|
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 |
$2,657.46 |
| Max. Negotiated Rate |
$7,684.82 |
| Rate for Payer: Aetna Commercial |
$5,647.01
|
| Rate for Payer: Aetna Medicare |
$4,957.95
|
| 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: ASR ASR |
$6,086.23
|
| Rate for Payer: ASR Commercial |
$6,086.23
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCBS Trust/PPO |
$5,138.16
|
| Rate for Payer: BCN Commercial |
$4,864.59
|
| 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 |
$5,897.99
|
| 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 |
$6,274.46
|
| Rate for Payer: Healthscope Whirlpool |
$6,086.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,957.95
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$5,145.06
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Commercial |
$5,453.74
|
| Rate for Payer: PHP Medicaid |
$2,657.46
|
| 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 HMO/PPO/Tiered Network |
$5,497.68
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Priority Health Narrow Network |
$4,398.40
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,521.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Exchange |
$7,684.82
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP DNSP |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,657.46
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
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 |
$4,833.95 |
| Max. Negotiated Rate |
$13,978.77 |
| Rate for Payer: Aetna Commercial |
$11,331.74
|
| Rate for Payer: Aetna Medicare |
$9,018.56
|
| 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: ASR ASR |
$12,213.10
|
| Rate for Payer: ASR Commercial |
$12,213.10
|
| Rate for Payer: BCBS Complete |
$5,075.65
|
| Rate for Payer: BCBS MAPPO |
$9,018.56
|
| Rate for Payer: BCBS Trust/PPO |
$10,310.62
|
| Rate for Payer: BCN Commercial |
$9,761.66
|
| 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 |
$11,835.37
|
| 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 |
$12,590.82
|
| Rate for Payer: Healthscope Whirlpool |
$12,213.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,018.56
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$10,324.47
|
| Rate for Payer: PACE Medicare |
$8,567.63
|
| Rate for Payer: PACE SWMI |
$9,018.56
|
| Rate for Payer: PHP Commercial |
$9,920.42
|
| Rate for Payer: PHP Medicaid |
$4,833.95
|
| 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 HMO/PPO/Tiered Network |
$11,032.08
|
| Rate for Payer: Priority Health Medicare |
$9,018.56
|
| Rate for Payer: Priority Health Narrow Network |
$8,826.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9,018.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,079.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,018.56
|
| Rate for Payer: UHC Exchange |
$13,978.77
|
| Rate for Payer: UHC Medicare Advantage |
$9,018.56
|
| Rate for Payer: UHCCP DNSP |
$9,018.56
|
| Rate for Payer: UHCCP Medicaid |
$4,833.95
|
| Rate for Payer: VA VA |
$9,018.56
|
|
|
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 |
$1,772.55 |
| Rate for Payer: Aetna Commercial |
$1,595.30
|
| Rate for Payer: Aetna Medicare |
$650.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: ASR ASR |
$1,719.37
|
| Rate for Payer: ASR Commercial |
$1,719.37
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,451.54
|
| Rate for Payer: BCN Commercial |
$1,374.26
|
| 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 |
$1,666.20
|
| 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 |
$1,772.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,719.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$650.97
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$1,453.49
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$716.07
|
| Rate for Payer: PHP Medicaid |
$348.92
|
| 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 HMO/PPO/Tiered Network |
$1,553.11
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,242.56
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,559.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Exchange |
$1,009.00
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP DNSP |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$348.92
|
| 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 |
$1,152.16 |
| 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 |
$1,070.86 |
| Max. Negotiated Rate |
$3,096.70 |
| Rate for Payer: Aetna Commercial |
$2,443.55
|
| Rate for Payer: Aetna Medicare |
$1,997.87
|
| 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: ASR ASR |
$2,633.61
|
| Rate for Payer: ASR Commercial |
$2,633.61
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,223.36
|
| Rate for Payer: BCN Commercial |
$2,104.99
|
| 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 |
$2,552.16
|
| 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 |
$2,715.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,633.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,997.87
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$2,226.35
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,197.66
|
| Rate for Payer: PHP Medicaid |
$1,070.86
|
| 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 HMO/PPO/Tiered Network |
$2,378.94
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,903.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,389.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,096.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP DNSP |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
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 |
$3,096.70 |
| Rate for Payer: Aetna Commercial |
$2,488.22
|
| Rate for Payer: Aetna Medicare |
$1,997.87
|
| 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: ASR ASR |
$2,681.75
|
| Rate for Payer: ASR Commercial |
$2,681.75
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.00
|
| Rate for Payer: BCN Commercial |
$2,143.46
|
| 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 |
$2,598.81
|
| 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 |
$2,764.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,681.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,997.87
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$2,267.05
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,197.66
|
| Rate for Payer: PHP Medicaid |
$1,070.86
|
| 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 HMO/PPO/Tiered Network |
$2,422.42
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,938.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,432.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,096.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP DNSP |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| 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 |
$1,797.05 |
| 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
|
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 |
$3,096.70 |
| Rate for Payer: Aetna Commercial |
$2,443.55
|
| Rate for Payer: Aetna Medicare |
$1,997.87
|
| 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: ASR ASR |
$2,633.61
|
| Rate for Payer: ASR Commercial |
$2,633.61
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,223.36
|
| Rate for Payer: BCN Commercial |
$2,104.99
|
| 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 |
$2,552.16
|
| 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 |
$2,715.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,633.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,997.87
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$2,226.35
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,197.66
|
| Rate for Payer: PHP Medicaid |
$1,070.86
|
| 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 HMO/PPO/Tiered Network |
$2,378.94
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,903.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,389.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,096.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP DNSP |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| 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 |
$1,764.79 |
| 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 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 |
$868.53 |
| Rate for Payer: Aetna Commercial |
$781.68
|
| Rate for Payer: ASR ASR |
$842.47
|
| Rate for Payer: ASR Commercial |
$842.47
|
| Rate for Payer: BCBS Trust/PPO |
$707.77
|
| Rate for Payer: BCN Commercial |
$673.37
|
| 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: Healthscope Commercial |
$868.53
|
| Rate for Payer: Healthscope Whirlpool |
$842.47
|
| Rate for Payer: Mclaren Commercial |
$781.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.25
|
| Rate for Payer: Nomi Health Commercial |
$712.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$764.31
|
|
|
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 |
$348.92 |
| Max. Negotiated Rate |
$1,009.00 |
| Rate for Payer: Aetna Commercial |
$781.68
|
| Rate for Payer: Aetna Medicare |
$650.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: ASR ASR |
$842.47
|
| Rate for Payer: ASR Commercial |
$842.47
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCBS Trust/PPO |
$711.24
|
| Rate for Payer: BCN Commercial |
$673.37
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| 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 |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$868.53
|
| Rate for Payer: Healthscope Whirlpool |
$842.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$650.97
|
| Rate for Payer: Mclaren Commercial |
$781.68
|
| 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 |
$738.25
|
| Rate for Payer: Nomi Health Commercial |
$712.19
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$716.07
|
| Rate for Payer: PHP Medicaid |
$348.92
|
| 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 |
$564.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$761.01
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health Narrow Network |
$608.84
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$764.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Exchange |
$1,009.00
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP DNSP |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$348.92
|
| Rate for Payer: VA VA |
$650.97
|
|
|
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 |
$997.25 |
| Rate for Payer: Aetna Commercial |
$897.52
|
| Rate for Payer: ASR ASR |
$967.33
|
| Rate for Payer: ASR Commercial |
$967.33
|
| Rate for Payer: BCBS Trust/PPO |
$812.66
|
| Rate for Payer: BCN Commercial |
$773.17
|
| Rate for Payer: Cash Price |
$797.80
|
| Rate for Payer: Cofinity Commercial |
$937.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$797.80
|
| Rate for Payer: Healthscope Commercial |
$997.25
|
| Rate for Payer: Healthscope Whirlpool |
$967.33
|
| Rate for Payer: Mclaren Commercial |
$897.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$847.66
|
| Rate for Payer: Nomi Health Commercial |
$817.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$877.58
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
OP
|
$997.25
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
45000095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,009.00 |
| Rate for Payer: Aetna Commercial |
$897.52
|
| Rate for Payer: Aetna Medicare |
$650.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: ASR ASR |
$967.33
|
| Rate for Payer: ASR Commercial |
$967.33
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCBS Trust/PPO |
$816.65
|
| Rate for Payer: BCN Commercial |
$773.17
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$797.80
|
| Rate for Payer: Cash Price |
$797.80
|
| Rate for Payer: Cofinity Commercial |
$937.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$797.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$997.25
|
| Rate for Payer: Healthscope Whirlpool |
$967.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$650.97
|
| Rate for Payer: Mclaren Commercial |
$897.52
|
| 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 |
$847.66
|
| Rate for Payer: Nomi Health Commercial |
$817.75
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$716.07
|
| Rate for Payer: PHP Medicaid |
$348.92
|
| 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 |
$648.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$873.79
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health Narrow Network |
$699.07
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$877.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Exchange |
$1,009.00
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP DNSP |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$348.92
|
| Rate for Payer: VA VA |
$650.97
|
|
|
HC CYSTOURETHROSCOPY BIOPSY
|
Facility
|
OP
|
$3,040.77
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$3,096.70 |
| Rate for Payer: Aetna Commercial |
$2,736.69
|
| Rate for Payer: Aetna Medicare |
$1,997.87
|
| 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: ASR ASR |
$2,949.55
|
| Rate for Payer: ASR Commercial |
$2,949.55
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,490.09
|
| Rate for Payer: BCN Commercial |
$2,357.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$2,432.62
|
| Rate for Payer: Cash Price |
$2,432.62
|
| Rate for Payer: Cofinity Commercial |
$2,858.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,432.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$3,040.77
|
| Rate for Payer: Healthscope Whirlpool |
$2,949.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,997.87
|
| Rate for Payer: Mclaren Commercial |
$2,736.69
|
| 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 |
$2,584.65
|
| Rate for Payer: Nomi Health Commercial |
$2,493.43
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,197.66
|
| Rate for Payer: PHP Medicaid |
$1,070.86
|
| 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 |
$1,976.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,664.32
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health Narrow Network |
$2,131.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,675.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,096.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP DNSP |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
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 |
$3,040.77 |
| Rate for Payer: Aetna Commercial |
$2,736.69
|
| Rate for Payer: ASR ASR |
$2,949.55
|
| Rate for Payer: ASR Commercial |
$2,949.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,477.92
|
| Rate for Payer: BCN Commercial |
$2,357.51
|
| Rate for Payer: Cash Price |
$2,432.62
|
| Rate for Payer: Cofinity Commercial |
$2,858.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,432.62
|
| Rate for Payer: Healthscope Commercial |
$3,040.77
|
| Rate for Payer: Healthscope Whirlpool |
$2,949.55
|
| Rate for Payer: Mclaren Commercial |
$2,736.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,584.65
|
| Rate for Payer: Nomi Health Commercial |
$2,493.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,675.88
|
|
|
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 |
$2,764.69 |
| 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 CYSTOURETHROSCOPY W/INJ FOR CHEMODENERV BLADDER
|
Facility
|
OP
|
$2,764.69
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
76100238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$3,096.70 |
| Rate for Payer: Aetna Commercial |
$2,488.22
|
| Rate for Payer: Aetna Medicare |
$1,997.87
|
| 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: ASR ASR |
$2,681.75
|
| Rate for Payer: ASR Commercial |
$2,681.75
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.00
|
| Rate for Payer: BCN Commercial |
$2,143.46
|
| 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 |
$2,598.81
|
| 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 |
$2,764.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,681.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,997.87
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$2,267.05
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,197.66
|
| Rate for Payer: PHP Medicaid |
$1,070.86
|
| 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 HMO/PPO/Tiered Network |
$2,422.42
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,938.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,432.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,096.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP DNSP |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
HC CYSTO W/IRRIG & EVAC CLOTS
|
Facility
|
OP
|
$4,710.21
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
76100226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$5,213.75 |
| Rate for Payer: Aetna Commercial |
$4,239.19
|
| Rate for Payer: Aetna Medicare |
$3,363.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: ASR ASR |
$4,568.90
|
| Rate for Payer: ASR Commercial |
$4,568.90
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,857.19
|
| Rate for Payer: BCN Commercial |
$3,651.83
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Cash Price |
$3,768.17
|
| Rate for Payer: Cash Price |
$3,768.17
|
| Rate for Payer: Cofinity Commercial |
$4,427.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,768.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Healthscope Commercial |
$4,710.21
|
| Rate for Payer: Healthscope Whirlpool |
$4,568.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,363.71
|
| Rate for Payer: Mclaren Commercial |
$4,239.19
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,003.68
|
| Rate for Payer: Nomi Health Commercial |
$3,862.37
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Commercial |
$3,700.08
|
| Rate for Payer: PHP Medicaid |
$1,802.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,061.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,127.09
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Priority Health Narrow Network |
$3,301.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,144.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$5,213.75
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP DNSP |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
HC CYSTO W/IRRIG & EVAC CLOTS
|
Facility
|
IP
|
$4,710.21
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
76100226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,061.64 |
| Max. Negotiated Rate |
$4,710.21 |
| Rate for Payer: Aetna Commercial |
$4,239.19
|
| Rate for Payer: ASR ASR |
$4,568.90
|
| Rate for Payer: ASR Commercial |
$4,568.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,838.35
|
| Rate for Payer: BCN Commercial |
$3,651.83
|
| Rate for Payer: Cash Price |
$3,768.17
|
| Rate for Payer: Cofinity Commercial |
$4,427.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,768.17
|
| Rate for Payer: Healthscope Commercial |
$4,710.21
|
| Rate for Payer: Healthscope Whirlpool |
$4,568.90
|
| Rate for Payer: Mclaren Commercial |
$4,239.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,003.68
|
| Rate for Payer: Nomi Health Commercial |
$3,862.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,061.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,144.98
|
|
|
HC CYTO DNA PROBE
|
Facility
|
IP
|
$133.17
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$86.56 |
| Max. Negotiated Rate |
$133.17 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: ASR ASR |
$129.17
|
| Rate for Payer: ASR Commercial |
$129.17
|
| Rate for Payer: BCBS Trust/PPO |
$108.52
|
| Rate for Payer: BCN Commercial |
$103.25
|
| Rate for Payer: Cash Price |
$106.54
|
| Rate for Payer: Cofinity Commercial |
$125.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.54
|
| Rate for Payer: Healthscope Commercial |
$133.17
|
| Rate for Payer: Healthscope Whirlpool |
$129.17
|
| Rate for Payer: Mclaren Commercial |
$119.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.19
|
| Rate for Payer: Nomi Health Commercial |
$109.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.19
|
|
