|
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 |
$6.82 |
| 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: BCBS Trust/PPO |
$6.82
|
| Rate for Payer: BCN Commercial |
$6.82
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$58.62
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: 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 |
$3.60 |
| 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: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCN Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$73.72
|
| Rate for Payer: 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 |
$15.51 |
| Max. Negotiated Rate |
$150.95 |
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: Aetna Medicare |
$47.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$61.59
|
| Rate for Payer: BCN Commercial |
$61.59
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| 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 |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$150.95
|
| Rate for Payer: Mclaren Medicaid |
$24.23
|
| Rate for Payer: Mclaren Medicare |
$45.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.47
|
| Rate for Payer: Meridian Medicaid |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.56
|
| Rate for Payer: Nomi Health Commercial |
$135.63
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$142.56
|
| Rate for Payer: PHP Medicare Advantage |
$45.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.07
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$113.66
|
| Rate for Payer: Priority Health SBD |
$105.66
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$25.45
|
| Rate for Payer: VA VA |
$45.21
|
|
|
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 |
$30.62 |
| 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: BCBS Trust/PPO |
$30.62
|
| Rate for Payer: BCN Commercial |
$30.62
|
| Rate for Payer: Cash Price |
$123.86
|
| 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
|
OP
|
$401.79
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$361.61 |
| Rate for Payer: Aetna Commercial |
$341.52
|
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$218.22
|
| Rate for Payer: BCN Commercial |
$218.22
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| 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 |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$361.61
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.52
|
| Rate for Payer: Nomi Health Commercial |
$209.19
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$341.52
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.18
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$175.34
|
| Rate for Payer: Priority Health SBD |
$253.13
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$297.32
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$39.26
|
| Rate for Payer: VA VA |
$69.73
|
|
|
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 INITIAL DRUG
|
Facility
|
OP
|
$696.51
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$99.77 |
| Max. Negotiated Rate |
$1,021.42 |
| Rate for Payer: Aetna Commercial |
$592.03
|
| Rate for Payer: Aetna Medicare |
$337.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$401.65
|
| Rate for Payer: BCN Commercial |
$401.65
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| 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 |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$626.86
|
| Rate for Payer: Mclaren Medicaid |
$174.19
|
| Rate for Payer: Mclaren Medicare |
$324.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.23
|
| Rate for Payer: Meridian Medicaid |
$182.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.03
|
| Rate for Payer: Nomi Health Commercial |
$974.94
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Commercial |
$592.03
|
| Rate for Payer: PHP Medicare Advantage |
$324.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.42
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$817.14
|
| Rate for Payer: Priority Health SBD |
$438.80
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$515.42
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$182.96
|
| Rate for Payer: VA VA |
$324.98
|
|
|
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 INITIAL DRUG
|
Facility
|
OP
|
$282.63
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.86 |
| Max. Negotiated Rate |
$648.80 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare |
$214.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.04
|
| Rate for Payer: BCBS Complete |
$116.18
|
| Rate for Payer: BCBS MAPPO |
$206.43
|
| Rate for Payer: BCBS Trust/PPO |
$147.28
|
| Rate for Payer: BCN Commercial |
$147.28
|
| Rate for Payer: BCN Medicare Advantage |
$206.43
|
| 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 |
$206.43
|
| Rate for Payer: Healthscope Commercial |
$254.37
|
| Rate for Payer: Mclaren Medicaid |
$110.65
|
| Rate for Payer: Mclaren Medicare |
$206.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.75
|
| Rate for Payer: Meridian Medicaid |
$116.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.24
|
| Rate for Payer: Nomi Health Commercial |
$619.29
|
| Rate for Payer: PACE Medicare |
$196.11
|
| Rate for Payer: PACE SWMI |
$206.43
|
| Rate for Payer: PHP Commercial |
$240.24
|
| Rate for Payer: PHP Medicare Advantage |
$206.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$648.80
|
| Rate for Payer: Priority Health Medicare |
$206.43
|
| Rate for Payer: Priority Health Narrow Network |
$519.04
|
| Rate for Payer: Priority Health SBD |
$178.06
|
| Rate for Payer: Railroad Medicare Medicare |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.43
|
| Rate for Payer: UHC Medicare Advantage |
$206.43
|
| Rate for Payer: UHCCP Medicaid |
$116.22
|
| Rate for Payer: VA VA |
$206.43
|
|
|
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 |
$28.59 |
| Max. Negotiated Rate |
$219.18 |
| Rate for Payer: Aetna Commercial |
$188.90
|
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$113.80
|
| Rate for Payer: BCN Commercial |
$113.80
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| 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 |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$200.02
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.90
|
| Rate for Payer: Nomi Health Commercial |
$209.19
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$188.90
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.18
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$175.34
|
| Rate for Payer: Priority Health SBD |
$140.01
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$164.46
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$39.26
|
| Rate for Payer: VA VA |
$69.73
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$236.59 |
| Max. Negotiated Rate |
$1,324.17 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$459.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$551.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$551.74
|
| Rate for Payer: BCBS Complete |
$248.41
|
| Rate for Payer: BCBS MAPPO |
$441.39
|
| Rate for Payer: BCN Medicare Advantage |
$441.39
|
| Rate for Payer: Cash Price |
$427.82
|
| 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: Health Alliance Plan Medicare Advantage |
$441.39
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Mclaren Medicaid |
$236.59
|
| Rate for Payer: Mclaren Medicare |
$441.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.46
|
| Rate for Payer: Meridian Medicaid |
$248.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$507.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$1,324.17
|
| Rate for Payer: PACE Medicare |
$419.32
|
| Rate for Payer: PACE SWMI |
$441.39
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: PHP Medicare Advantage |
$441.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.50
|
| Rate for Payer: Priority Health Medicare |
$441.39
|
| Rate for Payer: Priority Health Narrow Network |
$360.40
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: Railroad Medicare Medicare |
$441.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,242.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.39
|
| Rate for Payer: UHC Medicare Advantage |
$441.39
|
| Rate for Payer: UHCCP Medicaid |
$248.50
|
| Rate for Payer: VA VA |
$441.39
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$236.59 |
| Max. Negotiated Rate |
$1,324.17 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$459.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$551.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$551.74
|
| Rate for Payer: BCBS Complete |
$248.41
|
| Rate for Payer: BCBS MAPPO |
$441.39
|
| Rate for Payer: BCN Medicare Advantage |
$441.39
|
| Rate for Payer: Cash Price |
$427.82
|
| 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: Health Alliance Plan Medicare Advantage |
$441.39
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Mclaren Medicaid |
$236.59
|
| Rate for Payer: Mclaren Medicare |
$441.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.46
|
| Rate for Payer: Meridian Medicaid |
$248.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$507.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$1,324.17
|
| Rate for Payer: PACE Medicare |
$419.32
|
| Rate for Payer: PACE SWMI |
$441.39
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: PHP Medicare Advantage |
$441.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.50
|
| Rate for Payer: Priority Health Medicare |
$441.39
|
| Rate for Payer: Priority Health Narrow Network |
$360.40
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: Railroad Medicare Medicare |
$441.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,242.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.39
|
| Rate for Payer: UHC Medicare Advantage |
$441.39
|
| Rate for Payer: UHCCP Medicaid |
$248.50
|
| Rate for Payer: VA VA |
$441.39
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
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 IVUS CATHETER
|
Facility
|
OP
|
$2,739.36
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,095.74 |
| Max. Negotiated Rate |
$2,465.42 |
| Rate for Payer: Aetna Commercial |
$2,328.46
|
| Rate for Payer: Aetna Medicare |
$1,369.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,780.58
|
| Rate for Payer: BCBS Complete |
$1,095.74
|
| Rate for Payer: Cash Price |
$2,191.49
|
| Rate for Payer: Cofinity Commercial |
$1,917.55
|
| Rate for Payer: Cofinity Commercial |
$2,355.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,917.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,191.49
|
| Rate for Payer: Healthscope Commercial |
$2,465.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,328.46
|
| Rate for Payer: PHP Commercial |
$2,328.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.58
|
| Rate for Payer: Priority Health SBD |
$1,725.80
|
|
|
HC IVUS CATHETER
|
Facility
|
IP
|
$2,739.36
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,725.80 |
| Max. Negotiated Rate |
$2,465.42 |
| Rate for Payer: Aetna Commercial |
$2,328.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,780.58
|
| Rate for Payer: Cash Price |
$2,191.49
|
| Rate for Payer: Cofinity Commercial |
$2,355.85
|
| Rate for Payer: Cofinity Commercial |
$1,917.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,917.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,191.49
|
| Rate for Payer: Healthscope Commercial |
$2,465.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,328.46
|
| Rate for Payer: PHP Commercial |
$2,328.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.58
|
| Rate for Payer: Priority Health SBD |
$1,725.80
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
IP
|
$1,324.84
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$834.65 |
| Max. Negotiated Rate |
$1,192.36 |
| Rate for Payer: Aetna Commercial |
$1,126.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$861.15
|
| Rate for Payer: Cash Price |
$1,059.87
|
| Rate for Payer: Cofinity Commercial |
$1,139.36
|
| Rate for Payer: Cofinity Commercial |
$927.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$927.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,059.87
|
| Rate for Payer: Healthscope Commercial |
$1,192.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,126.11
|
| Rate for Payer: PHP Commercial |
$1,126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.15
|
| Rate for Payer: Priority Health SBD |
$834.65
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
OP
|
$1,324.84
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$1,192.36 |
| Rate for Payer: Aetna Commercial |
$1,126.11
|
| Rate for Payer: Aetna Medicare |
$662.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$861.15
|
| Rate for Payer: BCBS Complete |
$529.94
|
| Rate for Payer: BCBS Trust/PPO |
$781.80
|
| Rate for Payer: BCN Commercial |
$781.80
|
| Rate for Payer: Cash Price |
$1,059.87
|
| Rate for Payer: Cash Price |
$1,059.87
|
| Rate for Payer: Cash Price |
$1,059.87
|
| Rate for Payer: Cofinity Commercial |
$1,139.36
|
| Rate for Payer: Cofinity Commercial |
$927.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$927.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,059.87
|
| Rate for Payer: Healthscope Commercial |
$1,192.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,126.11
|
| Rate for Payer: PHP Commercial |
$1,126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.15
|
| Rate for Payer: Priority Health SBD |
$834.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.76
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
OP
|
$7,832.55
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.06 |
| Max. Negotiated Rate |
$7,049.30 |
| Rate for Payer: Aetna Commercial |
$6,657.67
|
| Rate for Payer: Aetna Medicare |
$3,916.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,091.16
|
| Rate for Payer: BCBS Complete |
$3,133.02
|
| Rate for Payer: BCBS Trust/PPO |
$5,298.54
|
| Rate for Payer: BCN Commercial |
$5,298.54
|
| Rate for Payer: Cash Price |
$6,266.04
|
| Rate for Payer: Cash Price |
$6,266.04
|
| Rate for Payer: Cash Price |
$6,266.04
|
| Rate for Payer: Cofinity Commercial |
$5,482.78
|
| Rate for Payer: Cofinity Commercial |
$6,735.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,482.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,266.04
|
| Rate for Payer: Healthscope Commercial |
$7,049.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,657.67
|
| Rate for Payer: PHP Commercial |
$6,657.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,091.16
|
| Rate for Payer: Priority Health SBD |
$4,934.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.06
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
