|
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 NORMAL SALINE 500 ML
|
Facility
|
OP
|
$85.72
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$85.72 |
| Rate for Payer: Aetna Commercial |
$77.15
|
| Rate for Payer: 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: 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 |
$75.11
|
| Rate for Payer: Priority Health Narrow Network |
$60.09
|
| 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 |
$24.12 |
| Max. Negotiated Rate |
$167.72 |
| Rate for Payer: Aetna Commercial |
$150.95
|
| 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 |
$162.69
|
| Rate for Payer: ASR Commercial |
$162.69
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$137.35
|
| Rate for Payer: BCN Commercial |
$130.03
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| 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 |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$167.72
|
| Rate for Payer: Healthscope Whirlpool |
$162.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.00
|
| Rate for Payer: Mclaren Commercial |
$150.95
|
| 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 |
$142.56
|
| Rate for Payer: Nomi Health Commercial |
$137.53
|
| 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 |
$109.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.96
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health Narrow Network |
$117.57
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.59
|
| 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 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 |
$61.93 |
| 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: 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 |
$135.66
|
| Rate for Payer: Priority Health Narrow Network |
$108.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.25
|
|
|
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 |
$37.20 |
| Max. Negotiated Rate |
$401.79 |
| Rate for Payer: Aetna Commercial |
$361.61
|
| Rate for Payer: Aetna Medicare |
$69.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.76
|
| Rate for Payer: ASR ASR |
$389.74
|
| Rate for Payer: ASR Commercial |
$389.74
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS MAPPO |
$69.41
|
| Rate for Payer: BCBS Trust/PPO |
$329.03
|
| Rate for Payer: BCN Commercial |
$311.51
|
| Rate for Payer: BCN Medicare Advantage |
$69.41
|
| 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 |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$401.79
|
| Rate for Payer: Healthscope Whirlpool |
$389.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$69.41
|
| Rate for Payer: Mclaren Commercial |
$361.61
|
| Rate for Payer: Mclaren Medicaid |
$37.20
|
| Rate for Payer: Mclaren Medicare |
$69.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.88
|
| Rate for Payer: Meridian Medicaid |
$39.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.52
|
| Rate for Payer: Nomi Health Commercial |
$329.47
|
| Rate for Payer: PACE Medicare |
$65.94
|
| Rate for Payer: PACE SWMI |
$69.41
|
| Rate for Payer: PHP Commercial |
$76.35
|
| Rate for Payer: PHP Medicaid |
$37.20
|
| Rate for Payer: PHP Medicare Advantage |
$69.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.05
|
| Rate for Payer: Priority Health Medicare |
$69.41
|
| Rate for Payer: Priority Health Narrow Network |
$281.65
|
| Rate for Payer: Railroad Medicare Medicare |
$69.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.41
|
| Rate for Payer: UHC Exchange |
$107.59
|
| Rate for Payer: UHC Medicare Advantage |
$69.41
|
| Rate for Payer: UHCCP DNSP |
$69.41
|
| Rate for Payer: UHCCP Medicaid |
$37.20
|
| Rate for Payer: VA VA |
$69.41
|
|
|
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 INITIAL DRUG
|
Facility
|
OP
|
$696.51
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$173.39 |
| Max. Negotiated Rate |
$696.51 |
| Rate for Payer: Aetna Commercial |
$626.86
|
| Rate for Payer: Aetna Medicare |
$323.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.36
|
| Rate for Payer: ASR ASR |
$675.61
|
| Rate for Payer: ASR Commercial |
$675.61
|
| Rate for Payer: BCBS Complete |
$182.06
|
| Rate for Payer: BCBS MAPPO |
$323.49
|
| Rate for Payer: BCBS Trust/PPO |
$570.37
|
| Rate for Payer: BCN Commercial |
$540.00
|
| Rate for Payer: BCN Medicare Advantage |
$323.49
|
| 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 |
$323.49
|
| Rate for Payer: Healthscope Commercial |
$696.51
|
| Rate for Payer: Healthscope Whirlpool |
$675.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$323.49
|
| Rate for Payer: Mclaren Commercial |
$626.86
|
| Rate for Payer: Mclaren Medicaid |
$173.39
|
| Rate for Payer: Mclaren Medicare |
$323.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.66
|
| Rate for Payer: Meridian Medicaid |
$182.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.03
|
| Rate for Payer: Nomi Health Commercial |
$571.14
|
| Rate for Payer: PACE Medicare |
$307.32
|
| Rate for Payer: PACE SWMI |
$323.49
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: PHP Medicaid |
$173.39
|
| Rate for Payer: PHP Medicare Advantage |
$323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$610.28
|
| Rate for Payer: Priority Health Medicare |
$323.49
|
| Rate for Payer: Priority Health Narrow Network |
$488.25
|
| Rate for Payer: Railroad Medicare Medicare |
$323.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$612.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.49
|
| Rate for Payer: UHC Exchange |
$501.41
|
| Rate for Payer: UHC Medicare Advantage |
$323.49
|
| Rate for Payer: UHCCP DNSP |
$323.49
|
| Rate for Payer: UHCCP Medicaid |
$173.39
|
| Rate for Payer: VA VA |
$323.49
|
|
|
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
|
OP
|
$282.63
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$318.49 |
| Rate for Payer: Aetna Commercial |
$254.37
|
| 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 |
$274.15
|
| Rate for Payer: ASR Commercial |
$274.15
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCBS Trust/PPO |
$231.45
|
| Rate for Payer: BCN Commercial |
$219.12
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| 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 |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$282.63
|
| Rate for Payer: Healthscope Whirlpool |
$274.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$205.48
|
| Rate for Payer: Mclaren Commercial |
$254.37
|
| 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 |
$240.24
|
| Rate for Payer: Nomi Health Commercial |
$231.76
|
| 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 |
$183.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.64
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health Narrow Network |
$198.12
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.71
|
| 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 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 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 |
$37.20 |
| Max. Negotiated Rate |
$222.24 |
| Rate for Payer: Aetna Commercial |
$200.02
|
| Rate for Payer: Aetna Medicare |
$69.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.76
|
| Rate for Payer: ASR ASR |
$215.57
|
| Rate for Payer: ASR Commercial |
$215.57
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS MAPPO |
$69.41
|
| Rate for Payer: BCBS Trust/PPO |
$181.99
|
| Rate for Payer: BCN Commercial |
$172.30
|
| Rate for Payer: BCN Medicare Advantage |
$69.41
|
| 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 |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$222.24
|
| Rate for Payer: Healthscope Whirlpool |
$215.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$69.41
|
| Rate for Payer: Mclaren Commercial |
$200.02
|
| Rate for Payer: Mclaren Medicaid |
$37.20
|
| Rate for Payer: Mclaren Medicare |
$69.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.88
|
| Rate for Payer: Meridian Medicaid |
$39.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.90
|
| Rate for Payer: Nomi Health Commercial |
$182.24
|
| Rate for Payer: PACE Medicare |
$65.94
|
| Rate for Payer: PACE SWMI |
$69.41
|
| Rate for Payer: PHP Commercial |
$76.35
|
| Rate for Payer: PHP Medicaid |
$37.20
|
| Rate for Payer: PHP Medicare Advantage |
$69.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.73
|
| Rate for Payer: Priority Health Medicare |
$69.41
|
| Rate for Payer: Priority Health Narrow Network |
$155.79
|
| Rate for Payer: Railroad Medicare Medicare |
$69.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.41
|
| Rate for Payer: UHC Exchange |
$107.59
|
| Rate for Payer: UHC Medicare Advantage |
$69.41
|
| Rate for Payer: UHCCP DNSP |
$69.41
|
| Rate for Payer: UHCCP Medicaid |
$37.20
|
| Rate for Payer: VA VA |
$69.41
|
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
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 IVUS CATHETER
|
Facility
|
IP
|
$2,739.36
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,780.58 |
| Max. Negotiated Rate |
$2,739.36 |
| Rate for Payer: Aetna Commercial |
$2,465.42
|
| Rate for Payer: ASR ASR |
$2,657.18
|
| Rate for Payer: ASR Commercial |
$2,657.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,232.30
|
| Rate for Payer: BCN Commercial |
$2,123.83
|
| Rate for Payer: Cash Price |
$2,191.49
|
| Rate for Payer: Cofinity Commercial |
$2,575.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,191.49
|
| Rate for Payer: Healthscope Commercial |
$2,739.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,657.18
|
| Rate for Payer: Mclaren Commercial |
$2,465.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,328.46
|
| Rate for Payer: Nomi Health Commercial |
$2,246.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,410.64
|
|
|
HC IVUS CATHETER
|
Facility
|
OP
|
$2,739.36
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,095.74 |
| Max. Negotiated Rate |
$2,739.36 |
| Rate for Payer: Aetna Commercial |
$2,465.42
|
| Rate for Payer: Aetna Medicare |
$1,369.68
|
| Rate for Payer: ASR ASR |
$2,657.18
|
| Rate for Payer: ASR Commercial |
$2,657.18
|
| Rate for Payer: BCBS Complete |
$1,095.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,243.26
|
| Rate for Payer: BCN Commercial |
$2,123.83
|
| Rate for Payer: Cash Price |
$2,191.49
|
| Rate for Payer: Cofinity Commercial |
$2,575.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,191.49
|
| Rate for Payer: Healthscope Commercial |
$2,739.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,657.18
|
| Rate for Payer: Mclaren Commercial |
$2,465.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,328.46
|
| Rate for Payer: Nomi Health Commercial |
$2,246.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,400.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,920.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,410.64
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
OP
|
$1,324.84
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$529.94 |
| Max. Negotiated Rate |
$1,324.84 |
| Rate for Payer: Aetna Commercial |
$1,192.36
|
| Rate for Payer: Aetna Medicare |
$662.42
|
| Rate for Payer: ASR ASR |
$1,285.09
|
| Rate for Payer: ASR Commercial |
$1,285.09
|
| Rate for Payer: BCBS Complete |
$529.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,084.91
|
| Rate for Payer: BCN Commercial |
$1,027.15
|
| Rate for Payer: Cash Price |
$1,059.87
|
| Rate for Payer: Cofinity Commercial |
$1,245.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,059.87
|
| Rate for Payer: Healthscope Commercial |
$1,324.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,285.09
|
| Rate for Payer: Mclaren Commercial |
$1,192.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,126.11
|
| Rate for Payer: Nomi Health Commercial |
$1,086.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,160.82
|
| Rate for Payer: Priority Health Narrow Network |
$928.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,165.86
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
IP
|
$1,324.84
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$861.15 |
| Max. Negotiated Rate |
$1,324.84 |
| Rate for Payer: Aetna Commercial |
$1,192.36
|
| Rate for Payer: ASR ASR |
$1,285.09
|
| Rate for Payer: ASR Commercial |
$1,285.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,079.61
|
| Rate for Payer: BCN Commercial |
$1,027.15
|
| Rate for Payer: Cash Price |
$1,059.87
|
| Rate for Payer: Cofinity Commercial |
$1,245.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,059.87
|
| Rate for Payer: Healthscope Commercial |
$1,324.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,285.09
|
| Rate for Payer: Mclaren Commercial |
$1,192.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,126.11
|
| Rate for Payer: Nomi Health Commercial |
$1,086.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,165.86
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
OP
|
$7,832.55
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,133.02 |
| Max. Negotiated Rate |
$7,832.55 |
| Rate for Payer: Aetna Commercial |
$7,049.30
|
| Rate for Payer: Aetna Medicare |
$3,916.28
|
| Rate for Payer: ASR ASR |
$7,597.57
|
| Rate for Payer: ASR Commercial |
$7,597.57
|
| Rate for Payer: BCBS Complete |
$3,133.02
|
| Rate for Payer: BCBS Trust/PPO |
$6,414.08
|
| Rate for Payer: BCN Commercial |
$6,072.58
|
| Rate for Payer: Cash Price |
$6,266.04
|
| Rate for Payer: Cofinity Commercial |
$7,362.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,266.04
|
| Rate for Payer: Healthscope Commercial |
$7,832.55
|
| Rate for Payer: Healthscope Whirlpool |
$7,597.57
|
| Rate for Payer: Mclaren Commercial |
$7,049.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,657.67
|
| Rate for Payer: Nomi Health Commercial |
$6,422.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,091.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,862.88
|
| Rate for Payer: Priority Health Narrow Network |
$5,490.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,892.64
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
IP
|
$7,832.55
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,091.16 |
| Max. Negotiated Rate |
$7,832.55 |
| Rate for Payer: Aetna Commercial |
$7,049.30
|
| Rate for Payer: ASR ASR |
$7,597.57
|
| Rate for Payer: ASR Commercial |
$7,597.57
|
| Rate for Payer: BCBS Trust/PPO |
$6,382.74
|
| Rate for Payer: BCN Commercial |
$6,072.58
|
| Rate for Payer: Cash Price |
$6,266.04
|
| Rate for Payer: Cofinity Commercial |
$7,362.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,266.04
|
| Rate for Payer: Healthscope Commercial |
$7,832.55
|
| Rate for Payer: Healthscope Whirlpool |
$7,597.57
|
| Rate for Payer: Mclaren Commercial |
$7,049.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,657.67
|
| Rate for Payer: Nomi Health Commercial |
$6,422.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,091.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,892.64
|
|
|
HC IVUS OR OCT EACH ADDL VESSEL
|
Facility
|
IP
|
$1,532.20
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
48100107
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$995.93 |
| Max. Negotiated Rate |
$1,532.20 |
| Rate for Payer: Aetna Commercial |
$1,378.98
|
| Rate for Payer: ASR ASR |
$1,486.23
|
| Rate for Payer: ASR Commercial |
$1,486.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,248.59
|
| Rate for Payer: BCN Commercial |
$1,187.91
|
| Rate for Payer: Cash Price |
$1,225.76
|
| Rate for Payer: Cofinity Commercial |
$1,440.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,225.76
|
| Rate for Payer: Healthscope Commercial |
$1,532.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,486.23
|
| Rate for Payer: Mclaren Commercial |
$1,378.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,302.37
|
| Rate for Payer: Nomi Health Commercial |
$1,256.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,348.34
|
|
