|
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 |
$402.42 |
| Max. Negotiated Rate |
$1,574.82 |
| Rate for Payer: Aetna Commercial |
$1,487.33
|
| Rate for Payer: Aetna Medicare |
$454.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$546.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$546.81
|
| Rate for Payer: BCBS Complete |
$422.57
|
| Rate for Payer: BCBS MAPPO |
$437.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,438.51
|
| Rate for Payer: BCN Commercial |
$1,360.47
|
| Rate for Payer: BCN Medicare Advantage |
$437.45
|
| 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: Encore Health Key Benefits Commercial |
$1,399.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$437.45
|
| Rate for Payer: Healthscope Commercial |
$1,574.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,312.35
|
| Rate for Payer: Mclaren Medicaid |
$402.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$459.32
|
| Rate for Payer: Meridian Medicaid |
$422.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$503.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,487.33
|
| Rate for Payer: Nomi Health Commercial |
$1,434.84
|
| Rate for Payer: PACE Senior Care Partners |
$415.58
|
| Rate for Payer: PACE SWMI |
$437.45
|
| Rate for Payer: PHP Commercial |
$1,487.33
|
| Rate for Payer: PHP Medicare Advantage |
$437.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.37
|
| Rate for Payer: Priority Health HMO/PPO |
$1,522.33
|
| Rate for Payer: Priority Health Medicare |
$441.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,172.37
|
| Rate for Payer: Railroad Medicare Medicare |
$437.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,539.82
|
| Rate for Payer: UHC Core |
$1,461.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$437.45
|
| Rate for Payer: UHC Exchange |
$437.45
|
| Rate for Payer: UHC Medicare Advantage |
$437.45
|
| Rate for Payer: UHCCP Medicaid |
$402.42
|
| Rate for Payer: VA VA |
$437.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,312.35
|
|
|
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 |
$1,137.37 |
| Max. Negotiated Rate |
$1,574.82 |
| Rate for Payer: Aetna Commercial |
$1,487.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,428.36
|
| Rate for Payer: BCN Commercial |
$1,352.25
|
| Rate for Payer: Cash Price |
$1,399.84
|
| Rate for Payer: Cofinity Commercial |
$1,504.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,399.84
|
| Rate for Payer: Healthscope Commercial |
$1,574.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,312.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,487.33
|
| Rate for Payer: Nomi Health Commercial |
$1,434.84
|
| Rate for Payer: PHP Commercial |
$1,487.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.37
|
| Rate for Payer: Priority Health HMO/PPO |
$1,522.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,172.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,539.82
|
| Rate for Payer: UHC Core |
$1,461.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,312.35
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$74.94
|
| Rate for Payer: BCN Commercial |
$70.94
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: BCBS Complete |
$14.89
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCN Commercial |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$14.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: Meridian Medicaid |
$14.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.95
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: UHCCP Medicaid |
$14.18
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
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: BCBS Trust/PPO |
$0.23
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cofinity Commercial |
$0.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.22
|
| Rate for Payer: Healthscope Commercial |
$0.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.24
|
| Rate for Payer: Nomi Health Commercial |
$0.23
|
| Rate for Payer: PHP Commercial |
$0.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.18
|
| Rate for Payer: Priority Health HMO/PPO |
$0.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.21
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna Commercial |
$0.24
|
| Rate for Payer: Aetna Medicare |
$0.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.09
|
| Rate for Payer: BCBS Complete |
$0.11
|
| Rate for Payer: BCBS MAPPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.23
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Medicare Advantage |
$0.07
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cofinity Commercial |
$0.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.07
|
| Rate for Payer: Healthscope Commercial |
$0.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.24
|
| Rate for Payer: Nomi Health Commercial |
$0.23
|
| Rate for Payer: PACE Senior Care Partners |
$0.07
|
| Rate for Payer: PACE SWMI |
$0.07
|
| Rate for Payer: PHP Commercial |
$0.24
|
| Rate for Payer: PHP Medicare Advantage |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.18
|
| Rate for Payer: Priority Health HMO/PPO |
$0.24
|
| Rate for Payer: Priority Health Medicare |
$0.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.19
|
| Rate for Payer: Railroad Medicare Medicare |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Medicare Advantage |
$0.07
|
| Rate for Payer: VA VA |
$0.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.21
|
|
|
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 |
$1,490.18 |
| Max. Negotiated Rate |
$5,647.01 |
| Rate for Payer: Aetna Commercial |
$5,333.29
|
| Rate for Payer: Aetna Medicare |
$1,631.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.77
|
| Rate for Payer: BCBS Complete |
$3,781.45
|
| Rate for Payer: BCBS MAPPO |
$1,568.62
|
| Rate for Payer: BCBS Trust/PPO |
$5,158.23
|
| Rate for Payer: BCN Commercial |
$4,878.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.62
|
| 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: Encore Health Key Benefits Commercial |
$5,019.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.62
|
| Rate for Payer: Healthscope Commercial |
$5,647.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,705.84
|
| Rate for Payer: Mclaren Medicaid |
$3,601.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,647.05
|
| Rate for Payer: Meridian Medicaid |
$3,781.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,333.29
|
| Rate for Payer: Nomi Health Commercial |
$5,145.06
|
| Rate for Payer: PACE Senior Care Partners |
$1,490.18
|
| Rate for Payer: PACE SWMI |
$1,568.62
|
| Rate for Payer: PHP Commercial |
$5,333.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,601.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,078.40
|
| Rate for Payer: Priority Health HMO/PPO |
$5,458.78
|
| Rate for Payer: Priority Health Medicare |
$1,584.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,203.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,521.52
|
| Rate for Payer: UHC Core |
$5,239.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.62
|
| Rate for Payer: UHC Exchange |
$1,568.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.62
|
| Rate for Payer: UHCCP Medicaid |
$3,601.14
|
| Rate for Payer: VA VA |
$1,568.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,705.84
|
|
|
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 |
$4,078.40 |
| Max. Negotiated Rate |
$5,647.01 |
| Rate for Payer: Aetna Commercial |
$5,333.29
|
| Rate for Payer: BCBS Trust/PPO |
$5,121.84
|
| Rate for Payer: BCN Commercial |
$4,848.90
|
| Rate for Payer: Cash Price |
$5,019.57
|
| Rate for Payer: Cofinity Commercial |
$5,396.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,019.57
|
| Rate for Payer: Healthscope Commercial |
$5,647.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,705.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,333.29
|
| Rate for Payer: Nomi Health Commercial |
$5,145.06
|
| Rate for Payer: PHP Commercial |
$5,333.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,078.40
|
| Rate for Payer: Priority Health HMO/PPO |
$5,458.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,203.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,521.52
|
| Rate for Payer: UHC Core |
$5,239.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,705.84
|
|
|
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 |
$8,184.03 |
| Max. Negotiated Rate |
$11,331.74 |
| Rate for Payer: Aetna Commercial |
$10,702.20
|
| Rate for Payer: BCBS Trust/PPO |
$10,277.89
|
| Rate for Payer: BCN Commercial |
$9,730.19
|
| Rate for Payer: Cash Price |
$10,072.66
|
| Rate for Payer: Cofinity Commercial |
$10,828.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,072.66
|
| Rate for Payer: Healthscope Commercial |
$11,331.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,443.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,702.20
|
| Rate for Payer: Nomi Health Commercial |
$10,324.47
|
| Rate for Payer: PHP Commercial |
$10,702.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,184.03
|
| Rate for Payer: Priority Health HMO/PPO |
$10,954.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,435.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,079.92
|
| Rate for Payer: UHC Core |
$10,513.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,443.12
|
|
|
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 |
$2,990.32 |
| Max. Negotiated Rate |
$11,331.74 |
| Rate for Payer: Aetna Commercial |
$10,702.20
|
| Rate for Payer: Aetna Medicare |
$3,273.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,934.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,934.63
|
| Rate for Payer: BCBS Complete |
$6,878.48
|
| Rate for Payer: BCBS MAPPO |
$3,147.70
|
| Rate for Payer: BCBS Trust/PPO |
$10,350.91
|
| Rate for Payer: BCN Commercial |
$9,789.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,147.70
|
| Rate for Payer: Cash Price |
$10,072.66
|
| Rate for Payer: Cash Price |
$10,072.66
|
| Rate for Payer: Cofinity Commercial |
$10,828.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,072.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,147.70
|
| Rate for Payer: Healthscope Commercial |
$11,331.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,443.12
|
| Rate for Payer: Mclaren Medicaid |
$6,550.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,305.09
|
| Rate for Payer: Meridian Medicaid |
$6,878.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,619.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,702.20
|
| Rate for Payer: Nomi Health Commercial |
$10,324.47
|
| Rate for Payer: PACE Senior Care Partners |
$2,990.32
|
| Rate for Payer: PACE SWMI |
$3,147.70
|
| Rate for Payer: PHP Commercial |
$10,702.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,147.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,550.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,184.03
|
| Rate for Payer: Priority Health HMO/PPO |
$10,954.01
|
| Rate for Payer: Priority Health Medicare |
$3,179.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,435.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3,147.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,079.92
|
| Rate for Payer: UHC Core |
$10,513.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,147.70
|
| Rate for Payer: UHC Exchange |
$3,147.70
|
| Rate for Payer: UHC Medicare Advantage |
$3,147.70
|
| Rate for Payer: UHCCP Medicaid |
$6,550.50
|
| Rate for Payer: VA VA |
$3,147.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,443.12
|
|
|
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 |
$1,152.16 |
| Max. Negotiated Rate |
$1,595.30 |
| Rate for Payer: Aetna Commercial |
$1,506.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,446.93
|
| Rate for Payer: BCN Commercial |
$1,369.83
|
| Rate for Payer: Cash Price |
$1,418.04
|
| Rate for Payer: Cofinity Commercial |
$1,524.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,418.04
|
| Rate for Payer: Healthscope Commercial |
$1,595.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,329.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,506.67
|
| Rate for Payer: Nomi Health Commercial |
$1,453.49
|
| Rate for Payer: PHP Commercial |
$1,506.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.16
|
| Rate for Payer: Priority Health HMO/PPO |
$1,542.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,187.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,559.84
|
| Rate for Payer: UHC Core |
$1,480.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,329.41
|
|
|
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 |
$420.98 |
| Max. Negotiated Rate |
$1,595.30 |
| Rate for Payer: Aetna Commercial |
$1,506.67
|
| Rate for Payer: Aetna Medicare |
$460.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$553.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$553.92
|
| Rate for Payer: BCBS Complete |
$496.49
|
| Rate for Payer: BCBS MAPPO |
$443.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.21
|
| Rate for Payer: BCN Commercial |
$1,378.16
|
| Rate for Payer: BCN Medicare Advantage |
$443.14
|
| 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: Encore Health Key Benefits Commercial |
$1,418.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.14
|
| Rate for Payer: Healthscope Commercial |
$1,595.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,329.41
|
| Rate for Payer: Mclaren Medicaid |
$472.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$465.29
|
| Rate for Payer: Meridian Medicaid |
$496.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$509.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,506.67
|
| Rate for Payer: Nomi Health Commercial |
$1,453.49
|
| Rate for Payer: PACE Senior Care Partners |
$420.98
|
| Rate for Payer: PACE SWMI |
$443.14
|
| Rate for Payer: PHP Commercial |
$1,506.67
|
| Rate for Payer: PHP Medicare Advantage |
$443.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.16
|
| Rate for Payer: Priority Health HMO/PPO |
$1,542.12
|
| Rate for Payer: Priority Health Medicare |
$447.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,187.61
|
| Rate for Payer: Railroad Medicare Medicare |
$443.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,559.84
|
| Rate for Payer: UHC Core |
$1,480.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$443.14
|
| Rate for Payer: UHC Exchange |
$443.14
|
| Rate for Payer: UHC Medicare Advantage |
$443.14
|
| Rate for Payer: UHCCP Medicaid |
$472.82
|
| Rate for Payer: VA VA |
$443.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,329.41
|
|
|
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 |
$644.83 |
| Max. Negotiated Rate |
$2,443.55 |
| Rate for Payer: Aetna Commercial |
$2,307.80
|
| Rate for Payer: Aetna Medicare |
$705.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.46
|
| Rate for Payer: BCBS Complete |
$1,523.78
|
| Rate for Payer: BCBS MAPPO |
$678.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,232.05
|
| Rate for Payer: BCN Commercial |
$2,110.96
|
| Rate for Payer: BCN Medicare Advantage |
$678.76
|
| 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: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.76
|
| Rate for Payer: Healthscope Commercial |
$2,443.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,036.30
|
| Rate for Payer: Mclaren Medicaid |
$1,451.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.70
|
| Rate for Payer: Meridian Medicaid |
$1,523.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: Nomi Health Commercial |
$2,226.35
|
| Rate for Payer: PACE Senior Care Partners |
$644.83
|
| Rate for Payer: PACE SWMI |
$678.76
|
| Rate for Payer: PHP Commercial |
$2,307.80
|
| Rate for Payer: PHP Medicare Advantage |
$678.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,451.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health HMO/PPO |
$2,362.10
|
| Rate for Payer: Priority Health Medicare |
$685.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,819.09
|
| Rate for Payer: Railroad Medicare Medicare |
$678.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,389.25
|
| Rate for Payer: UHC Core |
$2,267.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.76
|
| Rate for Payer: UHC Exchange |
$678.76
|
| Rate for Payer: UHC Medicare Advantage |
$678.76
|
| Rate for Payer: UHCCP Medicaid |
$1,451.13
|
| Rate for Payer: VA VA |
$678.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,036.30
|
|
|
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 |
$1,764.79 |
| Max. Negotiated Rate |
$2,443.55 |
| Rate for Payer: Aetna Commercial |
$2,307.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,216.30
|
| Rate for Payer: BCN Commercial |
$2,098.20
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$2,334.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Healthscope Commercial |
$2,443.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,036.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: Nomi Health Commercial |
$2,226.35
|
| Rate for Payer: PHP Commercial |
$2,307.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health HMO/PPO |
$2,362.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,819.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,389.25
|
| Rate for Payer: UHC Core |
$2,267.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,036.30
|
|
|
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 |
$1,797.05 |
| Max. Negotiated Rate |
$2,488.22 |
| Rate for Payer: Aetna Commercial |
$2,349.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,256.82
|
| Rate for Payer: BCN Commercial |
$2,136.55
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cofinity Commercial |
$2,377.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Healthscope Commercial |
$2,488.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,073.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: Nomi Health Commercial |
$2,267.05
|
| Rate for Payer: PHP Commercial |
$2,349.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2,405.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,852.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,432.93
|
| Rate for Payer: UHC Core |
$2,308.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,073.52
|
|
|
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 |
$656.61 |
| Max. Negotiated Rate |
$2,488.22 |
| Rate for Payer: Aetna Commercial |
$2,349.99
|
| Rate for Payer: Aetna Medicare |
$718.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$863.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$863.97
|
| Rate for Payer: BCBS Complete |
$1,523.78
|
| Rate for Payer: BCBS MAPPO |
$691.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,272.85
|
| Rate for Payer: BCN Commercial |
$2,149.55
|
| Rate for Payer: BCN Medicare Advantage |
$691.17
|
| 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: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$691.17
|
| Rate for Payer: Healthscope Commercial |
$2,488.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,073.52
|
| Rate for Payer: Mclaren Medicaid |
$1,451.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$725.73
|
| Rate for Payer: Meridian Medicaid |
$1,523.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$794.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: Nomi Health Commercial |
$2,267.05
|
| Rate for Payer: PACE Senior Care Partners |
$656.61
|
| Rate for Payer: PACE SWMI |
$691.17
|
| Rate for Payer: PHP Commercial |
$2,349.99
|
| Rate for Payer: PHP Medicare Advantage |
$691.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,451.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2,405.28
|
| Rate for Payer: Priority Health Medicare |
$698.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,852.34
|
| Rate for Payer: Railroad Medicare Medicare |
$691.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,432.93
|
| Rate for Payer: UHC Core |
$2,308.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$691.17
|
| Rate for Payer: UHC Exchange |
$691.17
|
| Rate for Payer: UHC Medicare Advantage |
$691.17
|
| Rate for Payer: UHCCP Medicaid |
$1,451.13
|
| Rate for Payer: VA VA |
$691.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,073.52
|
|
|
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 |
$1,764.79 |
| Max. Negotiated Rate |
$2,443.55 |
| Rate for Payer: Aetna Commercial |
$2,307.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,216.30
|
| Rate for Payer: BCN Commercial |
$2,098.20
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$2,334.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Healthscope Commercial |
$2,443.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,036.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: Nomi Health Commercial |
$2,226.35
|
| Rate for Payer: PHP Commercial |
$2,307.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health HMO/PPO |
$2,362.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,819.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,389.25
|
| Rate for Payer: UHC Core |
$2,267.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,036.30
|
|
|
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 |
$644.83 |
| Max. Negotiated Rate |
$2,443.55 |
| Rate for Payer: Aetna Commercial |
$2,307.80
|
| Rate for Payer: Aetna Medicare |
$705.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.46
|
| Rate for Payer: BCBS Complete |
$1,523.78
|
| Rate for Payer: BCBS MAPPO |
$678.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,232.05
|
| Rate for Payer: BCN Commercial |
$2,110.96
|
| Rate for Payer: BCN Medicare Advantage |
$678.76
|
| 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: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.76
|
| Rate for Payer: Healthscope Commercial |
$2,443.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,036.30
|
| Rate for Payer: Mclaren Medicaid |
$1,451.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.70
|
| Rate for Payer: Meridian Medicaid |
$1,523.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: Nomi Health Commercial |
$2,226.35
|
| Rate for Payer: PACE Senior Care Partners |
$644.83
|
| Rate for Payer: PACE SWMI |
$678.76
|
| Rate for Payer: PHP Commercial |
$2,307.80
|
| Rate for Payer: PHP Medicare Advantage |
$678.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,451.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health HMO/PPO |
$2,362.10
|
| Rate for Payer: Priority Health Medicare |
$685.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,819.09
|
| Rate for Payer: Railroad Medicare Medicare |
$678.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,389.25
|
| Rate for Payer: UHC Core |
$2,267.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.76
|
| Rate for Payer: UHC Exchange |
$678.76
|
| Rate for Payer: UHC Medicare Advantage |
$678.76
|
| Rate for Payer: UHCCP Medicaid |
$1,451.13
|
| Rate for Payer: VA VA |
$678.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,036.30
|
|
|
HC CYSTO TX FEMALE URETHRAL SYNDROME
|
Facility
|
IP
|
$868.53
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.54 |
| Max. Negotiated Rate |
$781.68 |
| Rate for Payer: Aetna Commercial |
$738.25
|
| Rate for Payer: BCBS Trust/PPO |
$708.98
|
| Rate for Payer: BCN Commercial |
$671.20
|
| Rate for Payer: Cash Price |
$694.82
|
| Rate for Payer: Cofinity Commercial |
$746.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.82
|
| Rate for Payer: Healthscope Commercial |
$781.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.25
|
| Rate for Payer: Nomi Health Commercial |
$712.19
|
| Rate for Payer: PHP Commercial |
$738.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.54
|
| Rate for Payer: Priority Health HMO/PPO |
$755.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$581.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.31
|
| Rate for Payer: UHC Core |
$725.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.40
|
|
|
HC CYSTO TX FEMALE URETHRAL SYNDROME
|
Facility
|
OP
|
$868.53
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.28 |
| Max. Negotiated Rate |
$781.68 |
| Rate for Payer: Aetna Commercial |
$738.25
|
| Rate for Payer: Aetna Medicare |
$225.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.42
|
| Rate for Payer: BCBS Complete |
$496.49
|
| Rate for Payer: BCBS MAPPO |
$217.13
|
| Rate for Payer: BCBS Trust/PPO |
$714.02
|
| Rate for Payer: BCN Commercial |
$675.28
|
| Rate for Payer: BCN Medicare Advantage |
$217.13
|
| Rate for Payer: Cash Price |
$694.82
|
| Rate for Payer: Cash Price |
$694.82
|
| Rate for Payer: Cofinity Commercial |
$746.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.13
|
| Rate for Payer: Healthscope Commercial |
$781.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.40
|
| Rate for Payer: Mclaren Medicaid |
$472.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.99
|
| Rate for Payer: Meridian Medicaid |
$496.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.25
|
| Rate for Payer: Nomi Health Commercial |
$712.19
|
| Rate for Payer: PACE Senior Care Partners |
$206.28
|
| Rate for Payer: PACE SWMI |
$217.13
|
| Rate for Payer: PHP Commercial |
$738.25
|
| Rate for Payer: PHP Medicare Advantage |
$217.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.54
|
| Rate for Payer: Priority Health HMO/PPO |
$755.62
|
| Rate for Payer: Priority Health Medicare |
$219.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$581.92
|
| Rate for Payer: Railroad Medicare Medicare |
$217.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.31
|
| Rate for Payer: UHC Core |
$725.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.13
|
| Rate for Payer: UHC Exchange |
$217.13
|
| Rate for Payer: UHC Medicare Advantage |
$217.13
|
| Rate for Payer: UHCCP Medicaid |
$472.82
|
| Rate for Payer: VA VA |
$217.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.40
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
OP
|
$997.25
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
45000095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.85 |
| Max. Negotiated Rate |
$897.52 |
| Rate for Payer: Aetna Commercial |
$847.66
|
| Rate for Payer: Aetna Medicare |
$259.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.64
|
| Rate for Payer: BCBS Complete |
$496.49
|
| Rate for Payer: BCBS MAPPO |
$249.31
|
| Rate for Payer: BCBS Trust/PPO |
$819.84
|
| Rate for Payer: BCN Commercial |
$775.36
|
| Rate for Payer: BCN Medicare Advantage |
$249.31
|
| Rate for Payer: Cash Price |
$797.80
|
| Rate for Payer: Cash Price |
$797.80
|
| Rate for Payer: Cofinity Commercial |
$857.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$797.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.31
|
| Rate for Payer: Healthscope Commercial |
$897.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$747.94
|
| Rate for Payer: Mclaren Medicaid |
$472.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.78
|
| Rate for Payer: Meridian Medicaid |
$496.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$847.66
|
| Rate for Payer: Nomi Health Commercial |
$817.74
|
| Rate for Payer: PACE Senior Care Partners |
$236.85
|
| Rate for Payer: PACE SWMI |
$249.31
|
| Rate for Payer: PHP Commercial |
$847.66
|
| Rate for Payer: PHP Medicare Advantage |
$249.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.21
|
| Rate for Payer: Priority Health HMO/PPO |
$867.61
|
| Rate for Payer: Priority Health Medicare |
$251.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$668.16
|
| Rate for Payer: Railroad Medicare Medicare |
$249.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$877.58
|
| Rate for Payer: UHC Core |
$832.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.31
|
| Rate for Payer: UHC Exchange |
$249.31
|
| Rate for Payer: UHC Medicare Advantage |
$249.31
|
| Rate for Payer: UHCCP Medicaid |
$472.82
|
| Rate for Payer: VA VA |
$249.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$747.94
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
IP
|
$997.25
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
45000095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$648.21 |
| Max. Negotiated Rate |
$897.52 |
| Rate for Payer: Aetna Commercial |
$847.66
|
| Rate for Payer: BCBS Trust/PPO |
$814.06
|
| Rate for Payer: BCN Commercial |
$770.67
|
| Rate for Payer: Cash Price |
$797.80
|
| Rate for Payer: Cofinity Commercial |
$857.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$797.80
|
| Rate for Payer: Healthscope Commercial |
$897.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$747.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$847.66
|
| Rate for Payer: Nomi Health Commercial |
$817.74
|
| Rate for Payer: PHP Commercial |
$847.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.21
|
| Rate for Payer: Priority Health HMO/PPO |
$867.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$668.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$877.58
|
| Rate for Payer: UHC Core |
$832.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$747.94
|
|
|
HC CYSTOURETHROSCOPY BIOPSY
|
Facility
|
OP
|
$3,040.77
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$722.18 |
| Max. Negotiated Rate |
$2,736.69 |
| Rate for Payer: Aetna Commercial |
$2,584.65
|
| Rate for Payer: Aetna Medicare |
$790.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$950.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$950.24
|
| Rate for Payer: BCBS Complete |
$1,523.78
|
| Rate for Payer: BCBS MAPPO |
$760.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,499.82
|
| Rate for Payer: BCN Commercial |
$2,364.20
|
| Rate for Payer: BCN Medicare Advantage |
$760.19
|
| Rate for Payer: Cash Price |
$2,432.62
|
| Rate for Payer: Cash Price |
$2,432.62
|
| Rate for Payer: Cofinity Commercial |
$2,615.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,432.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$760.19
|
| Rate for Payer: Healthscope Commercial |
$2,736.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,280.58
|
| Rate for Payer: Mclaren Medicaid |
$1,451.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$798.20
|
| Rate for Payer: Meridian Medicaid |
$1,523.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$874.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,584.65
|
| Rate for Payer: Nomi Health Commercial |
$2,493.43
|
| Rate for Payer: PACE Senior Care Partners |
$722.18
|
| Rate for Payer: PACE SWMI |
$760.19
|
| Rate for Payer: PHP Commercial |
$2,584.65
|
| Rate for Payer: PHP Medicare Advantage |
$760.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,451.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.50
|
| Rate for Payer: Priority Health HMO/PPO |
$2,645.47
|
| Rate for Payer: Priority Health Medicare |
$767.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,037.32
|
| Rate for Payer: Railroad Medicare Medicare |
$760.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,675.88
|
| Rate for Payer: UHC Core |
$2,539.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$760.19
|
| Rate for Payer: UHC Exchange |
$760.19
|
| Rate for Payer: UHC Medicare Advantage |
$760.19
|
| Rate for Payer: UHCCP Medicaid |
$1,451.13
|
| Rate for Payer: VA VA |
$760.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,280.58
|
|
|
HC CYSTOURETHROSCOPY BIOPSY
|
Facility
|
IP
|
$3,040.77
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,976.50 |
| Max. Negotiated Rate |
$2,736.69 |
| Rate for Payer: Aetna Commercial |
$2,584.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,482.18
|
| Rate for Payer: BCN Commercial |
$2,349.91
|
| Rate for Payer: Cash Price |
$2,432.62
|
| Rate for Payer: Cofinity Commercial |
$2,615.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,432.62
|
| Rate for Payer: Healthscope Commercial |
$2,736.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,280.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,584.65
|
| Rate for Payer: Nomi Health Commercial |
$2,493.43
|
| Rate for Payer: PHP Commercial |
$2,584.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.50
|
| Rate for Payer: Priority Health HMO/PPO |
$2,645.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,037.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,675.88
|
| Rate for Payer: UHC Core |
$2,539.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,280.58
|
|
|
HC CYSTOURETHROSCOPY W/INJ FOR CHEMODENERV BLADDER
|
Facility
|
IP
|
$2,764.69
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
76100238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,797.05 |
| Max. Negotiated Rate |
$2,488.22 |
| Rate for Payer: Aetna Commercial |
$2,349.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,256.82
|
| Rate for Payer: BCN Commercial |
$2,136.55
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cofinity Commercial |
$2,377.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Healthscope Commercial |
$2,488.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,073.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: Nomi Health Commercial |
$2,267.05
|
| Rate for Payer: PHP Commercial |
$2,349.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2,405.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,852.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,432.93
|
| Rate for Payer: UHC Core |
$2,308.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,073.52
|
|
