rate for Payer: Cash Price |
$138.94
|
| Rate for Payer: Cofinity Commercial |
$121.57
|
| Rate for Payer: Cofinity Commercial |
$149.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.94
|
| Rate for Payer: Healthscope Commercial |
$156.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.62
|
| Rate for Payer: PHP Commercial |
$147.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.89
|
| Rate for Payer: Priority Health SBD |
$109.41
|
| Rate for Payer: UHC Core |
$128.52
|
| Rate for Payer: UHC Exchange |
$128.52
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
IP
|
$173.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$109.41 |
| Max. Negotiated Rate |
$156.30 |
| Rate for Payer: Aetna Commercial |
$147.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.89
|
| Rate for Payer: Cash Price |
$138.94
|
| Rate for Payer: Cofinity Commercial |
$121.57
|
| Rate for Payer: Cofinity Commercial |
$149.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.94
|
| Rate for Payer: Healthscope Commercial |
$156.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.62
|
| Rate for Payer: PHP Commercial |
$147.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.89
|
| Rate for Payer: Priority Health SBD |
$109.41
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
OP
|
$194.54
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$175.09 |
| Rate for Payer: Aetna Commercial |
$165.36
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$155.63
|
| Rate for Payer: Cash Price |
$155.63
|
| Rate for Payer: Cofinity Commercial |
$167.30
|
| Rate for Payer: Cofinity Commercial |
$136.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Mclaren Medicaid |
$24.12
|
| Rate for Payer: Mclaren Medicare |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.36
|
| Rate for Payer: PACE Medicare |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$165.36
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.45
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health SBD |
$122.56
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.67
|
| Rate for Payer: UHC Core |
$143.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$143.96
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$25.34
|
| Rate for Payer: VA VA |
$45.00
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
IP
|
$194.54
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$122.56 |
| Max. Negotiated Rate |
$175.09 |
| Rate for Payer: Aetna Commercial |
$165.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.45
|
| Rate for Payer: Cash Price |
$155.63
|
| Rate for Payer: Cofinity Commercial |
$136.18
|
| Rate for Payer: Cofinity Commercial |
$167.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.63
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.36
|
| Rate for Payer: PHP Commercial |
$165.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.45
|
| Rate for Payer: Priority Health SBD |
$122.56
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
IP
|
$534.78
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$336.91 |
| Max. Negotiated Rate |
$481.30 |
| Rate for Payer: Aetna Commercial |
$454.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.61
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$374.35
|
| Rate for Payer: Cofinity Commercial |
$459.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.56
|
| Rate for Payer: PHP Commercial |
$454.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.61
|
| Rate for Payer: Priority Health SBD |
$336.91
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
OP
|
$534.78
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$578.41 |
| Rate for Payer: Aetna Commercial |
$454.56
|
| Rate for Payer: Aetna Medicare |
$213.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.91
|
| Rate for Payer: Cofinity Commercial |
$374.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$481.30
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.56
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$454.56
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.61
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.41
|
| Rate for Payer: UHC Core |
$395.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Exchange |
$395.74
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$115.69
|
| Rate for Payer: VA VA |
$205.48
|
|
|
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: Cofinity Medicare Advantage |
$58.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.18
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.43
|
| Rate for Payer: Priority Health SBD |
$52.76
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
OP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: Aetna Medicare |
$41.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.43
|
| Rate for Payer: BCBS Complete |
$33.50
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$58.62
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.18
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.43
|
| 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: Cofinity Medicare Advantage |
$60.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$77.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.86
|
| Rate for Payer: PHP Commercial |
$72.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.72
|
| 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 |
$34.29 |
| Max. Negotiated Rate |
$77.15 |
| Rate for Payer: Aetna Commercial |
$72.86
|
| Rate for Payer: Aetna Medicare |
$42.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.72
|
| Rate for Payer: BCBS Complete |
$34.29
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$73.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$77.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.86
|
| Rate for Payer: PHP Commercial |
$72.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.72
|
| Rate for Payer: Priority Health SBD |
$54.00
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
IP
|
$167.72
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.66 |
| Max. Negotiated Rate |
$150.95 |
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.02
|
| Rate for Payer: Cash Price |
$134.18
|
| Rate for Payer: Cofinity Commercial |
$117.40
|
| Rate for Payer: Cofinity Commercial |
$144.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.18
|
| Rate for Payer: Healthscope Commercial |
$150.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.56
|
| Rate for Payer: PHP Commercial |
$142.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.02
|
| Rate for Payer: Priority Health SBD |
$105.66
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
OP
|
$167.72
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$150.95 |
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$134.18
|
| Rate for Payer: Cash Price |
$134.18
|
| Rate for Payer: Cofinity Commercial |
$144.24
|
| Rate for Payer: Cofinity Commercial |
$117.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$150.95
|
| Rate for Payer: Mclaren Medicaid |
$24.12
|
| Rate for Payer: Mclaren Medicare |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.56
|
| Rate for Payer: PACE Medicare |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$142.56
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.02
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health SBD |
$105.66
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$25.34
|
| Rate for Payer: VA VA |
$45.00
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
IP
|
$154.83
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$139.35 |
| Rate for Payer: Aetna Commercial |
$131.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.64
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$108.38
|
| Rate for Payer: Cofinity Commercial |
$133.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$139.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: PHP Commercial |
$131.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health SBD |
$97.54
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
OP
|
$154.83
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$139.35 |
| Rate for Payer: Aetna Commercial |
$131.61
|
| Rate for Payer: Aetna Medicare |
$77.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.64
|
| Rate for Payer: BCBS Complete |
$61.93
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$108.38
|
| Rate for Payer: Cofinity Commercial |
$133.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$139.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: PHP Commercial |
$131.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health SBD |
$97.54
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
IP
|
$401.79
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$253.13 |
| Max. Negotiated Rate |
$361.61 |
| Rate for Payer: Aetna Commercial |
$341.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.16
|
| Rate for Payer: Cash Price |
$321.43
|
| Rate for Payer: Cofinity Commercial |
$281.25
|
| Rate for Payer: Cofinity Commercial |
$345.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.43
|
| Rate for Payer: Healthscope Commercial |
$361.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.52
|
| Rate for Payer: PHP Commercial |
$341.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.16
|
| Rate for Payer: Priority Health SBD |
$253.13
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
OP
|
$401.79
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$361.61 |
| Rate for Payer: Aetna Commercial |
$341.52
|
| Rate for Payer: Aetna Medicare |
$72.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.76
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS MAPPO |
$69.41
|
| Rate for Payer: BCN Medicare Advantage |
$69.41
|
| Rate for Payer: Cash Price |
$321.43
|
| Rate for Payer: Cash Price |
$321.43
|
| Rate for Payer: Cofinity Commercial |
$345.54
|
| Rate for Payer: Cofinity Commercial |
$281.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$361.61
|
| Rate for Payer: Mclaren Medicaid |
$37.20
|
| Rate for Payer: Mclaren Medicare |
$69.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.88
|
| Rate for Payer: Meridian Medicaid |
$39.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.52
|
| Rate for Payer: PACE Medicare |
$65.94
|
| Rate for Payer: PACE SWMI |
$69.41
|
| Rate for Payer: PHP Commercial |
$341.52
|
| Rate for Payer: PHP Medicare Advantage |
$69.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.16
|
| Rate for Payer: Priority Health Medicare |
$69.41
|
| Rate for Payer: Priority Health SBD |
$253.13
|
| Rate for Payer: Railroad Medicare Medicare |
$69.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.38
|
| Rate for Payer: UHC Core |
$297.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.41
|
| Rate for Payer: UHC Exchange |
$297.32
|
| Rate for Payer: UHC Medicare Advantage |
$69.41
|
| Rate for Payer: UHCCP Medicaid |
$39.08
|
| Rate for Payer: VA VA |
$69.41
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
IP
|
$696.51
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$438.80 |
| Max. Negotiated Rate |
$626.86 |
| Rate for Payer: Aetna Commercial |
$592.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.73
|
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$487.56
|
| Rate for Payer: Cofinity Commercial |
$599.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$487.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.21
|
| Rate for Payer: Healthscope Commercial |
$626.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.03
|
| Rate for Payer: PHP Commercial |
$592.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.73
|
| Rate for Payer: Priority Health SBD |
$438.80
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
OP
|
$696.51
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$173.39 |
| Max. Negotiated Rate |
$910.59 |
| Rate for Payer: Aetna Commercial |
$592.03
|
| Rate for Payer: Aetna Medicare |
$336.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.36
|
| Rate for Payer: BCBS Complete |
$182.06
|
| Rate for Payer: BCBS MAPPO |
$323.49
|
| Rate for Payer: BCN Medicare Advantage |
$323.49
|
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$599.00
|
| Rate for Payer: Cofinity Commercial |
$487.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$487.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.49
|
| Rate for Payer: Healthscope Commercial |
$626.86
|
| Rate for Payer: Mclaren Medicaid |
$173.39
|
| Rate for Payer: Mclaren Medicare |
$323.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.66
|
| Rate for Payer: Meridian Medicaid |
$182.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.03
|
| Rate for Payer: PACE Medicare |
$307.32
|
| Rate for Payer: PACE SWMI |
$323.49
|
| Rate for Payer: PHP Commercial |
$592.03
|
| Rate for Payer: PHP Medicare Advantage |
$323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.73
|
| Rate for Payer: Priority Health Medicare |
$323.49
|
| Rate for Payer: Priority Health SBD |
$438.80
|
| Rate for Payer: Railroad Medicare Medicare |
$323.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.59
|
| Rate for Payer: UHC Core |
$515.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.49
|
| Rate for Payer: UHC Exchange |
$515.42
|
| Rate for Payer: UHC Medicare Advantage |
$323.49
|
| Rate for Payer: UHCCP Medicaid |
$182.12
|
| Rate for Payer: VA VA |
$323.49
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
OP
|
$282.63
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$578.41 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare |
$213.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$243.06
|
| Rate for Payer: Cofinity Commercial |
$197.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$254.37
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.24
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$240.24
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.71
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health SBD |
$178.06
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$115.69
|
| Rate for Payer: VA VA |
$205.48
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
IP
|
$282.63
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.06 |
| Max. Negotiated Rate |
$254.37 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.71
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$197.84
|
| Rate for Payer: Cofinity Commercial |
$243.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.10
|
| Rate for Payer: Healthscope Commercial |
$254.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.24
|
| Rate for Payer: PHP Commercial |
$240.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.71
|
| Rate for Payer: Priority Health SBD |
$178.06
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
IP
|
$222.24
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$140.01 |
| Max. Negotiated Rate |
$200.02 |
| Rate for Payer: Aetna Commercial |
$188.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.46
|
| Rate for Payer: Cash Price |
$177.79
|
| Rate for Payer: Cofinity Commercial |
$155.57
|
| Rate for Payer: Cofinity Commercial |
$191.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.79
|
| Rate for Payer: Healthscope Commercial |
$200.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.90
|
| Rate for Payer: PHP Commercial |
$188.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.46
|
| Rate for Payer: Priority Health SBD |
$140.01
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
OP
|
$222.24
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$200.02 |
| Rate for Payer: Aetna Commercial |
$188.90
|
| Rate for Payer: Aetna Medicare |
$72.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.76
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS MAPPO |
$69.41
|
| Rate for Payer: BCN Medicare Advantage |
$69.41
|
| Rate for Payer: Cash Price |
$177.79
|
| Rate for Payer: Cash Price |
$177.79
|
| Rate for Payer: Cofinity Commercial |
$191.13
|
| Rate for Payer: Cofinity Commercial |
$155.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$200.02
|
| Rate for Payer: Mclaren Medicaid |
$37.20
|
| Rate for Payer: Mclaren Medicare |
$69.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.88
|
| Rate for Payer: Meridian Medicaid |
$39.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.90
|
| Rate for Payer: PACE Medicare |
$65.94
|
| Rate for Payer: PACE SWMI |
$69.41
|
| Rate for Payer: PHP Commercial |
$188.90
|
| Rate for Payer: PHP Medicare Advantage |
$69.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.46
|
| Rate for Payer: Priority Health Medicare |
$69.41
|
| Rate for Payer: Priority Health SBD |
$140.01
|
| Rate for Payer: Railroad Medicare Medicare |
$69.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.38
|
| Rate for Payer: UHC Core |
$164.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.41
|
| Rate for Payer: UHC Exchange |
$164.46
|
| Rate for Payer: UHC Medicare Advantage |
$69.41
|
| Rate for Payer: UHCCP Medicaid |
$39.08
|
| Rate for Payer: VA VA |
$69.41
|
|
