|
HC IV INF SOTROVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$236.59 |
| Max. Negotiated Rate |
$684.15 |
| Rate for Payer: Aetna Commercial |
$481.29
|
| Rate for Payer: Aetna Medicare |
$441.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$551.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$551.74
|
| Rate for Payer: ASR ASR |
$518.73
|
| Rate for Payer: ASR Commercial |
$518.73
|
| Rate for Payer: BCBS Complete |
$248.41
|
| Rate for Payer: BCBS MAPPO |
$441.39
|
| Rate for Payer: BCBS Trust/PPO |
$437.92
|
| Rate for Payer: BCN Commercial |
$414.61
|
| Rate for Payer: BCN Medicare Advantage |
$441.39
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$502.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.39
|
| Rate for Payer: Healthscope Commercial |
$534.77
|
| Rate for Payer: Healthscope Whirlpool |
$518.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$441.39
|
| Rate for Payer: Mclaren Commercial |
$481.29
|
| Rate for Payer: Mclaren Medicaid |
$236.59
|
| Rate for Payer: Mclaren Medicare |
$441.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.46
|
| Rate for Payer: Meridian Medicaid |
$248.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$507.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$438.51
|
| Rate for Payer: PACE Medicare |
$419.32
|
| Rate for Payer: PACE SWMI |
$441.39
|
| Rate for Payer: PHP Commercial |
$485.53
|
| Rate for Payer: PHP Medicaid |
$236.59
|
| Rate for Payer: PHP Medicare Advantage |
$441.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$468.57
|
| Rate for Payer: Priority Health Medicare |
$441.39
|
| Rate for Payer: Priority Health Narrow Network |
$374.87
|
| Rate for Payer: Railroad Medicare Medicare |
$441.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.39
|
| Rate for Payer: UHC Exchange |
$684.15
|
| Rate for Payer: UHC Medicare Advantage |
$441.39
|
| Rate for Payer: UHCCP DNSP |
$441.39
|
| Rate for Payer: UHCCP Medicaid |
$236.59
|
| Rate for Payer: VA VA |
$441.39
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$347.60 |
| Max. Negotiated Rate |
$534.77 |
| Rate for Payer: Aetna Commercial |
$481.29
|
| Rate for Payer: ASR ASR |
$518.73
|
| Rate for Payer: ASR Commercial |
$518.73
|
| Rate for Payer: BCBS Trust/PPO |
$435.78
|
| Rate for Payer: BCN Commercial |
$414.61
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$502.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$534.77
|
| Rate for Payer: Healthscope Whirlpool |
$518.73
|
| Rate for Payer: Mclaren Commercial |
$481.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$438.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.60
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
IP
|
$173.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$112.89 |
| Max. Negotiated Rate |
$173.67 |
| Rate for Payer: Aetna Commercial |
$156.30
|
| Rate for Payer: ASR ASR |
$168.46
|
| Rate for Payer: ASR Commercial |
$168.46
|
| Rate for Payer: BCBS Trust/PPO |
$141.52
|
| Rate for Payer: BCN Commercial |
$134.65
|
| Rate for Payer: Cash Price |
$138.94
|
| Rate for Payer: Cofinity Commercial |
$163.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.94
|
| Rate for Payer: Healthscope Commercial |
$173.67
|
| Rate for Payer: Healthscope Whirlpool |
$168.46
|
| Rate for Payer: Mclaren Commercial |
$156.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.62
|
| Rate for Payer: Nomi Health Commercial |
$142.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.83
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
OP
|
$173.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$173.67 |
| Rate for Payer: Aetna Commercial |
$156.30
|
| Rate for Payer: Aetna Medicare |
$86.84
|
| Rate for Payer: ASR ASR |
$168.46
|
| Rate for Payer: ASR Commercial |
$168.46
|
| Rate for Payer: BCBS Complete |
$69.47
|
| Rate for Payer: BCBS Trust/PPO |
$142.22
|
| Rate for Payer: BCN Commercial |
$134.65
|
| Rate for Payer: Cash Price |
$138.94
|
| Rate for Payer: Cash Price |
$138.94
|
| Rate for Payer: Cofinity Commercial |
$163.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.94
|
| Rate for Payer: Healthscope Commercial |
$173.67
|
| Rate for Payer: Healthscope Whirlpool |
$168.46
|
| Rate for Payer: Mclaren Commercial |
$156.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.62
|
| Rate for Payer: Nomi Health Commercial |
$142.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.90
|
| Rate for Payer: Priority Health Narrow Network |
$43.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.83
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
OP
|
$194.54
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$194.54 |
| Rate for Payer: Aetna Commercial |
$175.09
|
| Rate for Payer: Aetna Medicare |
$45.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: ASR ASR |
$188.70
|
| Rate for Payer: ASR Commercial |
$188.70
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$159.31
|
| Rate for Payer: BCN Commercial |
$150.83
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| Rate for Payer: Cash Price |
$155.63
|
| Rate for Payer: Cash Price |
$155.63
|
| Rate for Payer: Cofinity Commercial |
$182.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$194.54
|
| Rate for Payer: Healthscope Whirlpool |
$188.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.21
|
| Rate for Payer: Mclaren Commercial |
$175.09
|
| Rate for Payer: Mclaren Medicaid |
$24.23
|
| Rate for Payer: Mclaren Medicare |
$45.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.47
|
| Rate for Payer: Meridian Medicaid |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.36
|
| Rate for Payer: Nomi Health Commercial |
$159.52
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$49.73
|
| Rate for Payer: PHP Medicaid |
$24.23
|
| Rate for Payer: PHP Medicare Advantage |
$45.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.70
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$42.16
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$70.08
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP DNSP |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$24.23
|
| Rate for Payer: VA VA |
$45.21
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
IP
|
$194.54
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$194.54 |
| Rate for Payer: Aetna Commercial |
$175.09
|
| Rate for Payer: ASR ASR |
$188.70
|
| Rate for Payer: ASR Commercial |
$188.70
|
| Rate for Payer: BCBS Trust/PPO |
$158.53
|
| Rate for Payer: BCN Commercial |
$150.83
|
| Rate for Payer: Cash Price |
$155.63
|
| Rate for Payer: Cofinity Commercial |
$182.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.63
|
| Rate for Payer: Healthscope Commercial |
$194.54
|
| Rate for Payer: Healthscope Whirlpool |
$188.70
|
| Rate for Payer: Mclaren Commercial |
$175.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.36
|
| Rate for Payer: Nomi Health Commercial |
$159.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.20
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
OP
|
$534.78
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.65 |
| Max. Negotiated Rate |
$534.78 |
| Rate for Payer: Aetna Commercial |
$481.30
|
| Rate for Payer: Aetna Medicare |
$206.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.04
|
| Rate for Payer: ASR ASR |
$518.74
|
| Rate for Payer: ASR Commercial |
$518.74
|
| Rate for Payer: BCBS Complete |
$116.18
|
| Rate for Payer: BCBS MAPPO |
$206.43
|
| Rate for Payer: BCBS Trust/PPO |
$437.93
|
| Rate for Payer: BCN Commercial |
$414.61
|
| Rate for Payer: BCN Medicare Advantage |
$206.43
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$502.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.43
|
| Rate for Payer: Healthscope Commercial |
$534.78
|
| Rate for Payer: Healthscope Whirlpool |
$518.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$206.43
|
| Rate for Payer: Mclaren Commercial |
$481.30
|
| Rate for Payer: Mclaren Medicaid |
$110.65
|
| Rate for Payer: Mclaren Medicare |
$206.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.75
|
| Rate for Payer: Meridian Medicaid |
$116.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.56
|
| Rate for Payer: Nomi Health Commercial |
$438.52
|
| Rate for Payer: PACE Medicare |
$196.11
|
| Rate for Payer: PACE SWMI |
$206.43
|
| Rate for Payer: PHP Commercial |
$227.07
|
| Rate for Payer: PHP Medicaid |
$110.65
|
| Rate for Payer: PHP Medicare Advantage |
$206.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.18
|
| Rate for Payer: Priority Health Medicare |
$206.43
|
| Rate for Payer: Priority Health Narrow Network |
$225.74
|
| Rate for Payer: Railroad Medicare Medicare |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.43
|
| Rate for Payer: UHC Exchange |
$319.97
|
| Rate for Payer: UHC Medicare Advantage |
$206.43
|
| Rate for Payer: UHCCP DNSP |
$206.43
|
| Rate for Payer: UHCCP Medicaid |
$110.65
|
| Rate for Payer: VA VA |
$206.43
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
IP
|
$534.78
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$347.61 |
| Max. Negotiated Rate |
$534.78 |
| Rate for Payer: Aetna Commercial |
$481.30
|
| Rate for Payer: ASR ASR |
$518.74
|
| Rate for Payer: ASR Commercial |
$518.74
|
| Rate for Payer: BCBS Trust/PPO |
$435.79
|
| Rate for Payer: BCN Commercial |
$414.61
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$502.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$534.78
|
| Rate for Payer: Healthscope Whirlpool |
$518.74
|
| Rate for Payer: Mclaren Commercial |
$481.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.56
|
| Rate for Payer: Nomi Health Commercial |
$438.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.61
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
OP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$83.74 |
| Rate for Payer: Aetna Commercial |
$75.37
|
| Rate for Payer: Aetna Medicare |
$41.87
|
| Rate for Payer: ASR ASR |
$81.23
|
| Rate for Payer: ASR Commercial |
$81.23
|
| Rate for Payer: BCBS Complete |
$33.50
|
| Rate for Payer: BCBS Trust/PPO |
$68.57
|
| Rate for Payer: BCN Commercial |
$64.92
|
| Rate for Payer: Cash Price |
$66.99
|
| 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 Commercial |
$71.18
|
| Rate for Payer: Nomi Health Commercial |
$68.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.39
|
| Rate for Payer: Priority Health Narrow Network |
$1.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.69
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
IP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$83.74 |
| Rate for Payer: Aetna Commercial |
$75.37
|
| Rate for Payer: ASR ASR |
$81.23
|
| Rate for Payer: ASR Commercial |
$81.23
|
| Rate for Payer: BCBS Trust/PPO |
$68.24
|
| 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 Commercial |
$71.18
|
| Rate for Payer: Nomi Health Commercial |
$68.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.69
|
|
|
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 |
$1.02 |
| Max. Negotiated Rate |
$85.72 |
| Rate for Payer: Aetna Commercial |
$77.15
|
| Rate for Payer: Aetna Medicare |
$42.86
|
| Rate for Payer: ASR ASR |
$83.15
|
| Rate for Payer: ASR Commercial |
$83.15
|
| Rate for Payer: BCBS Complete |
$34.29
|
| Rate for Payer: BCBS Trust/PPO |
$70.20
|
| Rate for Payer: BCN Commercial |
$66.46
|
| Rate for Payer: Cash Price |
$68.58
|
| 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 Commercial |
$72.86
|
| Rate for Payer: Nomi Health Commercial |
$70.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.28
|
| Rate for Payer: Priority Health Narrow Network |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.43
|
|
|
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 |
$55.72 |
| Max. Negotiated Rate |
$85.72 |
| Rate for Payer: Aetna Commercial |
$77.15
|
| Rate for Payer: ASR ASR |
$83.15
|
| Rate for Payer: ASR Commercial |
$83.15
|
| Rate for Payer: BCBS Trust/PPO |
$69.85
|
| 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 Commercial |
$72.86
|
| Rate for Payer: Nomi Health Commercial |
$70.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.43
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
IP
|
$167.72
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.02 |
| Max. Negotiated Rate |
$167.72 |
| Rate for Payer: Aetna Commercial |
$150.95
|
| Rate for Payer: ASR ASR |
$162.69
|
| Rate for Payer: ASR Commercial |
$162.69
|
| Rate for Payer: BCBS Trust/PPO |
$136.68
|
| Rate for Payer: BCN Commercial |
$130.03
|
| Rate for Payer: Cash Price |
$134.18
|
| Rate for Payer: Cofinity Commercial |
$157.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.18
|
| Rate for Payer: Healthscope Commercial |
$167.72
|
| Rate for Payer: Healthscope Whirlpool |
$162.69
|
| Rate for Payer: Mclaren Commercial |
$150.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.56
|
| Rate for Payer: Nomi Health Commercial |
$137.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.59
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
OP
|
$167.72
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$167.72 |
| Rate for Payer: Aetna Commercial |
$150.95
|
| Rate for Payer: Aetna Medicare |
$45.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: ASR ASR |
$162.69
|
| Rate for Payer: ASR Commercial |
$162.69
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$137.35
|
| Rate for Payer: BCN Commercial |
$130.03
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| Rate for Payer: Cash Price |
$134.18
|
| Rate for Payer: Cash Price |
$134.18
|
| Rate for Payer: Cofinity Commercial |
$157.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$167.72
|
| Rate for Payer: Healthscope Whirlpool |
$162.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.21
|
| Rate for Payer: Mclaren Commercial |
$150.95
|
| Rate for Payer: Mclaren Medicaid |
$24.23
|
| Rate for Payer: Mclaren Medicare |
$45.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.47
|
| Rate for Payer: Meridian Medicaid |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.56
|
| Rate for Payer: Nomi Health Commercial |
$137.53
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$49.73
|
| Rate for Payer: PHP Medicaid |
$24.23
|
| Rate for Payer: PHP Medicare Advantage |
$45.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.26
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$65.01
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$70.08
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP DNSP |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$24.23
|
| Rate for Payer: VA VA |
$45.21
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
IP
|
$154.83
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$154.83 |
| Rate for Payer: Aetna Commercial |
$139.35
|
| Rate for Payer: ASR ASR |
$150.19
|
| Rate for Payer: ASR Commercial |
$150.19
|
| Rate for Payer: BCBS Trust/PPO |
$126.17
|
| Rate for Payer: BCN Commercial |
$120.04
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$145.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$154.83
|
| Rate for Payer: Healthscope Whirlpool |
$150.19
|
| Rate for Payer: Mclaren Commercial |
$139.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: Nomi Health Commercial |
$126.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.25
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
OP
|
$154.83
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.53 |
| Max. Negotiated Rate |
$154.83 |
| Rate for Payer: Aetna Commercial |
$139.35
|
| Rate for Payer: Aetna Medicare |
$77.42
|
| Rate for Payer: ASR ASR |
$150.19
|
| Rate for Payer: ASR Commercial |
$150.19
|
| Rate for Payer: BCBS Complete |
$61.93
|
| Rate for Payer: BCBS Trust/PPO |
$126.79
|
| Rate for Payer: BCN Commercial |
$120.04
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$145.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$154.83
|
| Rate for Payer: Healthscope Whirlpool |
$150.19
|
| Rate for Payer: Mclaren Commercial |
$139.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: Nomi Health Commercial |
$126.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.41
|
| Rate for Payer: Priority Health Narrow Network |
$39.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.25
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
IP
|
$401.79
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$261.16 |
| Max. Negotiated Rate |
$401.79 |
| Rate for Payer: Aetna Commercial |
$361.61
|
| Rate for Payer: ASR ASR |
$389.74
|
| Rate for Payer: ASR Commercial |
$389.74
|
| Rate for Payer: BCBS Trust/PPO |
$327.42
|
| Rate for Payer: BCN Commercial |
$311.51
|
| Rate for Payer: Cash Price |
$321.43
|
| Rate for Payer: Cofinity Commercial |
$377.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.43
|
| Rate for Payer: Healthscope Commercial |
$401.79
|
| Rate for Payer: Healthscope Whirlpool |
$389.74
|
| Rate for Payer: Mclaren Commercial |
$361.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.52
|
| Rate for Payer: Nomi Health Commercial |
$329.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.58
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
OP
|
$401.79
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$401.79 |
| Rate for Payer: Aetna Commercial |
$361.61
|
| Rate for Payer: Aetna Medicare |
$69.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: ASR ASR |
$389.74
|
| Rate for Payer: ASR Commercial |
$389.74
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$329.03
|
| Rate for Payer: BCN Commercial |
$311.51
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$321.43
|
| Rate for Payer: Cash Price |
$321.43
|
| Rate for Payer: Cofinity Commercial |
$377.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$401.79
|
| Rate for Payer: Healthscope Whirlpool |
$389.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$69.73
|
| Rate for Payer: Mclaren Commercial |
$361.61
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.52
|
| Rate for Payer: Nomi Health Commercial |
$329.47
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: PHP Medicaid |
$37.38
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.81
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$132.65
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$108.08
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP DNSP |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$37.38
|
| Rate for Payer: VA VA |
$69.73
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
OP
|
$696.51
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$174.19 |
| Max. Negotiated Rate |
$696.51 |
| Rate for Payer: Aetna Commercial |
$626.86
|
| Rate for Payer: Aetna Medicare |
$324.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: ASR ASR |
$675.61
|
| Rate for Payer: ASR Commercial |
$675.61
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$570.37
|
| Rate for Payer: BCN Commercial |
$540.00
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$654.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$696.51
|
| Rate for Payer: Healthscope Whirlpool |
$675.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$324.98
|
| Rate for Payer: Mclaren Commercial |
$626.86
|
| Rate for Payer: Mclaren Medicaid |
$174.19
|
| Rate for Payer: Mclaren Medicare |
$324.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.23
|
| Rate for Payer: Meridian Medicaid |
$182.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.03
|
| Rate for Payer: Nomi Health Commercial |
$571.14
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Commercial |
$357.48
|
| Rate for Payer: PHP Medicaid |
$174.19
|
| Rate for Payer: PHP Medicare Advantage |
$324.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.18
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$225.74
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$612.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$503.72
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP DNSP |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$174.19
|
| Rate for Payer: VA VA |
$324.98
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
IP
|
$696.51
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$452.73 |
| Max. Negotiated Rate |
$696.51 |
| Rate for Payer: Aetna Commercial |
$626.86
|
| Rate for Payer: ASR ASR |
$675.61
|
| Rate for Payer: ASR Commercial |
$675.61
|
| Rate for Payer: BCBS Trust/PPO |
$567.59
|
| Rate for Payer: BCN Commercial |
$540.00
|
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$654.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.21
|
| Rate for Payer: Healthscope Commercial |
$696.51
|
| Rate for Payer: Healthscope Whirlpool |
$675.61
|
| Rate for Payer: Mclaren Commercial |
$626.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.03
|
| Rate for Payer: Nomi Health Commercial |
$571.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$612.93
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
IP
|
$282.63
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.71 |
| Max. Negotiated Rate |
$282.63 |
| Rate for Payer: Aetna Commercial |
$254.37
|
| Rate for Payer: ASR ASR |
$274.15
|
| Rate for Payer: ASR Commercial |
$274.15
|
| Rate for Payer: BCBS Trust/PPO |
$230.32
|
| Rate for Payer: BCN Commercial |
$219.12
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$265.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.10
|
| Rate for Payer: Healthscope Commercial |
$282.63
|
| Rate for Payer: Healthscope Whirlpool |
$274.15
|
| Rate for Payer: Mclaren Commercial |
$254.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.24
|
| Rate for Payer: Nomi Health Commercial |
$231.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.71
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
OP
|
$282.63
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$319.97 |
| Rate for Payer: Aetna Commercial |
$254.37
|
| Rate for Payer: Aetna Medicare |
$206.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.04
|
| Rate for Payer: ASR ASR |
$274.15
|
| Rate for Payer: ASR Commercial |
$274.15
|
| Rate for Payer: BCBS Complete |
$116.18
|
| Rate for Payer: BCBS MAPPO |
$206.43
|
| Rate for Payer: BCBS Trust/PPO |
$231.45
|
| Rate for Payer: BCN Commercial |
$219.12
|
| Rate for Payer: BCN Medicare Advantage |
$206.43
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$265.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.43
|
| Rate for Payer: Healthscope Commercial |
$282.63
|
| Rate for Payer: Healthscope Whirlpool |
$274.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$206.43
|
| Rate for Payer: Mclaren Commercial |
$254.37
|
| Rate for Payer: Mclaren Medicaid |
$110.65
|
| Rate for Payer: Mclaren Medicare |
$206.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.75
|
| Rate for Payer: Meridian Medicaid |
$116.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.24
|
| Rate for Payer: Nomi Health Commercial |
$231.76
|
| Rate for Payer: PACE Medicare |
$196.11
|
| Rate for Payer: PACE SWMI |
$206.43
|
| Rate for Payer: PHP Commercial |
$227.07
|
| Rate for Payer: PHP Medicaid |
$110.65
|
| Rate for Payer: PHP Medicare Advantage |
$206.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.96
|
| Rate for Payer: Priority Health Medicare |
$206.43
|
| Rate for Payer: Priority Health Narrow Network |
$84.77
|
| Rate for Payer: Railroad Medicare Medicare |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.43
|
| Rate for Payer: UHC Exchange |
$319.97
|
| Rate for Payer: UHC Medicare Advantage |
$206.43
|
| Rate for Payer: UHCCP DNSP |
$206.43
|
| Rate for Payer: UHCCP Medicaid |
$110.65
|
| Rate for Payer: VA VA |
$206.43
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
IP
|
$222.24
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$144.46 |
| Max. Negotiated Rate |
$222.24 |
| Rate for Payer: Aetna Commercial |
$200.02
|
| Rate for Payer: ASR ASR |
$215.57
|
| Rate for Payer: ASR Commercial |
$215.57
|
| Rate for Payer: BCBS Trust/PPO |
$181.10
|
| Rate for Payer: BCN Commercial |
$172.30
|
| Rate for Payer: Cash Price |
$177.79
|
| Rate for Payer: Cofinity Commercial |
$208.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.79
|
| Rate for Payer: Healthscope Commercial |
$222.24
|
| Rate for Payer: Healthscope Whirlpool |
$215.57
|
| Rate for Payer: Mclaren Commercial |
$200.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.90
|
| Rate for Payer: Nomi Health Commercial |
$182.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.57
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
OP
|
$222.24
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$222.24 |
| Rate for Payer: Aetna Commercial |
$200.02
|
| Rate for Payer: Aetna Medicare |
$69.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: ASR ASR |
$215.57
|
| Rate for Payer: ASR Commercial |
$215.57
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$181.99
|
| Rate for Payer: BCN Commercial |
$172.30
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$177.79
|
| Rate for Payer: Cash Price |
$177.79
|
| Rate for Payer: Cofinity Commercial |
$208.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$222.24
|
| Rate for Payer: Healthscope Whirlpool |
$215.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$69.73
|
| Rate for Payer: Mclaren Commercial |
$200.02
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.90
|
| Rate for Payer: Nomi Health Commercial |
$182.24
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: PHP Medicaid |
$37.38
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.34
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$74.67
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$108.08
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP DNSP |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$37.38
|
| Rate for Payer: VA VA |
$69.73
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$236.59 |
| Max. Negotiated Rate |
$684.15 |
| Rate for Payer: Aetna Commercial |
$481.29
|
| Rate for Payer: Aetna Medicare |
$441.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$551.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$551.74
|
| Rate for Payer: ASR ASR |
$518.73
|
| Rate for Payer: ASR Commercial |
$518.73
|
| Rate for Payer: BCBS Complete |
$248.41
|
| Rate for Payer: BCBS MAPPO |
$441.39
|
| Rate for Payer: BCBS Trust/PPO |
$437.92
|
| Rate for Payer: BCN Commercial |
$414.61
|
| Rate for Payer: BCN Medicare Advantage |
$441.39
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$502.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.39
|
| Rate for Payer: Healthscope Commercial |
$534.77
|
| Rate for Payer: Healthscope Whirlpool |
$518.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$441.39
|
| Rate for Payer: Mclaren Commercial |
$481.29
|
| Rate for Payer: Mclaren Medicaid |
$236.59
|
| Rate for Payer: Mclaren Medicare |
$441.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.46
|
| Rate for Payer: Meridian Medicaid |
$248.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$507.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$438.51
|
| Rate for Payer: PACE Medicare |
$419.32
|
| Rate for Payer: PACE SWMI |
$441.39
|
| Rate for Payer: PHP Commercial |
$485.53
|
| Rate for Payer: PHP Medicaid |
$236.59
|
| Rate for Payer: PHP Medicare Advantage |
$441.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$468.57
|
| Rate for Payer: Priority Health Medicare |
$441.39
|
| Rate for Payer: Priority Health Narrow Network |
$374.87
|
| Rate for Payer: Railroad Medicare Medicare |
$441.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.39
|
| Rate for Payer: UHC Exchange |
$684.15
|
| Rate for Payer: UHC Medicare Advantage |
$441.39
|
| Rate for Payer: UHCCP DNSP |
$441.39
|
| Rate for Payer: UHCCP Medicaid |
$236.59
|
| Rate for Payer: VA VA |
$441.39
|
|
