|
HC IUPC ASSIST
|
Facility
|
IP
|
$119.72
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.82 |
| Max. Negotiated Rate |
$119.72 |
| Rate for Payer: Aetna Commercial |
$107.75
|
| Rate for Payer: ASR ASR |
$116.13
|
| Rate for Payer: ASR Commercial |
$116.13
|
| Rate for Payer: BCBS Trust/PPO |
$97.56
|
| Rate for Payer: BCN Commercial |
$92.82
|
| Rate for Payer: Cash Price |
$95.78
|
| Rate for Payer: Cofinity Commercial |
$112.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.78
|
| Rate for Payer: Healthscope Commercial |
$119.72
|
| Rate for Payer: Healthscope Whirlpool |
$116.13
|
| Rate for Payer: Mclaren Commercial |
$107.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.76
|
| Rate for Payer: Nomi Health Commercial |
$98.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.35
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
OP
|
$85.41
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.16 |
| Max. Negotiated Rate |
$85.41 |
| Rate for Payer: Aetna Commercial |
$76.87
|
| Rate for Payer: Aetna Medicare |
$42.70
|
| Rate for Payer: ASR ASR |
$82.85
|
| Rate for Payer: ASR Commercial |
$82.85
|
| Rate for Payer: BCBS Complete |
$34.16
|
| Rate for Payer: BCBS Trust/PPO |
$69.94
|
| Rate for Payer: BCN Commercial |
$66.22
|
| 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 |
$85.41
|
| Rate for Payer: Healthscope Whirlpool |
$82.85
|
| 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: Priority Health Cigna Priority Health |
$55.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.84
|
| Rate for Payer: Priority Health Narrow Network |
$59.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.16
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
IP
|
$85.41
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.52 |
| Max. Negotiated Rate |
$85.41 |
| Rate for Payer: Aetna Commercial |
$76.87
|
| Rate for Payer: ASR ASR |
$82.85
|
| Rate for Payer: ASR Commercial |
$82.85
|
| Rate for Payer: BCBS Trust/PPO |
$69.60
|
| Rate for Payer: BCN Commercial |
$66.22
|
| 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 |
$85.41
|
| Rate for Payer: Healthscope Whirlpool |
$82.85
|
| 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: Priority Health Cigna Priority Health |
$55.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.16
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
IP
|
$203.57
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$132.32 |
| Max. Negotiated Rate |
$203.57 |
| Rate for Payer: Aetna Commercial |
$183.21
|
| Rate for Payer: ASR ASR |
$197.46
|
| Rate for Payer: ASR Commercial |
$197.46
|
| Rate for Payer: BCBS Trust/PPO |
$165.89
|
| Rate for Payer: BCN Commercial |
$157.83
|
| Rate for Payer: Cash Price |
$162.86
|
| Rate for Payer: Cofinity Commercial |
$191.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.86
|
| Rate for Payer: Healthscope Commercial |
$203.57
|
| Rate for Payer: Healthscope Whirlpool |
$197.46
|
| Rate for Payer: Mclaren Commercial |
$183.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.03
|
| Rate for Payer: Nomi Health Commercial |
$166.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.14
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
OP
|
$203.57
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$203.57 |
| Rate for Payer: Aetna Commercial |
$183.21
|
| Rate for Payer: Aetna Medicare |
$45.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: ASR ASR |
$197.46
|
| Rate for Payer: ASR Commercial |
$197.46
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$166.70
|
| Rate for Payer: BCN Commercial |
$157.83
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$162.86
|
| Rate for Payer: Cash Price |
$162.86
|
| Rate for Payer: Cofinity Commercial |
$191.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$203.57
|
| Rate for Payer: Healthscope Whirlpool |
$197.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.00
|
| Rate for Payer: Mclaren Commercial |
$183.21
|
| Rate for Payer: Mclaren Medicaid |
$24.12
|
| Rate for Payer: Mclaren Medicare |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.03
|
| Rate for Payer: Nomi Health Commercial |
$166.93
|
| Rate for Payer: PACE Medicare |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Medicaid |
$24.12
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.37
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health Narrow Network |
$142.70
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$69.75
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP DNSP |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: VA VA |
$45.00
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
IP
|
$510.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$331.66 |
| Max. Negotiated Rate |
$510.24 |
| Rate for Payer: Aetna Commercial |
$459.22
|
| Rate for Payer: ASR ASR |
$494.93
|
| Rate for Payer: ASR Commercial |
$494.93
|
| Rate for Payer: BCBS Trust/PPO |
$415.79
|
| Rate for Payer: BCN Commercial |
$395.59
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$479.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$510.24
|
| Rate for Payer: Healthscope Whirlpool |
$494.93
|
| Rate for Payer: Mclaren Commercial |
$459.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: Nomi Health Commercial |
$418.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.01
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
OP
|
$510.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$510.24 |
| Rate for Payer: Aetna Commercial |
$459.22
|
| Rate for Payer: Aetna Medicare |
$205.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: ASR ASR |
$494.93
|
| Rate for Payer: ASR Commercial |
$494.93
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCBS Trust/PPO |
$417.84
|
| Rate for Payer: BCN Commercial |
$395.59
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$479.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$510.24
|
| Rate for Payer: Healthscope Whirlpool |
$494.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$205.48
|
| Rate for Payer: Mclaren Commercial |
$459.22
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: Nomi Health Commercial |
$418.40
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$226.03
|
| Rate for Payer: PHP Medicaid |
$110.14
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.07
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health Narrow Network |
$357.68
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Exchange |
$318.49
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP DNSP |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$110.14
|
| Rate for Payer: VA VA |
$205.48
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
OP
|
$129.02
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$129.02 |
| Rate for Payer: Aetna Commercial |
$116.12
|
| Rate for Payer: Aetna Medicare |
$45.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: ASR ASR |
$125.15
|
| Rate for Payer: ASR Commercial |
$125.15
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$105.65
|
| Rate for Payer: BCN Commercial |
$100.03
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$121.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$129.02
|
| Rate for Payer: Healthscope Whirlpool |
$125.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.00
|
| Rate for Payer: Mclaren Commercial |
$116.12
|
| Rate for Payer: Mclaren Medicaid |
$24.12
|
| Rate for Payer: Mclaren Medicare |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: Nomi Health Commercial |
$105.80
|
| Rate for Payer: PACE Medicare |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Medicaid |
$24.12
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.05
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health Narrow Network |
$90.44
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$69.75
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP DNSP |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: VA VA |
$45.00
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
IP
|
$129.02
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.86 |
| Max. Negotiated Rate |
$129.02 |
| Rate for Payer: Aetna Commercial |
$116.12
|
| Rate for Payer: ASR ASR |
$125.15
|
| Rate for Payer: ASR Commercial |
$125.15
|
| Rate for Payer: BCBS Trust/PPO |
$105.14
|
| Rate for Payer: BCN Commercial |
$100.03
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$121.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$129.02
|
| Rate for Payer: Healthscope Whirlpool |
$125.15
|
| Rate for Payer: Mclaren Commercial |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: Nomi Health Commercial |
$105.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.54
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
IP
|
$270.93
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$176.10 |
| Max. Negotiated Rate |
$270.93 |
| Rate for Payer: Aetna Commercial |
$243.84
|
| Rate for Payer: ASR ASR |
$262.80
|
| Rate for Payer: ASR Commercial |
$262.80
|
| Rate for Payer: BCBS Trust/PPO |
$220.78
|
| Rate for Payer: BCN Commercial |
$210.05
|
| Rate for Payer: Cash Price |
$216.74
|
| Rate for Payer: Cofinity Commercial |
$254.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.74
|
| Rate for Payer: Healthscope Commercial |
$270.93
|
| Rate for Payer: Healthscope Whirlpool |
$262.80
|
| Rate for Payer: Mclaren Commercial |
$243.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.29
|
| Rate for Payer: Nomi Health Commercial |
$222.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.42
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
OP
|
$270.93
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$318.49 |
| Rate for Payer: Aetna Commercial |
$243.84
|
| Rate for Payer: Aetna Medicare |
$205.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: ASR ASR |
$262.80
|
| Rate for Payer: ASR Commercial |
$262.80
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCBS Trust/PPO |
$221.86
|
| Rate for Payer: BCN Commercial |
$210.05
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$216.74
|
| Rate for Payer: Cash Price |
$216.74
|
| Rate for Payer: Cofinity Commercial |
$254.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$270.93
|
| Rate for Payer: Healthscope Whirlpool |
$262.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$205.48
|
| Rate for Payer: Mclaren Commercial |
$243.84
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.29
|
| Rate for Payer: Nomi Health Commercial |
$222.16
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$226.03
|
| Rate for Payer: PHP Medicaid |
$110.14
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.39
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health Narrow Network |
$189.92
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Exchange |
$318.49
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP DNSP |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$110.14
|
| Rate for Payer: VA VA |
$205.48
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
IP
|
$688.17
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$447.31 |
| Max. Negotiated Rate |
$688.17 |
| Rate for Payer: Aetna Commercial |
$619.35
|
| Rate for Payer: ASR ASR |
$667.52
|
| Rate for Payer: ASR Commercial |
$667.52
|
| Rate for Payer: BCBS Trust/PPO |
$560.79
|
| Rate for Payer: BCN Commercial |
$533.54
|
| Rate for Payer: Cash Price |
$550.54
|
| Rate for Payer: Cofinity Commercial |
$646.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.54
|
| Rate for Payer: Healthscope Commercial |
$688.17
|
| Rate for Payer: Healthscope Whirlpool |
$667.52
|
| Rate for Payer: Mclaren Commercial |
$619.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.94
|
| Rate for Payer: Nomi Health Commercial |
$564.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.59
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
OP
|
$688.17
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$688.17 |
| Rate for Payer: Aetna Commercial |
$619.35
|
| Rate for Payer: Aetna Medicare |
$205.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: ASR ASR |
$667.52
|
| Rate for Payer: ASR Commercial |
$667.52
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCBS Trust/PPO |
$563.54
|
| Rate for Payer: BCN Commercial |
$533.54
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$550.54
|
| Rate for Payer: Cash Price |
$550.54
|
| Rate for Payer: Cofinity Commercial |
$646.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$688.17
|
| Rate for Payer: Healthscope Whirlpool |
$667.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$205.48
|
| Rate for Payer: Mclaren Commercial |
$619.35
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.94
|
| Rate for Payer: Nomi Health Commercial |
$564.30
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$226.03
|
| Rate for Payer: PHP Medicaid |
$110.14
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$602.97
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health Narrow Network |
$482.41
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Exchange |
$318.49
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP DNSP |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$110.14
|
| Rate for Payer: VA VA |
$205.48
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$213.91 |
| Max. Negotiated Rate |
$534.77 |
| Rate for Payer: Aetna Commercial |
$481.29
|
| Rate for Payer: Aetna Medicare |
$267.38
|
| Rate for Payer: ASR ASR |
$518.73
|
| Rate for Payer: ASR Commercial |
$518.73
|
| Rate for Payer: BCBS Complete |
$213.91
|
| Rate for Payer: BCBS Trust/PPO |
$437.92
|
| 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: Priority Health HMO/PPO/Tiered Network |
$468.57
|
| Rate for Payer: Priority Health Narrow Network |
$374.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.60
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
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 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 INF SOTROVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$213.91 |
| Max. Negotiated Rate |
$534.77 |
| Rate for Payer: Aetna Commercial |
$481.29
|
| Rate for Payer: Aetna Medicare |
$267.38
|
| Rate for Payer: ASR ASR |
$518.73
|
| Rate for Payer: ASR Commercial |
$518.73
|
| Rate for Payer: BCBS Complete |
$213.91
|
| Rate for Payer: BCBS Trust/PPO |
$437.92
|
| 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: Priority Health HMO/PPO/Tiered Network |
$468.57
|
| Rate for Payer: Priority Health Narrow Network |
$374.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.60
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
OP
|
$173.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$69.47 |
| Max. Negotiated Rate |
$173.67 |
| Rate for Payer: Aetna Commercial |
$156.30
|
| Rate for Payer: Aetna Medicare |
$86.83
|
| 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: 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 |
$152.17
|
| Rate for Payer: Priority Health Narrow Network |
$121.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.83
|
|
|
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 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 EACH ADD HR
|
Facility
|
OP
|
$194.54
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$194.54 |
| Rate for Payer: Aetna Commercial |
$175.09
|
| Rate for Payer: Aetna Medicare |
$45.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: ASR ASR |
$188.70
|
| Rate for Payer: ASR Commercial |
$188.70
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$159.31
|
| Rate for Payer: BCN Commercial |
$150.83
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| 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 |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$194.54
|
| Rate for Payer: Healthscope Whirlpool |
$188.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.00
|
| Rate for Payer: Mclaren Commercial |
$175.09
|
| Rate for Payer: Mclaren Medicaid |
$24.12
|
| Rate for Payer: Mclaren Medicare |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.36
|
| Rate for Payer: Nomi Health Commercial |
$159.52
|
| Rate for Payer: PACE Medicare |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Medicaid |
$24.12
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.46
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health Narrow Network |
$136.37
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$69.75
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP DNSP |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: VA VA |
$45.00
|
|
|
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 INFUSION THERAPY INITIAL HOUR
|
Facility
|
OP
|
$534.78
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$534.78 |
| Rate for Payer: Aetna Commercial |
$481.30
|
| Rate for Payer: Aetna Medicare |
$205.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: ASR ASR |
$518.74
|
| Rate for Payer: ASR Commercial |
$518.74
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCBS Trust/PPO |
$437.93
|
| Rate for Payer: BCN Commercial |
$414.61
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| 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 |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$534.78
|
| Rate for Payer: Healthscope Whirlpool |
$518.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$205.48
|
| Rate for Payer: Mclaren Commercial |
$481.30
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.56
|
| Rate for Payer: Nomi Health Commercial |
$438.52
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$226.03
|
| Rate for Payer: PHP Medicaid |
$110.14
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$468.57
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health Narrow Network |
$374.88
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Exchange |
$318.49
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP DNSP |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$110.14
|
| Rate for Payer: VA VA |
$205.48
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
OP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$83.74 |
| Rate for Payer: Aetna Commercial |
$75.37
|
| Rate for Payer: 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: 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 |
$73.37
|
| Rate for Payer: Priority Health Narrow Network |
$58.70
|
| 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
|
|
