|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
IP
|
$126.49
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$88.54 |
| Max. Negotiated Rate |
$126.49 |
| Rate for Payer: Aetna Commercial |
$113.84
|
| Rate for Payer: ASR ASR |
$122.70
|
| Rate for Payer: BCBS Trust/PPO |
$98.07
|
| Rate for Payer: BCN Commercial |
$98.07
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cofinity Commercial |
$118.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.19
|
| Rate for Payer: Healthscope Commercial |
$126.49
|
| Rate for Payer: Healthscope Whirlpool |
$122.70
|
| Rate for Payer: Mclaren Commercial |
$113.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.31
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
OP
|
$126.49
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$126.49 |
| Rate for Payer: Aetna Commercial |
$113.84
|
| Rate for Payer: Aetna Medicare |
$42.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.78
|
| Rate for Payer: ASR ASR |
$122.70
|
| Rate for Payer: BCBS Complete |
$24.25
|
| Rate for Payer: BCBS MAPPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$98.07
|
| Rate for Payer: BCN Commercial |
$98.07
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cofinity Commercial |
$118.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$126.49
|
| Rate for Payer: Healthscope Whirlpool |
$122.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.22
|
| Rate for Payer: Mclaren Commercial |
$113.84
|
| Rate for Payer: Mclaren Medicaid |
$23.09
|
| Rate for Payer: Mclaren Medicare |
$42.22
|
| Rate for Payer: Meridian Medicaid |
$24.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.52
|
| Rate for Payer: PACE Medicare |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$46.44
|
| Rate for Payer: PHP Medicaid |
$23.09
|
| Rate for Payer: PHP Medicare Advantage |
$42.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.60
|
| Rate for Payer: Priority Health Medicare |
$42.22
|
| Rate for Payer: Priority Health Narrow Network |
$50.08
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.31
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: VA VA |
$42.22
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
IP
|
$265.62
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$185.93 |
| Max. Negotiated Rate |
$265.62 |
| Rate for Payer: Aetna Commercial |
$239.06
|
| Rate for Payer: ASR ASR |
$257.65
|
| Rate for Payer: BCBS Trust/PPO |
$205.94
|
| Rate for Payer: BCN Commercial |
$205.94
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cofinity Commercial |
$249.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.50
|
| Rate for Payer: Healthscope Commercial |
$265.62
|
| Rate for Payer: Healthscope Whirlpool |
$257.65
|
| Rate for Payer: Mclaren Commercial |
$239.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.75
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
OP
|
$265.62
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$265.62 |
| Rate for Payer: Aetna Commercial |
$239.06
|
| Rate for Payer: Aetna Medicare |
$190.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: ASR ASR |
$257.65
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$205.94
|
| Rate for Payer: BCN Commercial |
$205.94
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cofinity Commercial |
$249.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$265.62
|
| Rate for Payer: Healthscope Whirlpool |
$257.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.52
|
| Rate for Payer: Mclaren Commercial |
$239.06
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.78
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$209.57
|
| Rate for Payer: PHP Medicaid |
$104.21
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.96
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$123.97
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.75
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: VA VA |
$190.52
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
OP
|
$674.68
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$674.68 |
| Rate for Payer: Aetna Commercial |
$607.21
|
| Rate for Payer: Aetna Medicare |
$190.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: ASR ASR |
$654.44
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$523.08
|
| Rate for Payer: BCN Commercial |
$523.08
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$539.74
|
| Rate for Payer: Cash Price |
$539.74
|
| Rate for Payer: Cofinity Commercial |
$634.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$674.68
|
| Rate for Payer: Healthscope Whirlpool |
$654.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.52
|
| Rate for Payer: Mclaren Commercial |
$607.21
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.48
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$209.57
|
| Rate for Payer: PHP Medicaid |
$104.21
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.72
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$210.98
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$593.72
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: VA VA |
$190.52
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
IP
|
$674.68
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$472.28 |
| Max. Negotiated Rate |
$674.68 |
| Rate for Payer: Aetna Commercial |
$607.21
|
| Rate for Payer: ASR ASR |
$654.44
|
| Rate for Payer: BCBS Trust/PPO |
$523.08
|
| Rate for Payer: BCN Commercial |
$523.08
|
| Rate for Payer: Cash Price |
$539.74
|
| Rate for Payer: Cofinity Commercial |
$634.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.74
|
| Rate for Payer: Healthscope Commercial |
$674.68
|
| Rate for Payer: Healthscope Whirlpool |
$654.44
|
| Rate for Payer: Mclaren Commercial |
$607.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$593.72
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$367.00 |
| Max. Negotiated Rate |
$524.28 |
| Rate for Payer: Aetna Commercial |
$471.85
|
| Rate for Payer: ASR ASR |
$508.55
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$492.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Healthscope Commercial |
$524.28
|
| Rate for Payer: Healthscope Whirlpool |
$508.55
|
| Rate for Payer: Mclaren Commercial |
$471.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.37
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$229.89 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Aetna Commercial |
$471.85
|
| Rate for Payer: Aetna Medicare |
$420.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$525.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$525.35
|
| Rate for Payer: ASR ASR |
$508.55
|
| Rate for Payer: BCBS Complete |
$241.41
|
| Rate for Payer: BCBS MAPPO |
$420.28
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: BCN Medicare Advantage |
$420.28
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$492.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.28
|
| Rate for Payer: Healthscope Commercial |
$524.28
|
| Rate for Payer: Healthscope Whirlpool |
$508.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$420.28
|
| Rate for Payer: Mclaren Commercial |
$471.85
|
| Rate for Payer: Mclaren Medicaid |
$229.89
|
| Rate for Payer: Mclaren Medicare |
$420.28
|
| Rate for Payer: Meridian Medicaid |
$241.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Medicare |
$399.27
|
| Rate for Payer: PACE SWMI |
$420.28
|
| Rate for Payer: PHP Commercial |
$462.31
|
| Rate for Payer: PHP Medicaid |
$229.89
|
| Rate for Payer: PHP Medicare Advantage |
$420.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.09
|
| Rate for Payer: Priority Health Medicare |
$420.28
|
| Rate for Payer: Priority Health Narrow Network |
$372.24
|
| Rate for Payer: Railroad Medicare Medicare |
$420.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.37
|
| Rate for Payer: UHC Medicare Advantage |
$432.89
|
| Rate for Payer: VA VA |
$420.28
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$367.00 |
| Max. Negotiated Rate |
$524.28 |
| Rate for Payer: Aetna Commercial |
$471.85
|
| Rate for Payer: ASR ASR |
$508.55
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$492.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Healthscope Commercial |
$524.28
|
| Rate for Payer: Healthscope Whirlpool |
$508.55
|
| Rate for Payer: Mclaren Commercial |
$471.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.37
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$229.89 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Aetna Commercial |
$471.85
|
| Rate for Payer: Aetna Medicare |
$420.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$525.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$525.35
|
| Rate for Payer: ASR ASR |
$508.55
|
| Rate for Payer: BCBS Complete |
$241.41
|
| Rate for Payer: BCBS MAPPO |
$420.28
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: BCN Medicare Advantage |
$420.28
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$492.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.28
|
| Rate for Payer: Healthscope Commercial |
$524.28
|
| Rate for Payer: Healthscope Whirlpool |
$508.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$420.28
|
| Rate for Payer: Mclaren Commercial |
$471.85
|
| Rate for Payer: Mclaren Medicaid |
$229.89
|
| Rate for Payer: Mclaren Medicare |
$420.28
|
| Rate for Payer: Meridian Medicaid |
$241.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Medicare |
$399.27
|
| Rate for Payer: PACE SWMI |
$420.28
|
| Rate for Payer: PHP Commercial |
$462.31
|
| Rate for Payer: PHP Medicaid |
$229.89
|
| Rate for Payer: PHP Medicare Advantage |
$420.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.09
|
| Rate for Payer: Priority Health Medicare |
$420.28
|
| Rate for Payer: Priority Health Narrow Network |
$372.24
|
| Rate for Payer: Railroad Medicare Medicare |
$420.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.37
|
| Rate for Payer: UHC Medicare Advantage |
$432.89
|
| Rate for Payer: VA VA |
$420.28
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
IP
|
$170.26
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$119.18 |
| Max. Negotiated Rate |
$170.26 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: ASR ASR |
$165.15
|
| Rate for Payer: BCBS Trust/PPO |
$132.00
|
| Rate for Payer: BCN Commercial |
$132.00
|
| Rate for Payer: Cash Price |
$136.21
|
| Rate for Payer: Cofinity Commercial |
$160.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.21
|
| Rate for Payer: Healthscope Commercial |
$170.26
|
| Rate for Payer: Healthscope Whirlpool |
$165.15
|
| Rate for Payer: Mclaren Commercial |
$153.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.83
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
OP
|
$170.26
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$41.05 |
| Max. Negotiated Rate |
$170.26 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: ASR ASR |
$165.15
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS Trust/PPO |
$132.00
|
| Rate for Payer: BCN Commercial |
$132.00
|
| Rate for Payer: Cash Price |
$136.21
|
| Rate for Payer: Cash Price |
$136.21
|
| Rate for Payer: Cofinity Commercial |
$160.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.21
|
| Rate for Payer: Healthscope Commercial |
$170.26
|
| Rate for Payer: Healthscope Whirlpool |
$165.15
|
| Rate for Payer: Mclaren Commercial |
$153.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.31
|
| Rate for Payer: Priority Health Narrow Network |
$41.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.83
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
OP
|
$190.73
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$190.73 |
| Rate for Payer: Aetna Commercial |
$171.66
|
| Rate for Payer: Aetna Medicare |
$42.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.78
|
| Rate for Payer: ASR ASR |
$185.01
|
| Rate for Payer: BCBS Complete |
$24.25
|
| Rate for Payer: BCBS MAPPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$147.87
|
| Rate for Payer: BCN Commercial |
$147.87
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$152.58
|
| Rate for Payer: Cash Price |
$152.58
|
| Rate for Payer: Cofinity Commercial |
$179.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$190.73
|
| Rate for Payer: Healthscope Whirlpool |
$185.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.22
|
| Rate for Payer: Mclaren Commercial |
$171.66
|
| Rate for Payer: Mclaren Medicaid |
$23.09
|
| Rate for Payer: Mclaren Medicare |
$42.22
|
| Rate for Payer: Meridian Medicaid |
$24.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.12
|
| Rate for Payer: PACE Medicare |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$46.44
|
| Rate for Payer: PHP Medicaid |
$23.09
|
| Rate for Payer: PHP Medicare Advantage |
$42.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.25
|
| Rate for Payer: Priority Health Medicare |
$42.22
|
| Rate for Payer: Priority Health Narrow Network |
$39.40
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.84
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: VA VA |
$42.22
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
IP
|
$190.73
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$133.51 |
| Max. Negotiated Rate |
$190.73 |
| Rate for Payer: Aetna Commercial |
$171.66
|
| Rate for Payer: ASR ASR |
$185.01
|
| Rate for Payer: BCBS Trust/PPO |
$147.87
|
| Rate for Payer: BCN Commercial |
$147.87
|
| Rate for Payer: Cash Price |
$152.58
|
| Rate for Payer: Cofinity Commercial |
$179.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.58
|
| Rate for Payer: Healthscope Commercial |
$190.73
|
| Rate for Payer: Healthscope Whirlpool |
$185.01
|
| Rate for Payer: Mclaren Commercial |
$171.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.84
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
IP
|
$524.29
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$367.00 |
| Max. Negotiated Rate |
$524.29 |
| Rate for Payer: Aetna Commercial |
$471.86
|
| Rate for Payer: ASR ASR |
$508.56
|
| Rate for Payer: BCBS Trust/PPO |
$406.48
|
| Rate for Payer: BCN Commercial |
$406.48
|
| Rate for Payer: Cash Price |
$419.43
|
| Rate for Payer: Cofinity Commercial |
$492.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.43
|
| Rate for Payer: Healthscope Commercial |
$524.29
|
| Rate for Payer: Healthscope Whirlpool |
$508.56
|
| Rate for Payer: Mclaren Commercial |
$471.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.38
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
OP
|
$524.29
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$524.29 |
| Rate for Payer: Aetna Commercial |
$471.86
|
| Rate for Payer: Aetna Medicare |
$190.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: ASR ASR |
$508.56
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$406.48
|
| Rate for Payer: BCN Commercial |
$406.48
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$419.43
|
| Rate for Payer: Cash Price |
$419.43
|
| Rate for Payer: Cofinity Commercial |
$492.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$524.29
|
| Rate for Payer: Healthscope Whirlpool |
$508.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.52
|
| Rate for Payer: Mclaren Commercial |
$471.86
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.65
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$209.57
|
| Rate for Payer: PHP Medicaid |
$104.21
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.72
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$210.98
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.38
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: VA VA |
$190.52
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
IP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.62 |
| Max. Negotiated Rate |
$83.74 |
| Rate for Payer: Aetna Commercial |
$75.37
|
| Rate for Payer: ASR ASR |
$81.23
|
| Rate for Payer: BCBS Trust/PPO |
$64.92
|
| Rate for Payer: BCN Commercial |
$64.92
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$78.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$83.74
|
| Rate for Payer: Healthscope Whirlpool |
$81.23
|
| Rate for Payer: Mclaren Commercial |
$75.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.69
|
|
|
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 |
$83.74 |
| Rate for Payer: Aetna Commercial |
$75.37
|
| Rate for Payer: ASR ASR |
$81.23
|
| Rate for Payer: BCBS Complete |
$33.50
|
| Rate for Payer: BCBS Trust/PPO |
$64.92
|
| Rate for Payer: BCN Commercial |
$64.92
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$78.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$83.74
|
| Rate for Payer: Healthscope Whirlpool |
$81.23
|
| Rate for Payer: Mclaren Commercial |
$75.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.20
|
| Rate for Payer: Priority Health Narrow Network |
$59.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.69
|
|
|
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 |
$60.00 |
| Max. Negotiated Rate |
$85.72 |
| Rate for Payer: Aetna Commercial |
$77.15
|
| Rate for Payer: ASR ASR |
$83.15
|
| Rate for Payer: BCBS Trust/PPO |
$66.46
|
| Rate for Payer: BCN Commercial |
$66.46
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$80.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$85.72
|
| Rate for Payer: Healthscope Whirlpool |
$83.15
|
| Rate for Payer: Mclaren Commercial |
$77.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.43
|
|
|
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 |
$85.72 |
| Rate for Payer: Aetna Commercial |
$77.15
|
| Rate for Payer: ASR ASR |
$83.15
|
| Rate for Payer: BCBS Complete |
$34.29
|
| Rate for Payer: BCBS Trust/PPO |
$66.46
|
| Rate for Payer: BCN Commercial |
$66.46
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$80.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$85.72
|
| Rate for Payer: Healthscope Whirlpool |
$83.15
|
| Rate for Payer: Mclaren Commercial |
$77.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.01
|
| Rate for Payer: Priority Health Narrow Network |
$60.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.43
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
OP
|
$164.43
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$164.43 |
| Rate for Payer: Aetna Commercial |
$147.99
|
| Rate for Payer: Aetna Medicare |
$42.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.78
|
| Rate for Payer: ASR ASR |
$159.50
|
| Rate for Payer: BCBS Complete |
$24.25
|
| Rate for Payer: BCBS MAPPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$127.48
|
| Rate for Payer: BCN Commercial |
$127.48
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$154.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$164.43
|
| Rate for Payer: Healthscope Whirlpool |
$159.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.22
|
| Rate for Payer: Mclaren Commercial |
$147.99
|
| Rate for Payer: Mclaren Medicaid |
$23.09
|
| Rate for Payer: Mclaren Medicare |
$42.22
|
| Rate for Payer: Meridian Medicaid |
$24.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.77
|
| Rate for Payer: PACE Medicare |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$46.44
|
| Rate for Payer: PHP Medicaid |
$23.09
|
| Rate for Payer: PHP Medicare Advantage |
$42.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.94
|
| Rate for Payer: Priority Health Medicare |
$42.22
|
| Rate for Payer: Priority Health Narrow Network |
$60.75
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.70
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: VA VA |
$42.22
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
IP
|
$164.43
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.10 |
| Max. Negotiated Rate |
$164.43 |
| Rate for Payer: Aetna Commercial |
$147.99
|
| Rate for Payer: ASR ASR |
$159.50
|
| Rate for Payer: BCBS Trust/PPO |
$127.48
|
| Rate for Payer: BCN Commercial |
$127.48
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$154.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.54
|
| Rate for Payer: Healthscope Commercial |
$164.43
|
| Rate for Payer: Healthscope Whirlpool |
$159.50
|
| Rate for Payer: Mclaren Commercial |
$147.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.70
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
IP
|
$151.79
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$151.79 |
| Rate for Payer: Aetna Commercial |
$136.61
|
| Rate for Payer: ASR ASR |
$147.24
|
| Rate for Payer: BCBS Trust/PPO |
$117.68
|
| Rate for Payer: BCN Commercial |
$117.68
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$142.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$151.79
|
| Rate for Payer: Healthscope Whirlpool |
$147.24
|
| Rate for Payer: Mclaren Commercial |
$136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.58
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
OP
|
$151.79
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.94 |
| Max. Negotiated Rate |
$151.79 |
| Rate for Payer: Aetna Commercial |
$136.61
|
| Rate for Payer: ASR ASR |
$147.24
|
| Rate for Payer: BCBS Complete |
$60.72
|
| Rate for Payer: BCBS Trust/PPO |
$117.68
|
| Rate for Payer: BCN Commercial |
$117.68
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$142.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$151.79
|
| Rate for Payer: Healthscope Whirlpool |
$147.24
|
| Rate for Payer: Mclaren Commercial |
$136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.18
|
| Rate for Payer: Priority Health Narrow Network |
$36.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.58
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
IP
|
$365.26
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$255.68 |
| Max. Negotiated Rate |
$365.26 |
| Rate for Payer: Aetna Commercial |
$328.73
|
| Rate for Payer: ASR ASR |
$354.30
|
| Rate for Payer: BCBS Trust/PPO |
$283.19
|
| Rate for Payer: BCN Commercial |
$283.19
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cofinity Commercial |
$343.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.21
|
| Rate for Payer: Healthscope Commercial |
$365.26
|
| Rate for Payer: Healthscope Whirlpool |
$354.30
|
| Rate for Payer: Mclaren Commercial |
$328.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.43
|
|
