|
HC CYSTATIN C WITH ESTIMATED GFR, SERUM
|
Facility
|
IP
|
$66.46
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$59.81 |
| Rate for Payer: Aetna Commercial |
$56.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.20
|
| Rate for Payer: Cash Price |
$53.17
|
| Rate for Payer: Cofinity Commercial |
$46.52
|
| Rate for Payer: Cofinity Commercial |
$57.16
|
| Rate for Payer: Healthscope Commercial |
$59.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.49
|
| Rate for Payer: PHP Commercial |
$56.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.52
|
| Rate for Payer: Priority Health SBD |
$41.87
|
|
|
HC CYSTIC FIBROSIS CARRIER DETECT
|
Facility
|
OP
|
$1,715.49
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
31000098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$304.46 |
| Max. Negotiated Rate |
$1,543.94 |
| Rate for Payer: Aetna Commercial |
$1,458.17
|
| Rate for Payer: Aetna Medicare |
$578.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,115.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$695.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$695.75
|
| Rate for Payer: BCBS Complete |
$319.71
|
| Rate for Payer: BCBS MAPPO |
$556.60
|
| Rate for Payer: BCBS Trust/PPO |
$835.28
|
| Rate for Payer: BCN Medicare Advantage |
$556.60
|
| Rate for Payer: Cash Price |
$1,372.39
|
| Rate for Payer: Cash Price |
$1,372.39
|
| Rate for Payer: Cofinity Commercial |
$1,475.32
|
| Rate for Payer: Cofinity Commercial |
$1,200.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.60
|
| Rate for Payer: Healthscope Commercial |
$1,543.94
|
| Rate for Payer: Mclaren Medicaid |
$304.46
|
| Rate for Payer: Mclaren Medicare |
$556.60
|
| Rate for Payer: Meridian Medicaid |
$319.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$584.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,458.17
|
| Rate for Payer: PACE Medicare |
$528.77
|
| Rate for Payer: PACE SWMI |
$556.60
|
| Rate for Payer: PHP Commercial |
$1,458.17
|
| Rate for Payer: PHP Medicare Advantage |
$556.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.84
|
| Rate for Payer: Priority Health Medicare |
$556.60
|
| Rate for Payer: Priority Health SBD |
$1,080.76
|
| Rate for Payer: Railroad Medicare Medicare |
$556.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.92
|
| Rate for Payer: UHC Core |
$667.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$556.60
|
| Rate for Payer: UHC Exchange |
$556.60
|
| Rate for Payer: UHC Medicare Advantage |
$573.30
|
| Rate for Payer: VA VA |
$556.60
|
|
|
HC CYSTIC FIBROSIS CARRIER DETECT
|
Facility
|
IP
|
$1,715.49
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
31000098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,080.76 |
| Max. Negotiated Rate |
$1,543.94 |
| Rate for Payer: Aetna Commercial |
$1,458.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,115.07
|
| Rate for Payer: Cash Price |
$1,372.39
|
| Rate for Payer: Cofinity Commercial |
$1,475.32
|
| Rate for Payer: Cofinity Commercial |
$1,200.84
|
| Rate for Payer: Healthscope Commercial |
$1,543.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,458.17
|
| Rate for Payer: PHP Commercial |
$1,458.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.84
|
| Rate for Payer: Priority Health SBD |
$1,080.76
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health SBD |
$56.70
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare |
$20.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.51
|
| Rate for Payer: BCBS Complete |
$11.26
|
| Rate for Payer: BCBS MAPPO |
$19.61
|
| Rate for Payer: BCBS Trust/PPO |
$15.36
|
| Rate for Payer: BCN Medicare Advantage |
$19.61
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Mclaren Medicaid |
$10.73
|
| Rate for Payer: Mclaren Medicare |
$19.61
|
| Rate for Payer: Meridian Medicaid |
$11.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PACE Medicare |
$18.63
|
| Rate for Payer: PACE SWMI |
$19.61
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: PHP Medicare Advantage |
$19.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health Medicare |
$19.61
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: Railroad Medicare Medicare |
$19.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.53
|
| Rate for Payer: UHC Core |
$28.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.61
|
| Rate for Payer: UHC Exchange |
$19.61
|
| Rate for Payer: UHC Medicare Advantage |
$20.20
|
| Rate for Payer: VA VA |
$19.61
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna Commercial |
$0.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cofinity Commercial |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.23
|
| Rate for Payer: Healthscope Commercial |
$0.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.23
|
| Rate for Payer: PHP Commercial |
$0.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.19
|
| Rate for Payer: Priority Health SBD |
$0.17
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna Commercial |
$0.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.18
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cofinity Commercial |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.23
|
| Rate for Payer: Healthscope Commercial |
$0.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.23
|
| Rate for Payer: PHP Commercial |
$0.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.19
|
| Rate for Payer: Priority Health SBD |
$0.17
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
IP
|
$6,151.43
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,875.40 |
| Max. Negotiated Rate |
$5,536.29 |
| Rate for Payer: Aetna Commercial |
$5,228.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,998.43
|
| Rate for Payer: Cash Price |
$4,921.14
|
| Rate for Payer: Cofinity Commercial |
$4,306.00
|
| Rate for Payer: Cofinity Commercial |
$5,290.23
|
| Rate for Payer: Healthscope Commercial |
$5,536.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,228.72
|
| Rate for Payer: PHP Commercial |
$5,228.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,306.00
|
| Rate for Payer: Priority Health SBD |
$3,875.40
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
OP
|
$6,151.43
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,518.44 |
| Max. Negotiated Rate |
$12,908.52 |
| Rate for Payer: Aetna Commercial |
$5,228.72
|
| Rate for Payer: Aetna Medicare |
$4,788.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,998.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,755.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,755.12
|
| Rate for Payer: BCBS Complete |
$2,644.60
|
| Rate for Payer: BCBS MAPPO |
$4,604.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,753.13
|
| Rate for Payer: BCN Medicare Advantage |
$4,604.10
|
| Rate for Payer: Cash Price |
$4,921.14
|
| Rate for Payer: Cash Price |
$4,921.14
|
| Rate for Payer: Cofinity Commercial |
$5,290.23
|
| Rate for Payer: Cofinity Commercial |
$4,306.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,604.10
|
| Rate for Payer: Healthscope Commercial |
$5,536.29
|
| Rate for Payer: Mclaren Medicaid |
$2,518.44
|
| Rate for Payer: Mclaren Medicare |
$4,604.10
|
| Rate for Payer: Meridian Medicaid |
$2,644.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,834.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,294.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,228.72
|
| Rate for Payer: PACE Medicare |
$4,373.90
|
| Rate for Payer: PACE SWMI |
$4,604.10
|
| Rate for Payer: PHP Commercial |
$5,228.72
|
| Rate for Payer: PHP Medicare Advantage |
$4,604.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,518.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,306.00
|
| Rate for Payer: Priority Health Medicare |
$4,604.10
|
| Rate for Payer: Priority Health SBD |
$3,875.40
|
| Rate for Payer: Railroad Medicare Medicare |
$4,604.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,908.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,604.10
|
| Rate for Payer: UHC Exchange |
$8,798.90
|
| Rate for Payer: UHC Medicare Advantage |
$4,742.22
|
| Rate for Payer: VA VA |
$4,604.10
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
IP
|
$12,343.94
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,776.68 |
| Max. Negotiated Rate |
$11,109.55 |
| Rate for Payer: Aetna Commercial |
$10,492.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,023.56
|
| Rate for Payer: Cash Price |
$9,875.15
|
| Rate for Payer: Cofinity Commercial |
$8,640.76
|
| Rate for Payer: Cofinity Commercial |
$10,615.79
|
| Rate for Payer: Healthscope Commercial |
$11,109.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,492.35
|
| Rate for Payer: PHP Commercial |
$10,492.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,640.76
|
| Rate for Payer: Priority Health SBD |
$7,776.68
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
OP
|
$12,343.94
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,483.79 |
| Max. Negotiated Rate |
$22,982.07 |
| Rate for Payer: Aetna Commercial |
$10,492.35
|
| Rate for Payer: Aetna Medicare |
$8,524.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,023.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,246.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,246.31
|
| Rate for Payer: BCBS Complete |
$4,708.39
|
| Rate for Payer: BCBS MAPPO |
$8,197.05
|
| Rate for Payer: BCBS Trust/PPO |
$5,180.65
|
| Rate for Payer: BCN Medicare Advantage |
$8,197.05
|
| Rate for Payer: Cash Price |
$9,875.15
|
| Rate for Payer: Cash Price |
$9,875.15
|
| Rate for Payer: Cofinity Commercial |
$8,640.76
|
| Rate for Payer: Cofinity Commercial |
$10,615.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,197.05
|
| Rate for Payer: Healthscope Commercial |
$11,109.55
|
| Rate for Payer: Mclaren Medicaid |
$4,483.79
|
| Rate for Payer: Mclaren Medicare |
$8,197.05
|
| Rate for Payer: Meridian Medicaid |
$4,708.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,606.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,426.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,492.35
|
| Rate for Payer: PACE Medicare |
$7,787.20
|
| Rate for Payer: PACE SWMI |
$8,197.05
|
| Rate for Payer: PHP Commercial |
$10,492.35
|
| Rate for Payer: PHP Medicare Advantage |
$8,197.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,483.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,640.76
|
| Rate for Payer: Priority Health Medicare |
$8,197.05
|
| Rate for Payer: Priority Health SBD |
$7,776.68
|
| Rate for Payer: Railroad Medicare Medicare |
$8,197.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,982.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,197.05
|
| Rate for Payer: UHC Exchange |
$15,665.38
|
| Rate for Payer: UHC Medicare Advantage |
$8,442.96
|
| Rate for Payer: VA VA |
$8,197.05
|
|
|
HC CYSTOMETROGRAM W/VP & UP
|
Facility
|
OP
|
$1,737.79
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.79 |
| Max. Negotiated Rate |
$1,564.01 |
| Rate for Payer: Aetna Commercial |
$1,477.12
|
| Rate for Payer: Aetna Medicare |
$632.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.79
|
| Rate for Payer: BCBS Complete |
$349.14
|
| Rate for Payer: BCBS MAPPO |
$607.83
|
| Rate for Payer: BCBS Trust/PPO |
$158.79
|
| Rate for Payer: BCN Medicare Advantage |
$607.83
|
| Rate for Payer: Cash Price |
$1,390.23
|
| Rate for Payer: Cash Price |
$1,390.23
|
| Rate for Payer: Cofinity Commercial |
$1,216.45
|
| Rate for Payer: Cofinity Commercial |
$1,494.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.83
|
| Rate for Payer: Healthscope Commercial |
$1,564.01
|
| Rate for Payer: Mclaren Medicaid |
$332.48
|
| Rate for Payer: Mclaren Medicare |
$607.83
|
| Rate for Payer: Meridian Medicaid |
$349.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,477.12
|
| Rate for Payer: PACE Medicare |
$577.44
|
| Rate for Payer: PACE SWMI |
$607.83
|
| Rate for Payer: PHP Commercial |
$1,477.12
|
| Rate for Payer: PHP Medicare Advantage |
$607.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,216.45
|
| Rate for Payer: Priority Health Medicare |
$607.83
|
| Rate for Payer: Priority Health SBD |
$1,094.81
|
| Rate for Payer: Railroad Medicare Medicare |
$607.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.83
|
| Rate for Payer: UHC Exchange |
$376.89
|
| Rate for Payer: UHC Medicare Advantage |
$626.06
|
| Rate for Payer: VA VA |
$607.83
|
|
|
HC CYSTOMETROGRAM W/VP & UP
|
Facility
|
IP
|
$1,737.79
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,094.81 |
| Max. Negotiated Rate |
$1,564.01 |
| Rate for Payer: Aetna Commercial |
$1,477.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.56
|
| Rate for Payer: Cash Price |
$1,390.23
|
| Rate for Payer: Cofinity Commercial |
$1,216.45
|
| Rate for Payer: Cofinity Commercial |
$1,494.50
|
| Rate for Payer: Healthscope Commercial |
$1,564.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,477.12
|
| Rate for Payer: PHP Commercial |
$1,477.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,216.45
|
| Rate for Payer: Priority Health SBD |
$1,094.81
|
|
|
HC CYSTOSCOPY DIL URETHRAL STRICTURE
|
Facility
|
IP
|
$2,661.82
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
76100194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,676.95 |
| Max. Negotiated Rate |
$2,395.64 |
| Rate for Payer: Aetna Commercial |
$2,262.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,730.18
|
| Rate for Payer: Cash Price |
$2,129.46
|
| Rate for Payer: Cofinity Commercial |
$1,863.27
|
| Rate for Payer: Cofinity Commercial |
$2,289.17
|
| Rate for Payer: Healthscope Commercial |
$2,395.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,262.55
|
| Rate for Payer: PHP Commercial |
$2,262.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,863.27
|
| Rate for Payer: Priority Health SBD |
$1,676.95
|
|
|
HC CYSTOSCOPY DIL URETHRAL STRICTURE
|
Facility
|
OP
|
$2,661.82
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
76100194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.35 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna Commercial |
$2,262.55
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,730.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,196.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$2,129.46
|
| Rate for Payer: Cash Price |
$2,129.46
|
| Rate for Payer: Cofinity Commercial |
$2,289.17
|
| Rate for Payer: Cofinity Commercial |
$1,863.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$2,395.64
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,262.55
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$2,262.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,863.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,575.00
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,460.00
|
| Rate for Payer: Priority Health SBD |
$1,676.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$147.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC CYSTOSCOPY REMV CALCULUS, COMPLICATED
|
Facility
|
OP
|
$2,710.48
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.90 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna Commercial |
$2,303.91
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,761.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,174.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cofinity Commercial |
$1,897.34
|
| Rate for Payer: Cofinity Commercial |
$2,331.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$2,439.43
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,303.91
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$2,303.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,575.00
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,460.00
|
| Rate for Payer: Priority Health SBD |
$1,707.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$264.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC CYSTOSCOPY REMV CALCULUS, COMPLICATED
|
Facility
|
IP
|
$2,710.48
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,707.60 |
| Max. Negotiated Rate |
$2,439.43 |
| Rate for Payer: Aetna Commercial |
$2,303.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,761.81
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cofinity Commercial |
$1,897.34
|
| Rate for Payer: Cofinity Commercial |
$2,331.01
|
| Rate for Payer: Healthscope Commercial |
$2,439.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,303.91
|
| Rate for Payer: PHP Commercial |
$2,303.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.34
|
| Rate for Payer: Priority Health SBD |
$1,707.60
|
|
|
HC CYSTOSCOPY REMV CALCULUS SIMPLE
|
Facility
|
IP
|
$2,661.82
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
76100195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,676.95 |
| Max. Negotiated Rate |
$2,395.64 |
| Rate for Payer: Aetna Commercial |
$2,262.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,730.18
|
| Rate for Payer: Cash Price |
$2,129.46
|
| Rate for Payer: Cofinity Commercial |
$1,863.27
|
| Rate for Payer: Cofinity Commercial |
$2,289.17
|
| Rate for Payer: Healthscope Commercial |
$2,395.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,262.55
|
| Rate for Payer: PHP Commercial |
$2,262.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,863.27
|
| Rate for Payer: Priority Health SBD |
$1,676.95
|
|
|
HC CYSTOSCOPY REMV CALCULUS SIMPLE
|
Facility
|
OP
|
$2,661.82
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
76100195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna Commercial |
$2,262.55
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,730.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$766.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$2,129.46
|
| Rate for Payer: Cash Price |
$2,129.46
|
| Rate for Payer: Cofinity Commercial |
$2,289.17
|
| Rate for Payer: Cofinity Commercial |
$1,863.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$2,395.64
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,262.55
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$2,262.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,863.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,575.00
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,460.00
|
| Rate for Payer: Priority Health SBD |
$1,676.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$146.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC CYSTO TX FEMALE URETHRAL SYNDROME
|
Facility
|
OP
|
$851.50
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.92 |
| Max. Negotiated Rate |
$1,791.30 |
| Rate for Payer: Aetna Commercial |
$723.78
|
| Rate for Payer: Aetna Medicare |
$632.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.79
|
| Rate for Payer: BCBS Complete |
$349.14
|
| Rate for Payer: BCBS MAPPO |
$607.83
|
| Rate for Payer: BCBS Trust/PPO |
$687.80
|
| Rate for Payer: BCN Medicare Advantage |
$607.83
|
| Rate for Payer: Cash Price |
$681.20
|
| Rate for Payer: Cash Price |
$681.20
|
| Rate for Payer: Cofinity Commercial |
$732.29
|
| Rate for Payer: Cofinity Commercial |
$596.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.83
|
| Rate for Payer: Healthscope Commercial |
$766.35
|
| Rate for Payer: Mclaren Medicaid |
$332.48
|
| Rate for Payer: Mclaren Medicare |
$607.83
|
| Rate for Payer: Meridian Medicaid |
$349.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.78
|
| Rate for Payer: PACE Medicare |
$577.44
|
| Rate for Payer: PACE SWMI |
$607.83
|
| Rate for Payer: PHP Commercial |
$723.78
|
| Rate for Payer: PHP Medicare Advantage |
$607.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,791.30
|
| Rate for Payer: Priority Health Medicare |
$607.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,433.04
|
| Rate for Payer: Priority Health SBD |
$536.44
|
| Rate for Payer: Railroad Medicare Medicare |
$607.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.83
|
| Rate for Payer: UHC Exchange |
$189.92
|
| Rate for Payer: UHC Medicare Advantage |
$626.06
|
| Rate for Payer: VA VA |
$607.83
|
|
|
HC CYSTO TX FEMALE URETHRAL SYNDROME
|
Facility
|
IP
|
$851.50
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$536.44 |
| Max. Negotiated Rate |
$766.35 |
| Rate for Payer: Aetna Commercial |
$723.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.48
|
| Rate for Payer: Cash Price |
$681.20
|
| Rate for Payer: Cofinity Commercial |
$596.05
|
| Rate for Payer: Cofinity Commercial |
$732.29
|
| Rate for Payer: Healthscope Commercial |
$766.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.78
|
| Rate for Payer: PHP Commercial |
$723.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.05
|
| Rate for Payer: Priority Health SBD |
$536.44
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
IP
|
$977.70
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
45000095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.95 |
| Max. Negotiated Rate |
$879.93 |
| Rate for Payer: Aetna Commercial |
$831.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.50
|
| Rate for Payer: Cash Price |
$782.16
|
| Rate for Payer: Cofinity Commercial |
$684.39
|
| Rate for Payer: Cofinity Commercial |
$840.82
|
| Rate for Payer: Healthscope Commercial |
$879.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$831.04
|
| Rate for Payer: PHP Commercial |
$831.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.39
|
| Rate for Payer: Priority Health SBD |
$615.95
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
OP
|
$977.70
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
45000095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.93 |
| Max. Negotiated Rate |
$1,791.30 |
| Rate for Payer: Aetna Commercial |
$831.04
|
| Rate for Payer: Aetna Medicare |
$632.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.79
|
| Rate for Payer: BCBS Complete |
$349.14
|
| Rate for Payer: BCBS MAPPO |
$607.83
|
| Rate for Payer: BCBS Trust/PPO |
$425.94
|
| Rate for Payer: BCN Medicare Advantage |
$607.83
|
| Rate for Payer: Cash Price |
$782.16
|
| Rate for Payer: Cash Price |
$782.16
|
| Rate for Payer: Cofinity Commercial |
$840.82
|
| Rate for Payer: Cofinity Commercial |
$684.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.83
|
| Rate for Payer: Healthscope Commercial |
$879.93
|
| Rate for Payer: Mclaren Medicaid |
$332.48
|
| Rate for Payer: Mclaren Medicare |
$607.83
|
| Rate for Payer: Meridian Medicaid |
$349.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$831.04
|
| Rate for Payer: PACE Medicare |
$577.44
|
| Rate for Payer: PACE SWMI |
$607.83
|
| Rate for Payer: PHP Commercial |
$831.04
|
| Rate for Payer: PHP Medicare Advantage |
$607.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,791.30
|
| Rate for Payer: Priority Health Medicare |
$607.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,433.04
|
| Rate for Payer: Priority Health SBD |
$615.95
|
| Rate for Payer: Railroad Medicare Medicare |
$607.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.83
|
| Rate for Payer: UHC Exchange |
$77.93
|
| Rate for Payer: UHC Medicare Advantage |
$626.06
|
| Rate for Payer: VA VA |
$607.83
|
|
|
HC CYSTOURETHROSCOPY BIOPSY
|
Facility
|
OP
|
$2,981.15
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna Commercial |
$2,533.98
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,937.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,376.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$2,384.92
|
| Rate for Payer: Cash Price |
$2,384.92
|
| Rate for Payer: Cofinity Commercial |
$2,563.79
|
| Rate for Payer: Cofinity Commercial |
$2,086.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$2,683.04
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,533.98
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$2,533.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,086.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,575.00
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,460.00
|
| Rate for Payer: Priority Health SBD |
$1,878.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$137.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC CYSTOURETHROSCOPY BIOPSY
|
Facility
|
IP
|
$2,981.15
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,878.12 |
| Max. Negotiated Rate |
$2,683.04 |
| Rate for Payer: Aetna Commercial |
$2,533.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,937.75
|
| Rate for Payer: Cash Price |
$2,384.92
|
| Rate for Payer: Cofinity Commercial |
$2,086.80
|
| Rate for Payer: Cofinity Commercial |
$2,563.79
|
| Rate for Payer: Healthscope Commercial |
$2,683.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,533.98
|
| Rate for Payer: PHP Commercial |
$2,533.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,086.80
|
| Rate for Payer: Priority Health SBD |
$1,878.12
|
|
