|
HC CYGNUS MATRIX 4X6 PER SQ CM
|
Facility
|
IP
|
$159.89
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.73 |
| Max. Negotiated Rate |
$143.90 |
| Rate for Payer: Aetna Commercial |
$135.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.93
|
| Rate for Payer: Cash Price |
$127.91
|
| Rate for Payer: Cofinity Advantage |
$111.92
|
| Rate for Payer: Cofinity Commercial |
$137.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.91
|
| Rate for Payer: Healthscope Commercial |
$143.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.92
|
| Rate for Payer: PHP Commercial |
$135.91
|
| Rate for Payer: Priority Health SBD |
$100.73
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$10.17
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$19.75
|
| Rate for Payer: BCN Commercial |
$19.75
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$9.69
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$27.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.52
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: Priority Health Tiered Network |
$14.82
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.78
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.52
|
| Rate for Payer: UHC Exchange |
$27.78
|
| Rate for Payer: UHC Medicaid |
$9.69
|
| Rate for Payer: UHCCP Medicaid |
$9.69
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health SBD |
$42.61
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR, SERUM
|
Facility
|
IP
|
$69.15
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.56 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Aetna Commercial |
$58.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.95
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Advantage |
$48.41
|
| Rate for Payer: Cofinity Commercial |
$59.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Healthscope Commercial |
$62.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: PHP Commercial |
$58.78
|
| Rate for Payer: Priority Health SBD |
$43.56
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR, SERUM
|
Facility
|
OP
|
$69.15
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Aetna Commercial |
$58.78
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$10.17
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$19.75
|
| Rate for Payer: BCN Commercial |
$19.75
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Advantage |
$48.41
|
| Rate for Payer: Cofinity Commercial |
$59.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$62.23
|
| Rate for Payer: Mclaren Medicaid |
$9.69
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Nomi Health Commercial |
$27.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$58.78
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.52
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health SBD |
$43.56
|
| Rate for Payer: Priority Health Tiered Network |
$14.82
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.78
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.52
|
| Rate for Payer: UHC Exchange |
$27.78
|
| Rate for Payer: UHC Medicaid |
$9.69
|
| Rate for Payer: UHCCP Medicaid |
$9.69
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC CYSTIC FIBROSIS CARRIER DETECT
|
Facility
|
IP
|
$1,909.44
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
31000098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,202.95 |
| Max. Negotiated Rate |
$1,718.50 |
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.14
|
| Rate for Payer: Cash Price |
$1,527.55
|
| Rate for Payer: Cofinity Advantage |
$1,336.61
|
| Rate for Payer: Cofinity Commercial |
$1,642.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,527.55
|
| Rate for Payer: Healthscope Commercial |
$1,718.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,623.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,432.08
|
| Rate for Payer: PHP Commercial |
$1,623.02
|
| Rate for Payer: Priority Health SBD |
$1,202.95
|
|
|
HC CYSTIC FIBROSIS CARRIER DETECT
|
Facility
|
OP
|
$1,909.44
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
31000098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$291.10 |
| Max. Negotiated Rate |
$1,718.50 |
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: Aetna Medicare |
$578.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.14
|
| 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 |
$305.68
|
| Rate for Payer: BCBS MAPPO |
$556.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.28
|
| Rate for Payer: BCN Commercial |
$1,137.28
|
| Rate for Payer: BCN Medicare Advantage |
$556.60
|
| Rate for Payer: Cash Price |
$1,527.55
|
| Rate for Payer: Cash Price |
$1,527.55
|
| Rate for Payer: Cofinity Advantage |
$1,336.61
|
| Rate for Payer: Cofinity Commercial |
$1,642.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,527.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.60
|
| Rate for Payer: Healthscope Commercial |
$1,718.50
|
| Rate for Payer: Mclaren Medicaid |
$291.10
|
| Rate for Payer: Mclaren Medicare |
$556.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$584.43
|
| Rate for Payer: Meridian Medicaid |
$584.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$612.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,623.02
|
| Rate for Payer: Nomi Health Commercial |
$1,669.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,432.08
|
| Rate for Payer: PACE Medicare |
$528.77
|
| Rate for Payer: PACE SWMI |
$556.60
|
| Rate for Payer: PHP Commercial |
$1,623.02
|
| Rate for Payer: PHP Medicare Advantage |
$556.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$556.60
|
| Rate for Payer: Priority Health Medicare |
$556.60
|
| Rate for Payer: Priority Health SBD |
$1,202.95
|
| Rate for Payer: Priority Health Tiered Network |
$445.28
|
| Rate for Payer: Railroad Medicare Medicare |
$556.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$834.90
|
| Rate for Payer: UHC Core |
$834.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$556.60
|
| Rate for Payer: UHC Exchange |
$834.90
|
| Rate for Payer: UHC Medicaid |
$291.10
|
| Rate for Payer: UHCCP Medicaid |
$291.10
|
| Rate for Payer: VA VA |
$556.60
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$20.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| 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 |
$10.77
|
| Rate for Payer: BCBS MAPPO |
$19.61
|
| Rate for Payer: BCBS Trust/PPO |
$20.91
|
| Rate for Payer: BCN Commercial |
$20.91
|
| Rate for Payer: BCN Medicare Advantage |
$19.61
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Mclaren Medicaid |
$10.26
|
| Rate for Payer: Mclaren Medicare |
$19.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.59
|
| Rate for Payer: Meridian Medicaid |
$20.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PACE Medicare |
$18.63
|
| Rate for Payer: PACE SWMI |
$19.61
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Medicare Advantage |
$19.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.61
|
| Rate for Payer: Priority Health Medicare |
$19.61
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: Priority Health Tiered Network |
$15.69
|
| Rate for Payer: Railroad Medicare Medicare |
$19.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.42
|
| Rate for Payer: UHC Core |
$29.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.61
|
| Rate for Payer: UHC Exchange |
$29.42
|
| Rate for Payer: UHC Medicaid |
$10.26
|
| Rate for Payer: UHCCP Medicaid |
$10.26
|
| Rate for Payer: VA VA |
$19.61
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.99 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna Commercial |
$0.25
|
| Rate for Payer: Aetna Medicare |
$0.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.19
|
| Rate for Payer: BCBS Complete |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cofinity Advantage |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.23
|
| Rate for Payer: Healthscope Commercial |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.22
|
| Rate for Payer: PHP Commercial |
$0.25
|
| Rate for Payer: Priority Health SBD |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna Commercial |
$0.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.19
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cofinity Advantage |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.23
|
| Rate for Payer: Healthscope Commercial |
$0.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.22
|
| Rate for Payer: PHP Commercial |
$0.25
|
| Rate for Payer: Priority Health SBD |
$0.18
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
OP
|
$6,399.95
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,515.18 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna Commercial |
$5,439.96
|
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,159.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,950.34
|
| Rate for Payer: BCN Commercial |
$4,950.34
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cofinity Advantage |
$4,479.97
|
| Rate for Payer: Cofinity Commercial |
$5,503.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,119.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Healthscope Commercial |
$5,759.95
|
| Rate for Payer: Mclaren Medicaid |
$2,794.14
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,439.96
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,799.96
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Commercial |
$5,439.96
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health SBD |
$4,031.97
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,159.97
|
| Rate for Payer: UHC Core |
$3,334.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Exchange |
$2,515.18
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
IP
|
$6,399.95
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,031.97 |
| Max. Negotiated Rate |
$5,759.95 |
| Rate for Payer: Aetna Commercial |
$5,439.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,159.97
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cofinity Advantage |
$4,479.97
|
| Rate for Payer: Cofinity Commercial |
$5,503.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,119.96
|
| Rate for Payer: Healthscope Commercial |
$5,759.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,439.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,799.96
|
| Rate for Payer: PHP Commercial |
$5,439.96
|
| Rate for Payer: Priority Health SBD |
$4,031.97
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
OP
|
$12,842.64
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,933.16 |
| Max. Negotiated Rate |
$30,503.59 |
| Rate for Payer: Aetna Commercial |
$10,916.24
|
| Rate for Payer: Aetna Medicare |
$9,809.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,347.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,790.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,790.52
|
| Rate for Payer: BCBS Complete |
$5,180.29
|
| Rate for Payer: BCBS MAPPO |
$9,432.42
|
| Rate for Payer: BCBS Trust/PPO |
$6,833.22
|
| Rate for Payer: BCN Commercial |
$6,833.22
|
| Rate for Payer: BCN Medicare Advantage |
$9,432.42
|
| Rate for Payer: Cash Price |
$10,274.11
|
| Rate for Payer: Cash Price |
$10,274.11
|
| Rate for Payer: Cash Price |
$10,274.11
|
| Rate for Payer: Cofinity Advantage |
$8,989.85
|
| Rate for Payer: Cofinity Commercial |
$11,044.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,274.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,432.42
|
| Rate for Payer: Healthscope Commercial |
$11,558.38
|
| Rate for Payer: Mclaren Medicaid |
$4,933.16
|
| Rate for Payer: Mclaren Medicare |
$9,432.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,904.04
|
| Rate for Payer: Meridian Medicaid |
$9,904.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,847.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,375.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,916.24
|
| Rate for Payer: Nomi Health Commercial |
$28,297.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,631.98
|
| Rate for Payer: PACE Medicare |
$8,960.80
|
| Rate for Payer: PACE SWMI |
$9,432.42
|
| Rate for Payer: PHP Commercial |
$10,916.24
|
| Rate for Payer: PHP Medicare Advantage |
$9,432.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,933.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30,503.59
|
| Rate for Payer: Priority Health Medicare |
$9,432.42
|
| Rate for Payer: Priority Health SBD |
$8,090.86
|
| Rate for Payer: Priority Health Tiered Network |
$24,402.87
|
| Rate for Payer: Railroad Medicare Medicare |
$9,432.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,347.72
|
| Rate for Payer: UHC Core |
$6,691.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,432.42
|
| Rate for Payer: UHC Exchange |
$5,047.16
|
| Rate for Payer: UHC Medicaid |
$4,933.16
|
| Rate for Payer: UHCCP Medicaid |
$4,933.16
|
| Rate for Payer: VA VA |
$9,432.42
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
IP
|
$12,842.64
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,090.86 |
| Max. Negotiated Rate |
$11,558.38 |
| Rate for Payer: Aetna Commercial |
$10,916.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,347.72
|
| Rate for Payer: Cash Price |
$10,274.11
|
| Rate for Payer: Cofinity Advantage |
$8,989.85
|
| Rate for Payer: Cofinity Commercial |
$11,044.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,274.11
|
| Rate for Payer: Healthscope Commercial |
$11,558.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,916.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,631.98
|
| Rate for Payer: PHP Commercial |
$10,916.24
|
| Rate for Payer: Priority Health SBD |
$8,090.86
|
|
|
HC CYSTOMETROGRAM W/VP & UP
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.45 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna Commercial |
$1,536.80
|
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$209.45
|
| Rate for Payer: BCN Commercial |
$209.45
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cofinity Advantage |
$1,265.60
|
| Rate for Payer: Cofinity Commercial |
$1,554.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$1,627.20
|
| Rate for Payer: Mclaren Medicaid |
$363.38
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,536.80
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,356.00
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$1,536.80
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health SBD |
$1,139.04
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,175.20
|
| Rate for Payer: UHC Core |
$941.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Exchange |
$710.54
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
HC CYSTOMETROGRAM W/VP & UP
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,139.04 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Aetna Commercial |
$1,536.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.20
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cofinity Advantage |
$1,265.60
|
| Rate for Payer: Cofinity Commercial |
$1,554.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.40
|
| Rate for Payer: Healthscope Commercial |
$1,627.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,536.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,356.00
|
| Rate for Payer: PHP Commercial |
$1,536.80
|
| Rate for Payer: Priority Health SBD |
$1,139.04
|
|
|
HC CYSTOSCOPY DIL URETHRAL STRICTURE
|
Facility
|
IP
|
$2,769.36
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
76100194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,744.70 |
| Max. Negotiated Rate |
$2,492.42 |
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,800.08
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Advantage |
$1,938.55
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: Priority Health SBD |
$1,744.70
|
|
|
HC CYSTOSCOPY DIL URETHRAL STRICTURE
|
Facility
|
OP
|
$2,769.36
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
76100194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,088.36 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,800.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,578.55
|
| Rate for Payer: BCN Commercial |
$1,578.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Advantage |
$1,938.55
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,744.70
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,800.08
|
| Rate for Payer: UHC Core |
$1,442.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$1,088.36
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC CYSTOSCOPY REMV CALCULUS, COMPLICATED
|
Facility
|
OP
|
$2,819.98
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,832.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,549.19
|
| Rate for Payer: BCN Commercial |
$1,549.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Advantage |
$1,973.99
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,776.59
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.99
|
| Rate for Payer: UHC Core |
$1,469.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$1,108.25
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC CYSTOSCOPY REMV CALCULUS, COMPLICATED
|
Facility
|
IP
|
$2,819.98
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,776.59 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,832.99
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Advantage |
$1,973.99
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: Priority Health SBD |
$1,776.59
|
|
|
HC CYSTOSCOPY REMV CALCULUS SIMPLE
|
Facility
|
IP
|
$2,769.36
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
76100195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,744.70 |
| Max. Negotiated Rate |
$2,492.42 |
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,800.08
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Advantage |
$1,938.55
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: Priority Health SBD |
$1,744.70
|
|
|
HC CYSTOSCOPY REMV CALCULUS SIMPLE
|
Facility
|
OP
|
$2,769.36
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
76100195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,011.30 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,800.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.30
|
| Rate for Payer: BCN Commercial |
$1,011.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Advantage |
$1,938.55
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,744.70
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,800.08
|
| Rate for Payer: UHC Core |
$1,442.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$1,088.36
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC CYSTO TX FEMALE URETHRAL SYNDROME
|
Facility
|
OP
|
$885.90
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.16 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna Commercial |
$753.01
|
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$907.21
|
| Rate for Payer: BCN Commercial |
$907.21
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cofinity Advantage |
$620.13
|
| Rate for Payer: Cofinity Commercial |
$761.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$797.31
|
| Rate for Payer: Mclaren Medicaid |
$363.38
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.01
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$664.42
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$753.01
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health SBD |
$558.12
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$575.84
|
| Rate for Payer: UHC Core |
$461.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Exchange |
$348.16
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
HC CYSTO TX FEMALE URETHRAL SYNDROME
|
Facility
|
IP
|
$885.90
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$558.12 |
| Max. Negotiated Rate |
$797.31 |
| Rate for Payer: Aetna Commercial |
$753.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.84
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cofinity Advantage |
$620.13
|
| Rate for Payer: Cofinity Commercial |
$761.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.72
|
| Rate for Payer: Healthscope Commercial |
$797.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$664.42
|
| Rate for Payer: PHP Commercial |
$753.01
|
| Rate for Payer: Priority Health SBD |
$558.12
|
|
