|
HC ISOVUE 200 PER ML
|
Facility
|
OP
|
$4.55
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$4.09
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: ASR ASR |
$4.41
|
| Rate for Payer: BCBS Complete |
$1.82
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCN Commercial |
$3.75
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cofinity Commercial |
$4.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$4.41
|
| Rate for Payer: Healthscope Whirlpool |
$4.55
|
| Rate for Payer: Mclaren Commercial |
$4.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.87
|
| Rate for Payer: Nomi Health Commercial |
$3.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.00
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: ASR ASR |
$1.92
|
| Rate for Payer: BCBS Trust/PPO |
$1.63
|
| Rate for Payer: BCN Commercial |
$1.63
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.92
|
| Rate for Payer: Healthscope Whirlpool |
$1.98
|
| Rate for Payer: Mclaren Commercial |
$1.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: Nomi Health Commercial |
$1.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.74
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: ASR ASR |
$1.92
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$1.63
|
| Rate for Payer: BCN Commercial |
$1.63
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.92
|
| Rate for Payer: Healthscope Whirlpool |
$1.98
|
| Rate for Payer: Mclaren Commercial |
$1.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: Nomi Health Commercial |
$1.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.42
|
| Rate for Payer: Priority Health Narrow Network |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.74
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
OP
|
$1.70
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$1.53
|
| Rate for Payer: Aetna Medicare |
$0.63
|
| Rate for Payer: ASR ASR |
$1.65
|
| Rate for Payer: BCBS Complete |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.36
|
| Rate for Payer: Healthscope Commercial |
$1.65
|
| Rate for Payer: Healthscope Whirlpool |
$1.70
|
| Rate for Payer: Mclaren Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.45
|
| Rate for Payer: Nomi Health Commercial |
$1.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.42
|
| Rate for Payer: Priority Health Narrow Network |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.50
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
IP
|
$1.70
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna Commercial |
$1.53
|
| Rate for Payer: ASR ASR |
$1.65
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.36
|
| Rate for Payer: Healthscope Commercial |
$1.65
|
| Rate for Payer: Healthscope Whirlpool |
$1.70
|
| Rate for Payer: Mclaren Commercial |
$1.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.45
|
| Rate for Payer: Nomi Health Commercial |
$1.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.50
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
IP
|
$1.94
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: ASR ASR |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCN Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.55
|
| Rate for Payer: Healthscope Commercial |
$1.88
|
| Rate for Payer: Healthscope Whirlpool |
$1.94
|
| Rate for Payer: Mclaren Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.65
|
| Rate for Payer: Nomi Health Commercial |
$1.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.71
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
OP
|
$1.94
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna Medicare |
$0.72
|
| Rate for Payer: ASR ASR |
$1.88
|
| Rate for Payer: BCBS Complete |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$1.60
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.55
|
| Rate for Payer: Healthscope Commercial |
$1.88
|
| Rate for Payer: Healthscope Whirlpool |
$1.94
|
| Rate for Payer: Mclaren Commercial |
$1.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.65
|
| Rate for Payer: Nomi Health Commercial |
$1.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.42
|
| Rate for Payer: Priority Health Narrow Network |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.71
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$328.12
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$470.63 |
| Rate for Payer: Aetna Commercial |
$295.31
|
| Rate for Payer: Aetna Medicare |
$303.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: ASR ASR |
$318.28
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$270.53
|
| Rate for Payer: BCN Commercial |
$270.53
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$308.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Healthscope Commercial |
$318.28
|
| Rate for Payer: Healthscope Whirlpool |
$328.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.63
|
| Rate for Payer: Mclaren Commercial |
$295.31
|
| Rate for Payer: Mclaren Medicaid |
$303.63
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$166.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.90
|
| Rate for Payer: Nomi Health Commercial |
$269.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.09
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Commercial |
$333.99
|
| Rate for Payer: PHP Medicaid |
$162.75
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$272.38
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health Narrow Network |
$217.90
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Exchange |
$470.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP DNSP |
$303.63
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$328.12
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.09 |
| Max. Negotiated Rate |
$328.12 |
| Rate for Payer: Aetna Commercial |
$295.31
|
| Rate for Payer: ASR ASR |
$318.28
|
| Rate for Payer: BCBS Trust/PPO |
$269.45
|
| Rate for Payer: BCN Commercial |
$269.45
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$308.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.50
|
| Rate for Payer: Healthscope Commercial |
$318.28
|
| Rate for Payer: Healthscope Whirlpool |
$328.12
|
| Rate for Payer: Mclaren Commercial |
$295.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.90
|
| Rate for Payer: Nomi Health Commercial |
$269.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.75
|
|
|
HC IUPC ASSIST
|
Facility
|
IP
|
$122.11
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$122.11 |
| Rate for Payer: Aetna Commercial |
$109.90
|
| Rate for Payer: ASR ASR |
$118.45
|
| Rate for Payer: BCBS Trust/PPO |
$100.28
|
| Rate for Payer: BCN Commercial |
$100.28
|
| Rate for Payer: Cash Price |
$97.69
|
| Rate for Payer: Cofinity Commercial |
$114.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.69
|
| Rate for Payer: Healthscope Commercial |
$118.45
|
| Rate for Payer: Healthscope Whirlpool |
$122.11
|
| Rate for Payer: Mclaren Commercial |
$109.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.79
|
| Rate for Payer: Nomi Health Commercial |
$100.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.46
|
|
|
HC IUPC ASSIST
|
Facility
|
OP
|
$122.11
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$122.11 |
| Rate for Payer: Aetna Commercial |
$109.90
|
| Rate for Payer: Aetna Medicare |
$45.18
|
| Rate for Payer: ASR ASR |
$118.45
|
| Rate for Payer: BCBS Complete |
$48.84
|
| Rate for Payer: BCBS Trust/PPO |
$100.68
|
| Rate for Payer: BCN Commercial |
$100.68
|
| Rate for Payer: Cash Price |
$97.69
|
| Rate for Payer: Cofinity Commercial |
$114.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.69
|
| Rate for Payer: Healthscope Commercial |
$118.45
|
| Rate for Payer: Healthscope Whirlpool |
$122.11
|
| Rate for Payer: Mclaren Commercial |
$109.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.79
|
| Rate for Payer: Nomi Health Commercial |
$100.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$106.99
|
| Rate for Payer: Priority Health Narrow Network |
$85.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.46
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
OP
|
$207.64
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$207.64 |
| Rate for Payer: Aetna Commercial |
$186.88
|
| Rate for Payer: Aetna Medicare |
$46.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: ASR ASR |
$201.41
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$171.20
|
| Rate for Payer: BCN Commercial |
$171.20
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cofinity Commercial |
$195.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$201.41
|
| Rate for Payer: Healthscope Whirlpool |
$207.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.66
|
| Rate for Payer: Mclaren Commercial |
$186.88
|
| Rate for Payer: Mclaren Medicaid |
$46.66
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$25.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.49
|
| Rate for Payer: Nomi Health Commercial |
$170.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.73
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$51.33
|
| Rate for Payer: PHP Medicaid |
$25.01
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.85
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health Narrow Network |
$59.08
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$72.32
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP DNSP |
$46.66
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
IP
|
$207.64
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$155.73 |
| Max. Negotiated Rate |
$207.64 |
| Rate for Payer: Aetna Commercial |
$186.88
|
| Rate for Payer: ASR ASR |
$201.41
|
| Rate for Payer: BCBS Trust/PPO |
$170.51
|
| Rate for Payer: BCN Commercial |
$170.51
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cofinity Commercial |
$195.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.11
|
| Rate for Payer: Healthscope Commercial |
$201.41
|
| Rate for Payer: Healthscope Whirlpool |
$207.64
|
| Rate for Payer: Mclaren Commercial |
$186.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.49
|
| Rate for Payer: Nomi Health Commercial |
$170.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.72
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
OP
|
$520.44
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$520.44 |
| Rate for Payer: Aetna Commercial |
$468.40
|
| Rate for Payer: Aetna Medicare |
$211.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: ASR ASR |
$504.83
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$429.10
|
| Rate for Payer: BCN Commercial |
$429.10
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$416.35
|
| Rate for Payer: Cash Price |
$416.35
|
| Rate for Payer: Cofinity Commercial |
$489.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$504.83
|
| Rate for Payer: Healthscope Whirlpool |
$520.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$211.94
|
| Rate for Payer: Mclaren Commercial |
$468.40
|
| Rate for Payer: Mclaren Medicaid |
$211.94
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$116.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.37
|
| Rate for Payer: Nomi Health Commercial |
$426.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.33
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$233.13
|
| Rate for Payer: PHP Medicaid |
$113.60
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$182.81
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health Narrow Network |
$146.24
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$328.51
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP DNSP |
$211.94
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
IP
|
$520.44
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$390.33 |
| Max. Negotiated Rate |
$520.44 |
| Rate for Payer: Aetna Commercial |
$468.40
|
| Rate for Payer: ASR ASR |
$504.83
|
| Rate for Payer: BCBS Trust/PPO |
$427.39
|
| Rate for Payer: BCN Commercial |
$427.39
|
| Rate for Payer: Cash Price |
$416.35
|
| Rate for Payer: Cofinity Commercial |
$489.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.35
|
| Rate for Payer: Healthscope Commercial |
$504.83
|
| Rate for Payer: Healthscope Whirlpool |
$520.44
|
| Rate for Payer: Mclaren Commercial |
$468.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.37
|
| Rate for Payer: Nomi Health Commercial |
$426.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.99
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$131.60 |
| Rate for Payer: Aetna Commercial |
$118.44
|
| Rate for Payer: ASR ASR |
$127.65
|
| Rate for Payer: BCBS Trust/PPO |
$108.07
|
| Rate for Payer: BCN Commercial |
$108.07
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$123.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$127.65
|
| Rate for Payer: Healthscope Whirlpool |
$131.60
|
| Rate for Payer: Mclaren Commercial |
$118.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Nomi Health Commercial |
$107.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.81
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$131.60 |
| Rate for Payer: Aetna Commercial |
$118.44
|
| Rate for Payer: Aetna Medicare |
$46.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: ASR ASR |
$127.65
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$108.50
|
| Rate for Payer: BCN Commercial |
$108.50
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$123.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$127.65
|
| Rate for Payer: Healthscope Whirlpool |
$131.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.66
|
| Rate for Payer: Mclaren Commercial |
$118.44
|
| Rate for Payer: Mclaren Medicaid |
$46.66
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$25.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Nomi Health Commercial |
$107.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$51.33
|
| Rate for Payer: PHP Medicaid |
$25.01
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.85
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health Narrow Network |
$59.08
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$72.32
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP DNSP |
$46.66
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
OP
|
$276.35
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$328.51 |
| Rate for Payer: Aetna Commercial |
$248.72
|
| Rate for Payer: Aetna Medicare |
$211.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: ASR ASR |
$268.06
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$227.85
|
| Rate for Payer: BCN Commercial |
$227.85
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$221.08
|
| Rate for Payer: Cash Price |
$221.08
|
| Rate for Payer: Cofinity Commercial |
$259.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$268.06
|
| Rate for Payer: Healthscope Whirlpool |
$276.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$211.94
|
| Rate for Payer: Mclaren Commercial |
$248.72
|
| Rate for Payer: Mclaren Medicaid |
$211.94
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$116.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.90
|
| Rate for Payer: Nomi Health Commercial |
$226.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.26
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$233.13
|
| Rate for Payer: PHP Medicaid |
$113.60
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$182.81
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health Narrow Network |
$146.24
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$328.51
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP DNSP |
$211.94
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
IP
|
$276.35
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$207.26 |
| Max. Negotiated Rate |
$276.35 |
| Rate for Payer: Aetna Commercial |
$248.72
|
| Rate for Payer: ASR ASR |
$268.06
|
| Rate for Payer: BCBS Trust/PPO |
$226.94
|
| Rate for Payer: BCN Commercial |
$226.94
|
| Rate for Payer: Cash Price |
$221.08
|
| Rate for Payer: Cofinity Commercial |
$259.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.08
|
| Rate for Payer: Healthscope Commercial |
$268.06
|
| Rate for Payer: Healthscope Whirlpool |
$276.35
|
| Rate for Payer: Mclaren Commercial |
$248.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.90
|
| Rate for Payer: Nomi Health Commercial |
$226.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.19
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
IP
|
$701.93
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$526.45 |
| Max. Negotiated Rate |
$701.93 |
| Rate for Payer: Aetna Commercial |
$631.74
|
| Rate for Payer: ASR ASR |
$680.87
|
| Rate for Payer: BCBS Trust/PPO |
$576.42
|
| Rate for Payer: BCN Commercial |
$576.42
|
| Rate for Payer: Cash Price |
$561.54
|
| Rate for Payer: Cofinity Commercial |
$659.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.54
|
| Rate for Payer: Healthscope Commercial |
$680.87
|
| Rate for Payer: Healthscope Whirlpool |
$701.93
|
| Rate for Payer: Mclaren Commercial |
$631.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.64
|
| Rate for Payer: Nomi Health Commercial |
$575.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.70
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
OP
|
$701.93
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$701.93 |
| Rate for Payer: Aetna Commercial |
$631.74
|
| Rate for Payer: Aetna Medicare |
$211.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: ASR ASR |
$680.87
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$578.74
|
| Rate for Payer: BCN Commercial |
$578.74
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$561.54
|
| Rate for Payer: Cash Price |
$561.54
|
| Rate for Payer: Cofinity Commercial |
$659.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$680.87
|
| Rate for Payer: Healthscope Whirlpool |
$701.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$211.94
|
| Rate for Payer: Mclaren Commercial |
$631.74
|
| Rate for Payer: Mclaren Medicaid |
$211.94
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$116.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.64
|
| Rate for Payer: Nomi Health Commercial |
$575.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.45
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$233.13
|
| Rate for Payer: PHP Medicaid |
$113.60
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$311.10
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health Narrow Network |
$248.88
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$328.51
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP DNSP |
$211.94
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$201.82 |
| Max. Negotiated Rate |
$545.47 |
| Rate for Payer: Aetna Commercial |
$490.92
|
| Rate for Payer: Aetna Medicare |
$201.82
|
| Rate for Payer: ASR ASR |
$529.11
|
| Rate for Payer: BCBS Complete |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$449.74
|
| Rate for Payer: BCN Commercial |
$449.74
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$512.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$529.11
|
| Rate for Payer: Healthscope Whirlpool |
$545.47
|
| Rate for Payer: Mclaren Commercial |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$436.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$477.94
|
| Rate for Payer: Priority Health Narrow Network |
$382.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.01
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$409.10 |
| Max. Negotiated Rate |
$545.47 |
| Rate for Payer: Aetna Commercial |
$490.92
|
| Rate for Payer: ASR ASR |
$529.11
|
| Rate for Payer: BCBS Trust/PPO |
$447.94
|
| Rate for Payer: BCN Commercial |
$447.94
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$512.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$529.11
|
| Rate for Payer: Healthscope Whirlpool |
$545.47
|
| Rate for Payer: Mclaren Commercial |
$490.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.01
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$201.82 |
| Max. Negotiated Rate |
$545.47 |
| Rate for Payer: Aetna Commercial |
$490.92
|
| Rate for Payer: Aetna Medicare |
$201.82
|
| Rate for Payer: ASR ASR |
$529.11
|
| Rate for Payer: BCBS Complete |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$449.74
|
| Rate for Payer: BCN Commercial |
$449.74
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$512.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$529.11
|
| Rate for Payer: Healthscope Whirlpool |
$545.47
|
| Rate for Payer: Mclaren Commercial |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$436.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$477.94
|
| Rate for Payer: Priority Health Narrow Network |
$382.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.01
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$409.10 |
| Max. Negotiated Rate |
$545.47 |
| Rate for Payer: Aetna Commercial |
$490.92
|
| Rate for Payer: ASR ASR |
$529.11
|
| Rate for Payer: BCBS Trust/PPO |
$447.94
|
| Rate for Payer: BCN Commercial |
$447.94
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$512.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$529.11
|
| Rate for Payer: Healthscope Whirlpool |
$545.47
|
| Rate for Payer: Mclaren Commercial |
$490.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.01
|
|
