|
HC CYCLOSPORA DETECTION CMPT
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600108
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health SBD |
$30.20
|
|
|
HC CYCLOSPORINE
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
30100025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
|
|
HC CYCLOSPORINE
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
30100025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$50.81 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$18.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.56
|
| Rate for Payer: BCBS Complete |
$10.16
|
| Rate for Payer: BCBS MAPPO |
$18.05
|
| Rate for Payer: BCN Medicare Advantage |
$18.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$9.67
|
| Rate for Payer: Mclaren Medicare |
$18.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.95
|
| Rate for Payer: Meridian Medicaid |
$10.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PACE Medicare |
$17.15
|
| Rate for Payer: PACE SWMI |
$18.05
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$18.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: Railroad Medicare Medicare |
$18.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.05
|
| Rate for Payer: UHC Medicare Advantage |
$18.05
|
| Rate for Payer: UHCCP Medicaid |
$10.16
|
| Rate for Payer: VA VA |
$18.05
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.09
|
| 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 |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| 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 |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health SBD |
$41.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$10.43
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.09
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health SBD |
$41.77
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR, SERUM
|
Facility
|
IP
|
$67.79
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$61.01 |
| Rate for Payer: Aetna Commercial |
$57.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.06
|
| Rate for Payer: Cash Price |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Cofinity Commercial |
$58.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.23
|
| Rate for Payer: Healthscope Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.62
|
| Rate for Payer: PHP Commercial |
$57.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.06
|
| Rate for Payer: Priority Health SBD |
$42.71
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR, SERUM
|
Facility
|
OP
|
$67.79
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$61.01 |
| Rate for Payer: Aetna Commercial |
$57.62
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.06
|
| 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 |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$54.23
|
| Rate for Payer: Cash Price |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$58.30
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$61.01
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| 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 |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.62
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$57.62
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.06
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health SBD |
$42.71
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$10.43
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC CYSTIC FIBROSIS CARRIER DETECT
|
Facility
|
IP
|
$1,749.80
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
31000098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,102.37 |
| Max. Negotiated Rate |
$1,574.82 |
| Rate for Payer: Aetna Commercial |
$1,487.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,137.37
|
| Rate for Payer: Cash Price |
$1,399.84
|
| Rate for Payer: Cofinity Commercial |
$1,224.86
|
| Rate for Payer: Cofinity Commercial |
$1,504.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,224.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,399.84
|
| Rate for Payer: Healthscope Commercial |
$1,574.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,487.33
|
| Rate for Payer: PHP Commercial |
$1,487.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.37
|
| Rate for Payer: Priority Health SBD |
$1,102.37
|
|
|
HC CYSTIC FIBROSIS CARRIER DETECT
|
Facility
|
OP
|
$1,749.80
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
31000098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$298.34 |
| Max. Negotiated Rate |
$1,574.82 |
| Rate for Payer: Aetna Commercial |
$1,487.33
|
| Rate for Payer: Aetna Medicare |
$578.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,137.37
|
| 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 |
$313.25
|
| Rate for Payer: BCBS MAPPO |
$556.60
|
| Rate for Payer: BCN Medicare Advantage |
$556.60
|
| Rate for Payer: Cash Price |
$1,399.84
|
| Rate for Payer: Cash Price |
$1,399.84
|
| Rate for Payer: Cofinity Commercial |
$1,504.83
|
| Rate for Payer: Cofinity Commercial |
$1,224.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,224.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,399.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.60
|
| Rate for Payer: Healthscope Commercial |
$1,574.82
|
| Rate for Payer: Mclaren Medicaid |
$298.34
|
| 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 |
$313.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,487.33
|
| Rate for Payer: PACE Medicare |
$528.77
|
| Rate for Payer: PACE SWMI |
$556.60
|
| Rate for Payer: PHP Commercial |
$1,487.33
|
| Rate for Payer: PHP Medicare Advantage |
$556.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.37
|
| Rate for Payer: Priority Health Medicare |
$556.60
|
| Rate for Payer: Priority Health SBD |
$1,102.37
|
| Rate for Payer: Railroad Medicare Medicare |
$556.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,566.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$556.60
|
| Rate for Payer: UHC Medicare Advantage |
$556.60
|
| Rate for Payer: UHCCP Medicaid |
$313.37
|
| Rate for Payer: VA VA |
$556.60
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$20.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| 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 |
$11.04
|
| Rate for Payer: BCBS MAPPO |
$19.61
|
| Rate for Payer: BCN Medicare Advantage |
$19.61
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Mclaren Medicaid |
$10.51
|
| 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 |
$11.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PACE Medicare |
$18.63
|
| Rate for Payer: PACE SWMI |
$19.61
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$19.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health Medicare |
$19.61
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: Railroad Medicare Medicare |
$19.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.61
|
| Rate for Payer: UHC Medicare Advantage |
$19.61
|
| Rate for Payer: UHCCP Medicaid |
$11.04
|
| Rate for Payer: VA VA |
$19.61
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna Commercial |
$0.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.18
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cofinity Commercial |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.22
|
| Rate for Payer: Healthscope Commercial |
$0.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.24
|
| Rate for Payer: PHP Commercial |
$0.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.18
|
| Rate for Payer: Priority Health SBD |
$0.18
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna Commercial |
$0.24
|
| Rate for Payer: Aetna Medicare |
$0.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.11
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cofinity Commercial |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.22
|
| Rate for Payer: Healthscope Commercial |
$0.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.24
|
| Rate for Payer: PHP Commercial |
$0.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.18
|
| Rate for Payer: Priority Health SBD |
$0.18
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
IP
|
$6,274.46
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,952.91 |
| Max. Negotiated Rate |
$5,647.01 |
| Rate for Payer: Aetna Commercial |
$5,333.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,078.40
|
| Rate for Payer: Cash Price |
$5,019.57
|
| Rate for Payer: Cofinity Commercial |
$4,392.12
|
| Rate for Payer: Cofinity Commercial |
$5,396.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,392.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,019.57
|
| Rate for Payer: Healthscope Commercial |
$5,647.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,333.29
|
| Rate for Payer: PHP Commercial |
$5,333.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,078.40
|
| Rate for Payer: Priority Health SBD |
$3,952.91
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
OP
|
$6,274.46
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,657.46 |
| Max. Negotiated Rate |
$13,956.13 |
| Rate for Payer: Aetna Commercial |
$5,333.29
|
| Rate for Payer: Aetna Medicare |
$5,156.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,078.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Cash Price |
$5,019.57
|
| Rate for Payer: Cash Price |
$5,019.57
|
| Rate for Payer: Cofinity Commercial |
$5,396.04
|
| Rate for Payer: Cofinity Commercial |
$4,392.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,392.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,019.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Healthscope Commercial |
$5,647.01
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,333.29
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Commercial |
$5,333.29
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,078.40
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Priority Health SBD |
$3,952.91
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,956.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,791.33
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
OP
|
$12,590.82
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,833.95 |
| Max. Negotiated Rate |
$25,386.34 |
| Rate for Payer: Aetna Commercial |
$10,702.20
|
| Rate for Payer: Aetna Medicare |
$9,379.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,184.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,273.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,273.20
|
| Rate for Payer: BCBS Complete |
$5,075.65
|
| Rate for Payer: BCBS MAPPO |
$9,018.56
|
| Rate for Payer: BCN Medicare Advantage |
$9,018.56
|
| Rate for Payer: Cash Price |
$10,072.66
|
| Rate for Payer: Cash Price |
$10,072.66
|
| Rate for Payer: Cofinity Commercial |
$8,813.57
|
| Rate for Payer: Cofinity Commercial |
$10,828.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,813.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,072.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,018.56
|
| Rate for Payer: Healthscope Commercial |
$11,331.74
|
| Rate for Payer: Mclaren Medicaid |
$4,833.95
|
| Rate for Payer: Mclaren Medicare |
$9,018.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,469.49
|
| Rate for Payer: Meridian Medicaid |
$5,075.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,371.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,702.20
|
| Rate for Payer: PACE Medicare |
$8,567.63
|
| Rate for Payer: PACE SWMI |
$9,018.56
|
| Rate for Payer: PHP Commercial |
$10,702.20
|
| Rate for Payer: PHP Medicare Advantage |
$9,018.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,833.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,184.03
|
| Rate for Payer: Priority Health Medicare |
$9,018.56
|
| Rate for Payer: Priority Health SBD |
$7,932.22
|
| Rate for Payer: Railroad Medicare Medicare |
$9,018.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,386.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,018.56
|
| Rate for Payer: UHC Medicare Advantage |
$9,018.56
|
| Rate for Payer: UHCCP Medicaid |
$5,077.45
|
| Rate for Payer: VA VA |
$9,018.56
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
IP
|
$12,590.82
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,932.22 |
| Max. Negotiated Rate |
$11,331.74 |
| Rate for Payer: Aetna Commercial |
$10,702.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,184.03
|
| Rate for Payer: Cash Price |
$10,072.66
|
| Rate for Payer: Cofinity Commercial |
$10,828.11
|
| Rate for Payer: Cofinity Commercial |
$8,813.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,813.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,072.66
|
| Rate for Payer: Healthscope Commercial |
$11,331.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,702.20
|
| Rate for Payer: PHP Commercial |
$10,702.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,184.03
|
| Rate for Payer: Priority Health SBD |
$7,932.22
|
|
|
HC CYSTOMETROGRAM W/VP & UP
|
Facility
|
OP
|
$1,772.55
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna Commercial |
$1,506.67
|
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,152.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$1,418.04
|
| Rate for Payer: Cash Price |
$1,418.04
|
| Rate for Payer: Cofinity Commercial |
$1,524.39
|
| Rate for Payer: Cofinity Commercial |
$1,240.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,240.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,418.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$1,595.30
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,506.67
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$1,506.67
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.16
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health SBD |
$1,116.71
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$366.50
|
| Rate for Payer: VA VA |
$650.97
|
|
|
HC CYSTOMETROGRAM W/VP & UP
|
Facility
|
IP
|
$1,772.55
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,116.71 |
| Max. Negotiated Rate |
$1,595.30 |
| Rate for Payer: Aetna Commercial |
$1,506.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,152.16
|
| Rate for Payer: Cash Price |
$1,418.04
|
| Rate for Payer: Cofinity Commercial |
$1,240.79
|
| Rate for Payer: Cofinity Commercial |
$1,524.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,240.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,418.04
|
| Rate for Payer: Healthscope Commercial |
$1,595.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,506.67
|
| Rate for Payer: PHP Commercial |
$1,506.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.16
|
| Rate for Payer: Priority Health SBD |
$1,116.71
|
|
|
HC CYSTOSCOPY DIL URETHRAL STRICTURE
|
Facility
|
OP
|
$2,715.06
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
76100194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Commercial |
$2,307.80
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,764.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$1,900.54
|
| Rate for Payer: Cofinity Commercial |
$2,334.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,900.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$2,443.55
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,307.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$1,710.49
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,124.80
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
HC CYSTOSCOPY DIL URETHRAL STRICTURE
|
Facility
|
IP
|
$2,715.06
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
76100194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,710.49 |
| Max. Negotiated Rate |
$2,443.55 |
| Rate for Payer: Aetna Commercial |
$2,307.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,764.79
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$1,900.54
|
| Rate for Payer: Cofinity Commercial |
$2,334.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,900.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Healthscope Commercial |
$2,443.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: PHP Commercial |
$2,307.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health SBD |
$1,710.49
|
|
|
HC CYSTOSCOPY REMV CALCULUS, COMPLICATED
|
Facility
|
OP
|
$2,764.69
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Commercial |
$2,349.99
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,797.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cofinity Commercial |
$2,377.63
|
| Rate for Payer: Cofinity Commercial |
$1,935.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,935.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$2,488.22
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,349.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$1,741.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,124.80
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
HC CYSTOSCOPY REMV CALCULUS, COMPLICATED
|
Facility
|
IP
|
$2,764.69
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,741.75 |
| Max. Negotiated Rate |
$2,488.22 |
| Rate for Payer: Aetna Commercial |
$2,349.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,797.05
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cofinity Commercial |
$1,935.28
|
| Rate for Payer: Cofinity Commercial |
$2,377.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,935.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Healthscope Commercial |
$2,488.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: PHP Commercial |
$2,349.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: Priority Health SBD |
$1,741.75
|
|
|
HC CYSTOSCOPY REMV CALCULUS SIMPLE
|
Facility
|
OP
|
$2,715.06
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
76100195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Commercial |
$2,307.80
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,764.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$2,334.95
|
| Rate for Payer: Cofinity Commercial |
$1,900.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,900.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$2,443.55
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,307.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$1,710.49
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,124.80
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
HC CYSTOSCOPY REMV CALCULUS SIMPLE
|
Facility
|
IP
|
$2,715.06
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
76100195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,710.49 |
| Max. Negotiated Rate |
$2,443.55 |
| Rate for Payer: Aetna Commercial |
$2,307.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,764.79
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$1,900.54
|
| Rate for Payer: Cofinity Commercial |
$2,334.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,900.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Healthscope Commercial |
$2,443.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: PHP Commercial |
$2,307.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health SBD |
$1,710.49
|
|
