|
CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE-J TYPE)
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 52332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,374.56
|
| Rate for Payer: BCN Commercial |
$3,374.56
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT URETHRAL STENT
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 52282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,592.29
|
| Rate for Payer: BCN Commercial |
$2,592.29
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
CYSTOURETHROSCOPY, WITH INSERTION OF TRANSPROSTATIC IMPLANT; 4 OR MORE IMPLANTS
|
Facility
|
OP
|
$30,503.59
|
|
|
Service Code
|
CPT C9740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,933.16 |
| Max. Negotiated Rate |
$30,503.59 |
| Rate for Payer: Aetna Medicare |
$9,809.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,790.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,790.52
|
| Rate for Payer: BCBS Complete |
$5,180.29
|
| Rate for Payer: BCBS MAPPO |
$9,432.42
|
| Rate for Payer: BCBS Trust/PPO |
$11,229.85
|
| Rate for Payer: BCN Commercial |
$11,229.85
|
| Rate for Payer: BCN Medicare Advantage |
$9,432.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,432.42
|
| Rate for Payer: Mclaren Medicaid |
$9,432.42
|
| Rate for Payer: Mclaren Medicare |
$9,432.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,904.04
|
| Rate for Payer: Meridian Medicaid |
$9,904.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,847.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,375.66
|
| Rate for Payer: Nomi Health Commercial |
$28,297.26
|
| Rate for Payer: PACE Medicare |
$8,960.80
|
| Rate for Payer: PACE SWMI |
$9,432.42
|
| Rate for Payer: PHP Medicare Advantage |
$9,432.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,933.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30,503.59
|
| Rate for Payer: Priority Health Medicare |
$9,432.42
|
| Rate for Payer: Priority Health Tiered Network |
$24,402.87
|
| Rate for Payer: Railroad Medicare Medicare |
$9,432.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,432.42
|
| Rate for Payer: UHC Medicaid |
$4,933.16
|
| Rate for Payer: UHCCP Medicaid |
$4,933.16
|
| Rate for Payer: VA VA |
$9,432.42
|
|
|
CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; MALE
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 52275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,138.60
|
| Rate for Payer: BCN Commercial |
$2,138.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
CYSTOURETHROSCOPY WITH IRRIGATION AND EVACUATION OF MULTIPLE OBSTRUCTING CLOTS
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 52001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,716.16 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.16
|
| Rate for Payer: BCN Commercial |
$1,716.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
CYSTOURETHROSCOPY, WITH MECHANICAL URETHRAL DILATION AND URETHRAL THERAPEUTIC DRUG DELIVERY BY DRUG-COATED BALLOON CATHETER FOR URETHRAL STRICTURE OR STENOSIS, MALE, INCLUDING FLUOROSCOPY, WHEN PERFORMED
|
Facility
|
OP
|
$17,277.20
|
|
|
Service Code
|
CPT 52284
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,794.14 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$6,289.88
|
| Rate for Payer: BCN Commercial |
$6,289.88
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA OR BLADDER (SEPARATE PROCEDURE); COMPLICATED
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 52315
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,545.98
|
| Rate for Payer: BCN Commercial |
$2,545.98
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA OR BLADDER (SEPARATE PROCEDURE); SIMPLE
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 52310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.99
|
| Rate for Payer: BCN Commercial |
$1,661.99
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ORTHOTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 52300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,221.94
|
| Rate for Payer: BCN Commercial |
$2,221.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 52341
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,054.49
|
| Rate for Payer: BCN Commercial |
$2,054.49
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE;
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 52005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$3,275.14
|
| Rate for Payer: BCN Commercial |
$3,275.14
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 52351
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,488.46
|
| Rate for Payer: BCN Commercial |
$3,488.46
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH BIOPSY AND/OR FULGURATION OF URETERAL OR RENAL PELVIC LESION
|
Facility
|
OP
|
$17,277.20
|
|
|
Service Code
|
CPT 52354
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,794.14 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,486.55
|
| Rate for Payer: BCN Commercial |
$4,486.55
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY INCLUDING INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE-J TYPE)
|
Facility
|
OP
|
$17,277.20
|
|
|
Service Code
|
CPT 52356
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,794.14 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,640.06
|
| Rate for Payer: BCN Commercial |
$4,640.06
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY (URETERAL CATHETERIZATION IS INCLUDED)
|
Facility
|
OP
|
$17,277.20
|
|
|
Service Code
|
CPT 52353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,794.14 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,653.91
|
| Rate for Payer: BCN Commercial |
$4,653.91
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR MANIPULATION OF CALCULUS (URETERAL CATHETERIZATION IS INCLUDED)
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 52352
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,303.50
|
| Rate for Payer: BCN Commercial |
$3,303.50
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 52344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,221.94
|
| Rate for Payer: BCN Commercial |
$2,221.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$132.44
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
118877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$119.20 |
| Rate for Payer: Aetna American Axle |
$86.09
|
| Rate for Payer: Aetna American Axle |
$37.08
|
| Rate for Payer: Aetna Commercial |
$112.57
|
| Rate for Payer: Aetna Commercial |
$48.48
|
| Rate for Payer: Aetna Medicare |
$66.22
|
| Rate for Payer: Aetna Medicare |
$28.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.08
|
| Rate for Payer: BCBS Complete |
$22.82
|
| Rate for Payer: BCBS Complete |
$52.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cofinity Advantage |
$92.71
|
| Rate for Payer: Cofinity Advantage |
$39.93
|
| Rate for Payer: Cofinity Commercial |
$113.90
|
| Rate for Payer: Cofinity Commercial |
$49.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.63
|
| Rate for Payer: Healthscope Commercial |
$119.20
|
| Rate for Payer: Healthscope Commercial |
$51.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.33
|
| Rate for Payer: PHP Commercial |
$112.57
|
| Rate for Payer: PHP Commercial |
$48.48
|
| Rate for Payer: Priority Health SBD |
$83.44
|
| Rate for Payer: Priority Health SBD |
$35.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.39
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$49.00
|
| Rate for Payer: UMR Bronson Commercial |
$21.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.78
|
|
|
CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$132.44
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
118877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.27 |
| Max. Negotiated Rate |
$119.20 |
| Rate for Payer: Aetna American Axle |
$86.09
|
| Rate for Payer: Aetna American Axle |
$37.08
|
| Rate for Payer: Aetna Commercial |
$112.57
|
| Rate for Payer: Aetna Commercial |
$48.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.08
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cofinity Advantage |
$39.93
|
| Rate for Payer: Cofinity Advantage |
$92.71
|
| Rate for Payer: Cofinity Commercial |
$49.05
|
| Rate for Payer: Cofinity Commercial |
$113.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.63
|
| Rate for Payer: Healthscope Commercial |
$119.20
|
| Rate for Payer: Healthscope Commercial |
$51.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.78
|
| Rate for Payer: PHP Commercial |
$112.57
|
| Rate for Payer: PHP Commercial |
$48.48
|
| Rate for Payer: Priority Health SBD |
$35.94
|
| Rate for Payer: Priority Health SBD |
$83.44
|
| Rate for Payer: UMR Bronson Commercial |
$58.27
|
| Rate for Payer: UMR Bronson Commercial |
$25.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.78
|
|
|
CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$152.93
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
20156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$137.64 |
| Rate for Payer: Aetna American Axle |
$99.40
|
| Rate for Payer: Aetna American Axle |
$159.37
|
| Rate for Payer: Aetna American Axle |
$154.04
|
| Rate for Payer: Aetna American Axle |
$137.96
|
| Rate for Payer: Aetna American Axle |
$198.28
|
| Rate for Payer: Aetna Commercial |
$129.99
|
| Rate for Payer: Aetna Commercial |
$180.41
|
| Rate for Payer: Aetna Commercial |
$259.28
|
| Rate for Payer: Aetna Commercial |
$208.40
|
| Rate for Payer: Aetna Commercial |
$201.43
|
| Rate for Payer: Aetna Medicare |
$152.52
|
| Rate for Payer: Aetna Medicare |
$106.12
|
| Rate for Payer: Aetna Medicare |
$76.47
|
| Rate for Payer: Aetna Medicare |
$118.49
|
| Rate for Payer: Aetna Medicare |
$122.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.28
|
| Rate for Payer: BCBS Complete |
$98.07
|
| Rate for Payer: BCBS Complete |
$61.17
|
| Rate for Payer: BCBS Complete |
$84.90
|
| Rate for Payer: BCBS Complete |
$94.79
|
| Rate for Payer: BCBS Complete |
$122.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: Cash Price |
$196.14
|
| Rate for Payer: Cash Price |
$244.03
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$122.34
|
| Rate for Payer: Cash Price |
$189.58
|
| Rate for Payer: Cash Price |
$122.34
|
| Rate for Payer: Cash Price |
$189.58
|
| Rate for Payer: Cash Price |
$196.14
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$244.03
|
| Rate for Payer: Cofinity Advantage |
$171.63
|
| Rate for Payer: Cofinity Advantage |
$148.57
|
| Rate for Payer: Cofinity Advantage |
$165.89
|
| Rate for Payer: Cofinity Advantage |
$213.53
|
| Rate for Payer: Cofinity Advantage |
$107.05
|
| Rate for Payer: Cofinity Commercial |
$210.85
|
| Rate for Payer: Cofinity Commercial |
$131.52
|
| Rate for Payer: Cofinity Commercial |
$182.53
|
| Rate for Payer: Cofinity Commercial |
$203.80
|
| Rate for Payer: Cofinity Commercial |
$262.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.58
|
| Rate for Payer: Healthscope Commercial |
$213.28
|
| Rate for Payer: Healthscope Commercial |
$274.54
|
| Rate for Payer: Healthscope Commercial |
$220.66
|
| Rate for Payer: Healthscope Commercial |
$137.64
|
| Rate for Payer: Healthscope Commercial |
$191.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.78
|
| Rate for Payer: PHP Commercial |
$180.41
|
| Rate for Payer: PHP Commercial |
$201.43
|
| Rate for Payer: PHP Commercial |
$259.28
|
| Rate for Payer: PHP Commercial |
$208.40
|
| Rate for Payer: PHP Commercial |
$129.99
|
| Rate for Payer: Priority Health SBD |
$149.30
|
| Rate for Payer: Priority Health SBD |
$96.35
|
| Rate for Payer: Priority Health SBD |
$154.46
|
| Rate for Payer: Priority Health SBD |
$192.18
|
| Rate for Payer: Priority Health SBD |
$133.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.39
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$56.58
|
| Rate for Payer: UMR Bronson Commercial |
$90.72
|
| Rate for Payer: UMR Bronson Commercial |
$87.68
|
| Rate for Payer: UMR Bronson Commercial |
$112.86
|
| Rate for Payer: UMR Bronson Commercial |
$78.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.70
|
|
|
CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$245.18
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
20156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.88 |
| Max. Negotiated Rate |
$220.66 |
| Rate for Payer: Aetna American Axle |
$159.37
|
| Rate for Payer: Aetna American Axle |
$154.04
|
| Rate for Payer: Aetna American Axle |
$198.28
|
| Rate for Payer: Aetna American Axle |
$137.96
|
| Rate for Payer: Aetna Commercial |
$259.28
|
| Rate for Payer: Aetna Commercial |
$208.40
|
| Rate for Payer: Aetna Commercial |
$180.41
|
| Rate for Payer: Aetna Commercial |
$201.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.96
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$244.03
|
| Rate for Payer: Cash Price |
$189.58
|
| Rate for Payer: Cash Price |
$196.14
|
| Rate for Payer: Cofinity Advantage |
$165.89
|
| Rate for Payer: Cofinity Advantage |
$148.57
|
| Rate for Payer: Cofinity Advantage |
$171.63
|
| Rate for Payer: Cofinity Advantage |
$213.53
|
| Rate for Payer: Cofinity Commercial |
$210.85
|
| Rate for Payer: Cofinity Commercial |
$182.53
|
| Rate for Payer: Cofinity Commercial |
$203.80
|
| Rate for Payer: Cofinity Commercial |
$262.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.58
|
| Rate for Payer: Healthscope Commercial |
$213.28
|
| Rate for Payer: Healthscope Commercial |
$274.54
|
| Rate for Payer: Healthscope Commercial |
$220.66
|
| Rate for Payer: Healthscope Commercial |
$191.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.19
|
| Rate for Payer: PHP Commercial |
$180.41
|
| Rate for Payer: PHP Commercial |
$208.40
|
| Rate for Payer: PHP Commercial |
$201.43
|
| Rate for Payer: PHP Commercial |
$259.28
|
| Rate for Payer: Priority Health SBD |
$192.18
|
| Rate for Payer: Priority Health SBD |
$133.72
|
| Rate for Payer: Priority Health SBD |
$154.46
|
| Rate for Payer: Priority Health SBD |
$149.30
|
| Rate for Payer: UMR Bronson Commercial |
$104.27
|
| Rate for Payer: UMR Bronson Commercial |
$107.88
|
| Rate for Payer: UMR Bronson Commercial |
$93.39
|
| Rate for Payer: UMR Bronson Commercial |
$134.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.78
|
|
|
DABIGATRAN ETEXILATE 110 MG CAPSULE
|
Facility
|
OP
|
$679.99
|
|
|
Service Code
|
NDC 00597010854
|
| Hospital Charge Code |
177096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.60 |
| Max. Negotiated Rate |
$611.99 |
| Rate for Payer: Aetna American Axle |
$441.99
|
| Rate for Payer: Aetna Commercial |
$577.99
|
| Rate for Payer: Aetna Medicare |
$340.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.99
|
| Rate for Payer: BCBS Complete |
$272.00
|
| Rate for Payer: Cash Price |
$543.99
|
| Rate for Payer: Cofinity Advantage |
$475.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.99
|
| Rate for Payer: Healthscope Commercial |
$611.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$475.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$543.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.99
|
| Rate for Payer: PHP Commercial |
$577.99
|
| Rate for Payer: Priority Health SBD |
$428.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.99
|
| Rate for Payer: UHC Core |
$354.27
|
| Rate for Payer: UHC Exchange |
$267.24
|
| Rate for Payer: UMR Bronson Commercial |
$251.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.99
|
|
|
DABIGATRAN ETEXILATE 110 MG CAPSULE
|
Facility
|
IP
|
$679.99
|
|
|
Service Code
|
NDC 00597010854
|
| Hospital Charge Code |
177096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.20 |
| Max. Negotiated Rate |
$611.99 |
| Rate for Payer: Aetna American Axle |
$441.99
|
| Rate for Payer: Aetna Commercial |
$577.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.99
|
| Rate for Payer: Cash Price |
$543.99
|
| Rate for Payer: Cofinity Advantage |
$475.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.99
|
| Rate for Payer: Healthscope Commercial |
$611.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$475.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.99
|
| Rate for Payer: PHP Commercial |
$577.99
|
| Rate for Payer: Priority Health SBD |
$428.39
|
| Rate for Payer: UMR Bronson Commercial |
$299.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.99
|
|
|
DABIGATRAN ETEXILATE 75 MG CAPSULE
|
Facility
|
IP
|
$679.99
|
|
|
Service Code
|
NDC 00597035556
|
| Hospital Charge Code |
106490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.20 |
| Max. Negotiated Rate |
$611.99 |
| Rate for Payer: Aetna American Axle |
$441.99
|
| Rate for Payer: Aetna Commercial |
$577.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.99
|
| Rate for Payer: Cash Price |
$543.99
|
| Rate for Payer: Cofinity Advantage |
$475.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.99
|
| Rate for Payer: Healthscope Commercial |
$611.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$475.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.99
|
| Rate for Payer: PHP Commercial |
$577.99
|
| Rate for Payer: Priority Health SBD |
$428.39
|
| Rate for Payer: UMR Bronson Commercial |
$299.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.99
|
|
|
DABIGATRAN ETEXILATE 75 MG CAPSULE
|
Facility
|
OP
|
$679.99
|
|
|
Service Code
|
NDC 00597035556
|
| Hospital Charge Code |
106490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.60 |
| Max. Negotiated Rate |
$611.99 |
| Rate for Payer: Aetna American Axle |
$441.99
|
| Rate for Payer: Aetna Commercial |
$577.99
|
| Rate for Payer: Aetna Medicare |
$340.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.99
|
| Rate for Payer: BCBS Complete |
$272.00
|
| Rate for Payer: Cash Price |
$543.99
|
| Rate for Payer: Cofinity Advantage |
$475.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.99
|
| Rate for Payer: Healthscope Commercial |
$611.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$475.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$543.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.99
|
| Rate for Payer: PHP Commercial |
$577.99
|
| Rate for Payer: Priority Health SBD |
$428.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.99
|
| Rate for Payer: UHC Core |
$354.27
|
| Rate for Payer: UHC Exchange |
$267.24
|
| Rate for Payer: UMR Bronson Commercial |
$251.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.99
|
|
