|
HC CYCLOSPORINE
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
30100025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$33.92
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
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 |
$127.37 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Aetna Medicare |
$18.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.56
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Complete |
$10.16
|
| Rate for Payer: BCBS MAPPO |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$34.08
|
| Rate for Payer: BCN Commercial |
$32.27
|
| 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 |
$39.12
|
| 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 |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.05
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Medicare |
$17.15
|
| Rate for Payer: PACE SWMI |
$18.05
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: PHP Medicaid |
$9.67
|
| 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 HMO/PPO/Tiered Network |
$127.37
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: Priority Health Narrow Network |
$101.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.05
|
| Rate for Payer: UHC Exchange |
$27.98
|
| Rate for Payer: UHC Medicare Advantage |
$18.05
|
| Rate for Payer: UHCCP DNSP |
$18.05
|
| Rate for Payer: UHCCP Medicaid |
$9.67
|
| 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 |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Medicare |
$18.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: ASR Commercial |
$64.31
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$54.29
|
| Rate for Payer: BCN Commercial |
$51.40
|
| 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 |
$62.32
|
| 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 |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren 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 |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Medicaid |
$9.93
|
| 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 |
$43.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.09
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$46.48
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Exchange |
$28.71
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: UHCCP DNSP |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| 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 |
$43.10 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: ASR Commercial |
$64.31
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
|
|
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 |
$67.79 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Aetna Medicare |
$18.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: ASR ASR |
$65.76
|
| Rate for Payer: ASR Commercial |
$65.76
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$55.51
|
| Rate for Payer: BCN Commercial |
$52.56
|
| 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 |
$63.72
|
| 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 |
$67.79
|
| Rate for Payer: Healthscope Whirlpool |
$65.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$55.59
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Medicaid |
$9.93
|
| 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 HMO/PPO/Tiered Network |
$59.40
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$47.52
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Exchange |
$28.71
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: UHCCP DNSP |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| Rate for Payer: VA VA |
$18.52
|
|
|
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 |
$44.06 |
| Max. Negotiated Rate |
$67.79 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: ASR ASR |
$65.76
|
| Rate for Payer: ASR Commercial |
$65.76
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCN Commercial |
$52.56
|
| Rate for Payer: Cash Price |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$63.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.23
|
| Rate for Payer: Healthscope Commercial |
$67.79
|
| Rate for Payer: Healthscope Whirlpool |
$65.76
|
| Rate for Payer: Mclaren Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.62
|
| Rate for Payer: Nomi Health Commercial |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.66
|
|
|
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 |
$1,749.80 |
| Rate for Payer: Aetna Commercial |
$1,574.82
|
| Rate for Payer: Aetna Medicare |
$556.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$695.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$695.75
|
| Rate for Payer: ASR ASR |
$1,697.31
|
| Rate for Payer: ASR Commercial |
$1,697.31
|
| Rate for Payer: BCBS Complete |
$313.25
|
| Rate for Payer: BCBS MAPPO |
$556.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.91
|
| Rate for Payer: BCN Commercial |
$1,356.62
|
| 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 |
$1,644.81
|
| 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 |
$1,749.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,697.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$556.60
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$1,434.84
|
| Rate for Payer: PACE Medicare |
$528.77
|
| Rate for Payer: PACE SWMI |
$556.60
|
| Rate for Payer: PHP Commercial |
$612.26
|
| Rate for Payer: PHP Medicaid |
$298.34
|
| 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 HMO/PPO/Tiered Network |
$855.25
|
| Rate for Payer: Priority Health Medicare |
$556.60
|
| Rate for Payer: Priority Health Narrow Network |
$684.20
|
| Rate for Payer: Railroad Medicare Medicare |
$556.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,539.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$556.60
|
| Rate for Payer: UHC Exchange |
$862.73
|
| Rate for Payer: UHC Medicare Advantage |
$556.60
|
| Rate for Payer: UHCCP DNSP |
$556.60
|
| Rate for Payer: UHCCP Medicaid |
$298.34
|
| Rate for Payer: VA VA |
$556.60
|
|
|
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 |
$1,749.80 |
| Rate for Payer: Aetna Commercial |
$1,574.82
|
| Rate for Payer: ASR ASR |
$1,697.31
|
| Rate for Payer: ASR Commercial |
$1,697.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,425.91
|
| Rate for Payer: BCN Commercial |
$1,356.62
|
| Rate for Payer: Cash Price |
$1,399.84
|
| Rate for Payer: Cofinity Commercial |
$1,644.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,399.84
|
| Rate for Payer: Healthscope Commercial |
$1,749.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,697.31
|
| Rate for Payer: Mclaren Commercial |
$1,574.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,487.33
|
| Rate for Payer: Nomi Health Commercial |
$1,434.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,539.82
|
|
|
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 |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
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 |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: Aetna Medicare |
$19.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.51
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Complete |
$11.04
|
| Rate for Payer: BCBS MAPPO |
$19.61
|
| Rate for Payer: BCBS Trust/PPO |
$75.18
|
| Rate for Payer: BCN Commercial |
$71.17
|
| 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 |
$86.29
|
| 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 |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.61
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PACE Medicare |
$18.63
|
| Rate for Payer: PACE SWMI |
$19.61
|
| Rate for Payer: PHP Commercial |
$21.57
|
| Rate for Payer: PHP Medicaid |
$10.51
|
| 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 HMO/PPO/Tiered Network |
$80.44
|
| Rate for Payer: Priority Health Medicare |
$19.61
|
| Rate for Payer: Priority Health Narrow Network |
$64.35
|
| Rate for Payer: Railroad Medicare Medicare |
$19.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.61
|
| Rate for Payer: UHC Exchange |
$30.40
|
| Rate for Payer: UHC Medicare Advantage |
$19.61
|
| Rate for Payer: UHCCP DNSP |
$19.61
|
| Rate for Payer: UHCCP Medicaid |
$10.51
|
| Rate for Payer: VA VA |
$19.61
|
|
|
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 |
$0.28 |
| Rate for Payer: Aetna Commercial |
$0.25
|
| Rate for Payer: Aetna Medicare |
$0.14
|
| Rate for Payer: ASR ASR |
$0.27
|
| Rate for Payer: ASR Commercial |
$0.27
|
| Rate for Payer: BCBS Complete |
$0.11
|
| 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 |
$0.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.22
|
| Rate for Payer: Healthscope Commercial |
$0.28
|
| Rate for Payer: Healthscope Whirlpool |
$0.27
|
| Rate for Payer: Mclaren Commercial |
$0.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.24
|
| Rate for Payer: Nomi Health Commercial |
$0.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.25
|
| Rate for Payer: Priority Health Narrow Network |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.25
|
|
|
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 |
$0.28 |
| Rate for Payer: Aetna Commercial |
$0.25
|
| Rate for Payer: ASR ASR |
$0.27
|
| Rate for Payer: ASR Commercial |
$0.27
|
| 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 |
$0.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.22
|
| Rate for Payer: Healthscope Commercial |
$0.28
|
| Rate for Payer: Healthscope Whirlpool |
$0.27
|
| Rate for Payer: Mclaren Commercial |
$0.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.24
|
| Rate for Payer: Nomi Health Commercial |
$0.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.25
|
|
|
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 |
$2,669.72 |
| Max. Negotiated Rate |
$7,720.29 |
| Rate for Payer: Aetna Commercial |
$5,647.01
|
| Rate for Payer: Aetna Medicare |
$4,980.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: ASR ASR |
$6,086.23
|
| Rate for Payer: ASR Commercial |
$6,086.23
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$5,138.16
|
| Rate for Payer: BCN Commercial |
$4,864.59
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Cash Price |
$5,019.57
|
| Rate for Payer: Cash Price |
$5,019.57
|
| Rate for Payer: Cofinity Commercial |
$5,897.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,019.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Healthscope Commercial |
$6,274.46
|
| Rate for Payer: Healthscope Whirlpool |
$6,086.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,980.83
|
| Rate for Payer: Mclaren Commercial |
$5,647.01
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,333.29
|
| Rate for Payer: Nomi Health Commercial |
$5,145.06
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Commercial |
$5,478.91
|
| Rate for Payer: PHP Medicaid |
$2,669.72
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,078.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,497.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$4,398.40
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,521.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$7,720.29
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP DNSP |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
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 |
$6,274.46 |
| Rate for Payer: Aetna Commercial |
$5,647.01
|
| Rate for Payer: ASR ASR |
$6,086.23
|
| Rate for Payer: ASR Commercial |
$6,086.23
|
| Rate for Payer: BCBS Trust/PPO |
$5,113.06
|
| Rate for Payer: BCN Commercial |
$4,864.59
|
| Rate for Payer: Cash Price |
$5,019.57
|
| Rate for Payer: Cofinity Commercial |
$5,897.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,019.57
|
| Rate for Payer: Healthscope Commercial |
$6,274.46
|
| Rate for Payer: Healthscope Whirlpool |
$6,086.23
|
| Rate for Payer: Mclaren Commercial |
$5,647.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,333.29
|
| Rate for Payer: Nomi Health Commercial |
$5,145.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,078.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,521.52
|
|
|
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 |
$12,590.82 |
| Rate for Payer: Aetna Commercial |
$11,331.74
|
| Rate for Payer: ASR ASR |
$12,213.10
|
| Rate for Payer: ASR Commercial |
$12,213.10
|
| Rate for Payer: BCBS Trust/PPO |
$10,260.26
|
| Rate for Payer: BCN Commercial |
$9,761.66
|
| Rate for Payer: Cash Price |
$10,072.66
|
| Rate for Payer: Cofinity Commercial |
$11,835.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,072.66
|
| Rate for Payer: Healthscope Commercial |
$12,590.82
|
| Rate for Payer: Healthscope Whirlpool |
$12,213.10
|
| Rate for Payer: Mclaren Commercial |
$11,331.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,702.20
|
| Rate for Payer: Nomi Health Commercial |
$10,324.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,184.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,079.92
|
|
|
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 |
$4,856.25 |
| Max. Negotiated Rate |
$14,043.26 |
| Rate for Payer: Aetna Commercial |
$11,331.74
|
| Rate for Payer: Aetna Medicare |
$9,060.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,325.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,325.21
|
| Rate for Payer: ASR ASR |
$12,213.10
|
| Rate for Payer: ASR Commercial |
$12,213.10
|
| Rate for Payer: BCBS Complete |
$5,099.06
|
| Rate for Payer: BCBS MAPPO |
$9,060.17
|
| Rate for Payer: BCBS Trust/PPO |
$10,310.62
|
| Rate for Payer: BCN Commercial |
$9,761.66
|
| Rate for Payer: BCN Medicare Advantage |
$9,060.17
|
| Rate for Payer: Cash Price |
$10,072.66
|
| Rate for Payer: Cash Price |
$10,072.66
|
| Rate for Payer: Cofinity Commercial |
$11,835.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,072.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,060.17
|
| Rate for Payer: Healthscope Commercial |
$12,590.82
|
| Rate for Payer: Healthscope Whirlpool |
$12,213.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,060.17
|
| Rate for Payer: Mclaren Commercial |
$11,331.74
|
| Rate for Payer: Mclaren Medicaid |
$4,856.25
|
| Rate for Payer: Mclaren Medicare |
$9,060.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,513.18
|
| Rate for Payer: Meridian Medicaid |
$5,099.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,419.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,702.20
|
| Rate for Payer: Nomi Health Commercial |
$10,324.47
|
| Rate for Payer: PACE Medicare |
$8,607.16
|
| Rate for Payer: PACE SWMI |
$9,060.17
|
| Rate for Payer: PHP Commercial |
$9,966.19
|
| Rate for Payer: PHP Medicaid |
$4,856.25
|
| Rate for Payer: PHP Medicare Advantage |
$9,060.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,856.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,184.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,032.08
|
| Rate for Payer: Priority Health Medicare |
$9,060.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,826.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9,060.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,079.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,060.17
|
| Rate for Payer: UHC Exchange |
$14,043.26
|
| Rate for Payer: UHC Medicare Advantage |
$9,060.17
|
| Rate for Payer: UHCCP DNSP |
$9,060.17
|
| Rate for Payer: UHCCP Medicaid |
$4,856.25
|
| Rate for Payer: VA VA |
$9,060.17
|
|
|
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 |
$350.53 |
| Max. Negotiated Rate |
$1,772.55 |
| Rate for Payer: Aetna Commercial |
$1,595.30
|
| Rate for Payer: Aetna Medicare |
$653.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: ASR ASR |
$1,719.37
|
| Rate for Payer: ASR Commercial |
$1,719.37
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,451.54
|
| Rate for Payer: BCN Commercial |
$1,374.26
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Cash Price |
$1,418.04
|
| Rate for Payer: Cash Price |
$1,418.04
|
| Rate for Payer: Cofinity Commercial |
$1,666.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,418.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.97
|
| Rate for Payer: Healthscope Commercial |
$1,772.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,719.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$653.97
|
| Rate for Payer: Mclaren Commercial |
$1,595.30
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,506.67
|
| Rate for Payer: Nomi Health Commercial |
$1,453.49
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Commercial |
$719.37
|
| Rate for Payer: PHP Medicaid |
$350.53
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,553.11
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,242.56
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,559.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Exchange |
$1,013.65
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP DNSP |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$350.53
|
| Rate for Payer: VA VA |
$653.97
|
|
|
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 |
$1,152.16 |
| Max. Negotiated Rate |
$1,772.55 |
| Rate for Payer: Aetna Commercial |
$1,595.30
|
| Rate for Payer: ASR ASR |
$1,719.37
|
| Rate for Payer: ASR Commercial |
$1,719.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,444.45
|
| Rate for Payer: BCN Commercial |
$1,374.26
|
| Rate for Payer: Cash Price |
$1,418.04
|
| Rate for Payer: Cofinity Commercial |
$1,666.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,418.04
|
| Rate for Payer: Healthscope Commercial |
$1,772.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,719.37
|
| Rate for Payer: Mclaren Commercial |
$1,595.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,506.67
|
| Rate for Payer: Nomi Health Commercial |
$1,453.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,559.84
|
|
|
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 |
$2,715.06 |
| Rate for Payer: Aetna Commercial |
$2,443.55
|
| Rate for Payer: ASR ASR |
$2,633.61
|
| Rate for Payer: ASR Commercial |
$2,633.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,212.50
|
| Rate for Payer: BCN Commercial |
$2,104.99
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$2,552.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Healthscope Commercial |
$2,715.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,633.61
|
| Rate for Payer: Mclaren Commercial |
$2,443.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: Nomi Health Commercial |
$2,226.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,389.25
|
|
|
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 |
$1,075.80 |
| Max. Negotiated Rate |
$3,110.99 |
| Rate for Payer: Aetna Commercial |
$2,443.55
|
| Rate for Payer: Aetna Medicare |
$2,007.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: ASR ASR |
$2,633.61
|
| Rate for Payer: ASR Commercial |
$2,633.61
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,223.36
|
| Rate for Payer: BCN Commercial |
$2,104.99
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$2,552.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$2,715.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,633.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,007.09
|
| Rate for Payer: Mclaren Commercial |
$2,443.55
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: Nomi Health Commercial |
$2,226.35
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$2,207.80
|
| Rate for Payer: PHP Medicaid |
$1,075.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,378.94
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,903.26
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,389.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$3,110.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP DNSP |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
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 |
$1,075.80 |
| Max. Negotiated Rate |
$3,110.99 |
| Rate for Payer: Aetna Commercial |
$2,488.22
|
| Rate for Payer: Aetna Medicare |
$2,007.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: ASR ASR |
$2,681.75
|
| Rate for Payer: ASR Commercial |
$2,681.75
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.00
|
| Rate for Payer: BCN Commercial |
$2,143.46
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cofinity Commercial |
$2,598.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$2,764.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,681.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,007.09
|
| Rate for Payer: Mclaren Commercial |
$2,488.22
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: Nomi Health Commercial |
$2,267.05
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$2,207.80
|
| Rate for Payer: PHP Medicaid |
$1,075.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,422.42
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,938.05
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,432.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$3,110.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP DNSP |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
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 |
$2,764.69 |
| Rate for Payer: Aetna Commercial |
$2,488.22
|
| Rate for Payer: ASR ASR |
$2,681.75
|
| Rate for Payer: ASR Commercial |
$2,681.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,252.95
|
| Rate for Payer: BCN Commercial |
$2,143.46
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cofinity Commercial |
$2,598.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Healthscope Commercial |
$2,764.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,681.75
|
| Rate for Payer: Mclaren Commercial |
$2,488.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: Nomi Health Commercial |
$2,267.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,432.93
|
|
|
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 |
$2,715.06 |
| Rate for Payer: Aetna Commercial |
$2,443.55
|
| Rate for Payer: ASR ASR |
$2,633.61
|
| Rate for Payer: ASR Commercial |
$2,633.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,212.50
|
| Rate for Payer: BCN Commercial |
$2,104.99
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$2,552.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Healthscope Commercial |
$2,715.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,633.61
|
| Rate for Payer: Mclaren Commercial |
$2,443.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: Nomi Health Commercial |
$2,226.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,389.25
|
|
|
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 |
$1,075.80 |
| Max. Negotiated Rate |
$3,110.99 |
| Rate for Payer: Aetna Commercial |
$2,443.55
|
| Rate for Payer: Aetna Medicare |
$2,007.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: ASR ASR |
$2,633.61
|
| Rate for Payer: ASR Commercial |
$2,633.61
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,223.36
|
| Rate for Payer: BCN Commercial |
$2,104.99
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$2,552.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$2,715.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,633.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,007.09
|
| Rate for Payer: Mclaren Commercial |
$2,443.55
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: Nomi Health Commercial |
$2,226.35
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$2,207.80
|
| Rate for Payer: PHP Medicaid |
$1,075.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,378.94
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,903.26
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,389.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$3,110.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP DNSP |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
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 |
$350.53 |
| Max. Negotiated Rate |
$1,013.65 |
| Rate for Payer: Aetna Commercial |
$781.68
|
| Rate for Payer: Aetna Medicare |
$653.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: ASR ASR |
$842.47
|
| Rate for Payer: ASR Commercial |
$842.47
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$711.24
|
| Rate for Payer: BCN Commercial |
$673.37
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Cash Price |
$694.82
|
| Rate for Payer: Cash Price |
$694.82
|
| Rate for Payer: Cofinity Commercial |
$816.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.97
|
| Rate for Payer: Healthscope Commercial |
$868.53
|
| Rate for Payer: Healthscope Whirlpool |
$842.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$653.97
|
| Rate for Payer: Mclaren Commercial |
$781.68
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.25
|
| Rate for Payer: Nomi Health Commercial |
$712.19
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Commercial |
$719.37
|
| Rate for Payer: PHP Medicaid |
$350.53
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$761.01
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$608.84
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$764.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Exchange |
$1,013.65
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP DNSP |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$350.53
|
| Rate for Payer: VA VA |
$653.97
|
|
