|
HC IV INFUSION CONCURRENT
|
Facility
|
IP
|
$177.14
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$132.85 |
| Max. Negotiated Rate |
$177.14 |
| Rate for Payer: Aetna Commercial |
$159.43
|
| Rate for Payer: ASR ASR |
$171.83
|
| Rate for Payer: BCBS Trust/PPO |
$145.47
|
| Rate for Payer: BCN Commercial |
$145.47
|
| Rate for Payer: Cash Price |
$141.71
|
| Rate for Payer: Cofinity Commercial |
$166.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.71
|
| Rate for Payer: Healthscope Commercial |
$171.83
|
| Rate for Payer: Healthscope Whirlpool |
$177.14
|
| Rate for Payer: Mclaren Commercial |
$159.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.57
|
| Rate for Payer: Nomi Health Commercial |
$145.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.88
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
OP
|
$177.14
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$48.43 |
| Max. Negotiated Rate |
$177.14 |
| Rate for Payer: Aetna Commercial |
$159.43
|
| Rate for Payer: Aetna Medicare |
$65.54
|
| Rate for Payer: ASR ASR |
$171.83
|
| Rate for Payer: BCBS Complete |
$70.86
|
| Rate for Payer: BCBS Trust/PPO |
$146.05
|
| Rate for Payer: BCN Commercial |
$146.05
|
| Rate for Payer: Cash Price |
$141.71
|
| Rate for Payer: Cash Price |
$141.71
|
| Rate for Payer: Cofinity Commercial |
$166.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.71
|
| Rate for Payer: Healthscope Commercial |
$171.83
|
| Rate for Payer: Healthscope Whirlpool |
$177.14
|
| Rate for Payer: Mclaren Commercial |
$159.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.57
|
| Rate for Payer: Nomi Health Commercial |
$145.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$60.53
|
| Rate for Payer: Priority Health Narrow Network |
$48.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.88
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
IP
|
$198.43
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$148.82 |
| Max. Negotiated Rate |
$198.43 |
| Rate for Payer: Aetna Commercial |
$178.59
|
| Rate for Payer: ASR ASR |
$192.48
|
| Rate for Payer: BCBS Trust/PPO |
$162.95
|
| Rate for Payer: BCN Commercial |
$162.95
|
| Rate for Payer: Cash Price |
$158.74
|
| Rate for Payer: Cofinity Commercial |
$186.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.74
|
| Rate for Payer: Healthscope Commercial |
$192.48
|
| Rate for Payer: Healthscope Whirlpool |
$198.43
|
| Rate for Payer: Mclaren Commercial |
$178.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.67
|
| Rate for Payer: Nomi Health Commercial |
$162.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.62
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
OP
|
$198.43
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$198.43 |
| Rate for Payer: Aetna Commercial |
$178.59
|
| 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 |
$192.48
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$163.61
|
| Rate for Payer: BCN Commercial |
$163.61
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$158.74
|
| Rate for Payer: Cash Price |
$158.74
|
| Rate for Payer: Cofinity Commercial |
$186.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$192.48
|
| Rate for Payer: Healthscope Whirlpool |
$198.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.66
|
| Rate for Payer: Mclaren Commercial |
$178.59
|
| 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 |
$168.67
|
| Rate for Payer: Nomi Health Commercial |
$162.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.82
|
| 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 |
$58.11
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health Narrow Network |
$46.49
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.62
|
| 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 INFUSION THERAPY INITIAL HOUR
|
Facility
|
IP
|
$545.48
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$409.11 |
| Max. Negotiated Rate |
$545.48 |
| Rate for Payer: Aetna Commercial |
$490.93
|
| Rate for Payer: ASR ASR |
$529.12
|
| Rate for Payer: BCBS Trust/PPO |
$447.95
|
| Rate for Payer: BCN Commercial |
$447.95
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$512.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$529.12
|
| Rate for Payer: Healthscope Whirlpool |
$545.48
|
| Rate for Payer: Mclaren Commercial |
$490.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.66
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.02
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
OP
|
$545.48
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$545.48 |
| Rate for Payer: Aetna Commercial |
$490.93
|
| 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 |
$529.12
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$449.75
|
| Rate for Payer: BCN Commercial |
$449.75
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$512.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$529.12
|
| Rate for Payer: Healthscope Whirlpool |
$545.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$211.94
|
| Rate for Payer: Mclaren Commercial |
$490.93
|
| 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 |
$463.66
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.11
|
| 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 |
$480.02
|
| 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 LACTATED RINGERS 1000
|
Facility
|
OP
|
$85.41
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$85.41 |
| Rate for Payer: Aetna Commercial |
$76.87
|
| Rate for Payer: Aetna Medicare |
$31.60
|
| Rate for Payer: ASR ASR |
$82.85
|
| Rate for Payer: BCBS Complete |
$34.16
|
| Rate for Payer: BCBS Trust/PPO |
$70.42
|
| Rate for Payer: BCN Commercial |
$70.42
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cofinity Commercial |
$80.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$82.85
|
| Rate for Payer: Healthscope Whirlpool |
$85.41
|
| Rate for Payer: Mclaren Commercial |
$76.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.60
|
| Rate for Payer: Nomi Health Commercial |
$70.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.47
|
| Rate for Payer: Priority Health Narrow Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.16
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
IP
|
$85.41
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.06 |
| Max. Negotiated Rate |
$85.41 |
| Rate for Payer: Aetna Commercial |
$76.87
|
| Rate for Payer: ASR ASR |
$82.85
|
| Rate for Payer: BCBS Trust/PPO |
$70.14
|
| Rate for Payer: BCN Commercial |
$70.14
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cofinity Commercial |
$80.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$82.85
|
| Rate for Payer: Healthscope Whirlpool |
$85.41
|
| Rate for Payer: Mclaren Commercial |
$76.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.60
|
| Rate for Payer: Nomi Health Commercial |
$70.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.16
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
IP
|
$87.43
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.57 |
| Max. Negotiated Rate |
$87.43 |
| Rate for Payer: Aetna Commercial |
$78.69
|
| Rate for Payer: ASR ASR |
$84.81
|
| Rate for Payer: BCBS Trust/PPO |
$71.80
|
| Rate for Payer: BCN Commercial |
$71.80
|
| Rate for Payer: Cash Price |
$69.94
|
| Rate for Payer: Cofinity Commercial |
$82.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.94
|
| Rate for Payer: Healthscope Commercial |
$84.81
|
| Rate for Payer: Healthscope Whirlpool |
$87.43
|
| Rate for Payer: Mclaren Commercial |
$78.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.32
|
| Rate for Payer: Nomi Health Commercial |
$71.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.94
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
OP
|
$87.43
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$87.43 |
| Rate for Payer: Aetna Commercial |
$78.69
|
| Rate for Payer: Aetna Medicare |
$32.35
|
| Rate for Payer: ASR ASR |
$84.81
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS Trust/PPO |
$72.09
|
| Rate for Payer: BCN Commercial |
$72.09
|
| Rate for Payer: Cash Price |
$69.94
|
| Rate for Payer: Cash Price |
$69.94
|
| Rate for Payer: Cofinity Commercial |
$82.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.94
|
| Rate for Payer: Healthscope Commercial |
$84.81
|
| Rate for Payer: Healthscope Whirlpool |
$87.43
|
| Rate for Payer: Mclaren Commercial |
$78.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.32
|
| Rate for Payer: Nomi Health Commercial |
$71.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.33
|
| Rate for Payer: Priority Health Narrow Network |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.94
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
IP
|
$171.07
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.30 |
| Max. Negotiated Rate |
$171.07 |
| Rate for Payer: Aetna Commercial |
$153.96
|
| Rate for Payer: ASR ASR |
$165.94
|
| Rate for Payer: BCBS Trust/PPO |
$140.48
|
| Rate for Payer: BCN Commercial |
$140.48
|
| Rate for Payer: Cash Price |
$136.86
|
| Rate for Payer: Cofinity Commercial |
$160.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.86
|
| Rate for Payer: Healthscope Commercial |
$165.94
|
| Rate for Payer: Healthscope Whirlpool |
$171.07
|
| Rate for Payer: Mclaren Commercial |
$153.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.41
|
| Rate for Payer: Nomi Health Commercial |
$140.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.54
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
OP
|
$171.07
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$171.07 |
| Rate for Payer: Aetna Commercial |
$153.96
|
| 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 |
$165.94
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$141.05
|
| Rate for Payer: BCN Commercial |
$141.05
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$136.86
|
| Rate for Payer: Cash Price |
$136.86
|
| Rate for Payer: Cofinity Commercial |
$160.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$165.94
|
| Rate for Payer: Healthscope Whirlpool |
$171.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.66
|
| Rate for Payer: Mclaren Commercial |
$153.96
|
| 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 |
$145.41
|
| Rate for Payer: Nomi Health Commercial |
$140.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.30
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$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 |
$89.59
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health Narrow Network |
$71.67
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.54
|
| 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 PUSH ADDL SAME DRUG
|
Facility
|
IP
|
$157.93
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.45 |
| Max. Negotiated Rate |
$157.93 |
| Rate for Payer: Aetna Commercial |
$142.14
|
| Rate for Payer: ASR ASR |
$153.19
|
| Rate for Payer: BCBS Trust/PPO |
$129.69
|
| Rate for Payer: BCN Commercial |
$129.69
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Commercial |
$148.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Healthscope Commercial |
$153.19
|
| Rate for Payer: Healthscope Whirlpool |
$157.93
|
| Rate for Payer: Mclaren Commercial |
$142.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Nomi Health Commercial |
$129.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.98
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
OP
|
$157.93
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$157.93 |
| Rate for Payer: Aetna Commercial |
$142.14
|
| Rate for Payer: Aetna Medicare |
$58.43
|
| Rate for Payer: ASR ASR |
$153.19
|
| Rate for Payer: BCBS Complete |
$63.17
|
| Rate for Payer: BCBS Trust/PPO |
$130.21
|
| Rate for Payer: BCN Commercial |
$130.21
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Commercial |
$148.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Healthscope Commercial |
$153.19
|
| Rate for Payer: Healthscope Whirlpool |
$157.93
|
| Rate for Payer: Mclaren Commercial |
$142.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Nomi Health Commercial |
$129.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.47
|
| Rate for Payer: Priority Health Narrow Network |
$43.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.98
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
OP
|
$409.83
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$409.83 |
| Rate for Payer: Aetna Commercial |
$368.85
|
| Rate for Payer: Aetna Medicare |
$71.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: ASR ASR |
$397.54
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$337.90
|
| Rate for Payer: BCN Commercial |
$337.90
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$327.86
|
| Rate for Payer: Cash Price |
$327.86
|
| Rate for Payer: Cofinity Commercial |
$385.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$397.54
|
| Rate for Payer: Healthscope Whirlpool |
$409.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$71.74
|
| Rate for Payer: Mclaren Commercial |
$368.85
|
| Rate for Payer: Mclaren Medicaid |
$71.74
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$39.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.36
|
| Rate for Payer: Nomi Health Commercial |
$336.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.37
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$78.91
|
| Rate for Payer: PHP Medicaid |
$38.45
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$182.81
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health Narrow Network |
$146.24
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$111.20
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP DNSP |
$71.74
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
IP
|
$409.83
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$307.37 |
| Max. Negotiated Rate |
$409.83 |
| Rate for Payer: Aetna Commercial |
$368.85
|
| Rate for Payer: ASR ASR |
$397.54
|
| Rate for Payer: BCBS Trust/PPO |
$336.55
|
| Rate for Payer: BCN Commercial |
$336.55
|
| Rate for Payer: Cash Price |
$327.86
|
| Rate for Payer: Cofinity Commercial |
$385.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.86
|
| Rate for Payer: Healthscope Commercial |
$397.54
|
| Rate for Payer: Healthscope Whirlpool |
$409.83
|
| Rate for Payer: Mclaren Commercial |
$368.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.36
|
| Rate for Payer: Nomi Health Commercial |
$336.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.65
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
OP
|
$710.44
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$710.44 |
| Rate for Payer: Aetna Commercial |
$639.40
|
| Rate for Payer: Aetna Medicare |
$329.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: ASR ASR |
$689.13
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$585.76
|
| Rate for Payer: BCN Commercial |
$585.76
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cofinity Commercial |
$667.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$689.13
|
| Rate for Payer: Healthscope Whirlpool |
$710.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$329.12
|
| Rate for Payer: Mclaren Commercial |
$639.40
|
| Rate for Payer: Mclaren Medicaid |
$329.12
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$180.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.87
|
| Rate for Payer: Nomi Health Commercial |
$582.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.83
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$362.03
|
| Rate for Payer: PHP Medicaid |
$176.41
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$311.10
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health Narrow Network |
$248.88
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$510.14
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP DNSP |
$329.12
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
IP
|
$710.44
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$532.83 |
| Max. Negotiated Rate |
$710.44 |
| Rate for Payer: Aetna Commercial |
$639.40
|
| Rate for Payer: ASR ASR |
$689.13
|
| Rate for Payer: BCBS Trust/PPO |
$583.41
|
| Rate for Payer: BCN Commercial |
$583.41
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cofinity Commercial |
$667.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.35
|
| Rate for Payer: Healthscope Commercial |
$689.13
|
| Rate for Payer: Healthscope Whirlpool |
$710.44
|
| Rate for Payer: Mclaren Commercial |
$639.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.87
|
| Rate for Payer: Nomi Health Commercial |
$582.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.19
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
OP
|
$288.28
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.46 |
| Max. Negotiated Rate |
$328.51 |
| Rate for Payer: Aetna Commercial |
$259.45
|
| 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 |
$279.63
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$237.69
|
| Rate for Payer: BCN Commercial |
$237.69
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$230.62
|
| Rate for Payer: Cash Price |
$230.62
|
| Rate for Payer: Cofinity Commercial |
$270.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$279.63
|
| Rate for Payer: Healthscope Whirlpool |
$288.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$211.94
|
| Rate for Payer: Mclaren Commercial |
$259.45
|
| 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 |
$245.04
|
| Rate for Payer: Nomi Health Commercial |
$236.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.21
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$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 |
$116.82
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health Narrow Network |
$93.46
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$253.69
|
| 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 PUSH INITIAL DRUG
|
Facility
|
IP
|
$288.28
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.21 |
| Max. Negotiated Rate |
$288.28 |
| Rate for Payer: Aetna Commercial |
$259.45
|
| Rate for Payer: ASR ASR |
$279.63
|
| Rate for Payer: BCBS Trust/PPO |
$236.74
|
| Rate for Payer: BCN Commercial |
$236.74
|
| Rate for Payer: Cash Price |
$230.62
|
| Rate for Payer: Cofinity Commercial |
$270.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.62
|
| Rate for Payer: Healthscope Commercial |
$279.63
|
| Rate for Payer: Healthscope Whirlpool |
$288.28
|
| Rate for Payer: Mclaren Commercial |
$259.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.04
|
| Rate for Payer: Nomi Health Commercial |
$236.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$253.69
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
OP
|
$226.68
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$226.68 |
| Rate for Payer: Aetna Commercial |
$204.01
|
| Rate for Payer: Aetna Medicare |
$71.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: ASR ASR |
$219.88
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$186.90
|
| Rate for Payer: BCN Commercial |
$186.90
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$181.34
|
| Rate for Payer: Cash Price |
$181.34
|
| Rate for Payer: Cofinity Commercial |
$213.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$219.88
|
| Rate for Payer: Healthscope Whirlpool |
$226.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$71.74
|
| Rate for Payer: Mclaren Commercial |
$204.01
|
| Rate for Payer: Mclaren Medicaid |
$71.74
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$39.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.68
|
| Rate for Payer: Nomi Health Commercial |
$185.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.01
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$78.91
|
| Rate for Payer: PHP Medicaid |
$38.45
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$102.91
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health Narrow Network |
$82.33
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$111.20
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP DNSP |
$71.74
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
IP
|
$226.68
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$170.01 |
| Max. Negotiated Rate |
$226.68 |
| Rate for Payer: Aetna Commercial |
$204.01
|
| Rate for Payer: ASR ASR |
$219.88
|
| Rate for Payer: BCBS Trust/PPO |
$186.15
|
| Rate for Payer: BCN Commercial |
$186.15
|
| Rate for Payer: Cash Price |
$181.34
|
| Rate for Payer: Cofinity Commercial |
$213.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.34
|
| Rate for Payer: Healthscope Commercial |
$219.88
|
| Rate for Payer: Healthscope Whirlpool |
$226.68
|
| Rate for Payer: Mclaren Commercial |
$204.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.68
|
| Rate for Payer: Nomi Health Commercial |
$185.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.48
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$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/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
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
|
|
