|
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
|
$15,654.68
|
|
|
Service Code
|
CPT 52284
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.27 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.00
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$157.27
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA OR BLADDER (SEPARATE PROCEDURE); COMPLICATED
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 52315
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$261.97 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,107.43
|
| Rate for Payer: BCN Commercial |
$2,107.43
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.17
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$261.97
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA OR BLADDER (SEPARATE PROCEDURE); SIMPLE
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 52310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.83 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,375.71
|
| Rate for Payer: BCN Commercial |
$1,375.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.31
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$144.83
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 52341
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$271.23 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,700.60
|
| Rate for Payer: BCN Commercial |
$1,700.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.35
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$271.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE;
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 52005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.22 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,711.00
|
| Rate for Payer: BCN Commercial |
$2,711.00
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.94
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$127.22
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 52351
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$289.23 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,887.57
|
| Rate for Payer: BCN Commercial |
$2,887.57
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.15
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$289.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH BIOPSY AND/OR FULGURATION OF URETERAL OR RENAL PELVIC LESION
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 52354
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,669.72 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$3,713.74
|
| Rate for Payer: BCN Commercial |
$3,713.74
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,020.54
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$9,518.86
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY INCLUDING INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE-J TYPE)
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 52356
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$396.84 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$3,840.81
|
| Rate for Payer: BCN Commercial |
$3,840.81
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.52
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$396.84
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY (URETERAL CATHETERIZATION IS INCLUDED)
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 52353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$373.99 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$3,852.27
|
| Rate for Payer: BCN Commercial |
$3,852.27
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.39
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$373.99
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR MANIPULATION OF CALCULUS (URETERAL CATHETERIZATION IS INCLUDED)
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 52352
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$337.83 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,734.47
|
| Rate for Payer: BCN Commercial |
$2,734.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.61
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$337.83
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH RESECTION OF URETERAL OR RENAL PELVIC TUMOR
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 52355
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$446.21 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,710.51
|
| Rate for Payer: BCN Commercial |
$2,710.51
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.83
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$446.21
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 52346
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$426.06 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,710.51
|
| Rate for Payer: BCN Commercial |
$2,710.51
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$468.67
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$426.06
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 52344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$352.86 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,839.21
|
| Rate for Payer: BCN Commercial |
$1,839.21
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.15
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$352.86
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 52345
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$376.61 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,710.51
|
| Rate for Payer: BCN Commercial |
$2,710.51
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.27
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$376.61
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$130.48
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
118877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.41 |
| Max. Negotiated Rate |
$117.43 |
| Rate for Payer: Aetna American Axle |
$84.81
|
| Rate for Payer: Aetna American Axle |
$37.08
|
| Rate for Payer: Aetna Commercial |
$110.91
|
| Rate for Payer: Aetna Commercial |
$48.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.08
|
| Rate for Payer: Cash Price |
$104.38
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cofinity Commercial |
$49.05
|
| Rate for Payer: Cofinity Commercial |
$39.93
|
| Rate for Payer: Cofinity Commercial |
$112.21
|
| Rate for Payer: Cofinity Commercial |
$91.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.63
|
| Rate for Payer: Healthscope Commercial |
$117.43
|
| Rate for Payer: Healthscope Commercial |
$51.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.91
|
| Rate for Payer: PHP Commercial |
$48.48
|
| Rate for Payer: PHP Commercial |
$110.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.08
|
| Rate for Payer: Priority Health SBD |
$82.20
|
| Rate for Payer: Priority Health SBD |
$35.94
|
| Rate for Payer: UMR Bronson Commercial |
$57.41
|
| Rate for Payer: UMR Bronson Commercial |
$25.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.78
|
|
|
CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$130.48
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
118877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$117.43 |
| Rate for Payer: Aetna American Axle |
$84.81
|
| Rate for Payer: Aetna American Axle |
$37.08
|
| Rate for Payer: Aetna Commercial |
$48.48
|
| Rate for Payer: Aetna Commercial |
$110.91
|
| Rate for Payer: Aetna Medicare |
$65.24
|
| Rate for Payer: Aetna Medicare |
$28.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.08
|
| Rate for Payer: BCBS Complete |
$22.82
|
| Rate for Payer: BCBS Complete |
$52.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCN Commercial |
$2.06
|
| Rate for Payer: BCN Commercial |
$2.06
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cash Price |
$104.38
|
| Rate for Payer: Cash Price |
$104.38
|
| Rate for Payer: Cofinity Commercial |
$49.05
|
| Rate for Payer: Cofinity Commercial |
$112.21
|
| Rate for Payer: Cofinity Commercial |
$39.93
|
| Rate for Payer: Cofinity Commercial |
$91.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.38
|
| Rate for Payer: Healthscope Commercial |
$51.34
|
| Rate for Payer: Healthscope Commercial |
$117.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.48
|
| Rate for Payer: PHP Commercial |
$110.91
|
| Rate for Payer: PHP Commercial |
$48.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.08
|
| Rate for Payer: Priority Health SBD |
$35.94
|
| Rate for Payer: Priority Health SBD |
$82.20
|
| Rate for Payer: UMR Bronson Commercial |
$48.28
|
| Rate for Payer: UMR Bronson Commercial |
$21.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.86
|
|
|
CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$212.25
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
20156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$191.02 |
| Rate for Payer: Cofinity Commercial |
$148.58
|
| Rate for Payer: Cofinity Commercial |
$262.33
|
| Rate for Payer: Cofinity Commercial |
$107.05
|
| Rate for Payer: Cofinity Commercial |
$203.80
|
| Rate for Payer: Cofinity Commercial |
$165.89
|
| Rate for Payer: Cofinity Commercial |
$213.53
|
| Rate for Payer: Cofinity Commercial |
$210.85
|
| Rate for Payer: Cofinity Commercial |
$171.63
|
| Rate for Payer: Cofinity Commercial |
$182.54
|
| Rate for Payer: Cofinity Commercial |
$131.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.05
|
| Rate for Payer: Aetna American Axle |
$137.96
|
| Rate for Payer: Aetna American Axle |
$159.37
|
| Rate for Payer: Aetna American Axle |
$154.04
|
| Rate for Payer: Aetna American Axle |
$99.40
|
| Rate for Payer: Aetna American Axle |
$198.28
|
| Rate for Payer: Aetna Commercial |
$180.41
|
| Rate for Payer: Aetna Commercial |
$129.99
|
| Rate for Payer: Aetna Commercial |
$259.28
|
| Rate for Payer: Aetna Commercial |
$201.43
|
| Rate for Payer: Aetna Commercial |
$208.40
|
| Rate for Payer: Aetna Medicare |
$118.49
|
| Rate for Payer: Aetna Medicare |
$122.59
|
| Rate for Payer: Aetna Medicare |
$106.12
|
| Rate for Payer: Aetna Medicare |
$76.46
|
| Rate for Payer: Aetna Medicare |
$152.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.28
|
| 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) |
$154.04
|
| Rate for Payer: BCBS Complete |
$84.90
|
| Rate for Payer: BCBS Complete |
$61.17
|
| Rate for Payer: BCBS Complete |
$98.07
|
| Rate for Payer: BCBS Complete |
$122.02
|
| Rate for Payer: BCBS Complete |
$94.79
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCN Commercial |
$2.06
|
| Rate for Payer: BCN Commercial |
$2.06
|
| Rate for Payer: BCN Commercial |
$2.06
|
| Rate for Payer: BCN Commercial |
$2.06
|
| Rate for Payer: BCN Commercial |
$2.06
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$189.58
|
| Rate for Payer: Cash Price |
$122.34
|
| 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 |
$244.03
|
| Rate for Payer: Cash Price |
$244.03
|
| Rate for Payer: Cash Price |
$196.14
|
| Rate for Payer: Cash Price |
$196.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.03
|
| 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 |
$196.14
|
| Rate for Payer: Healthscope Commercial |
$220.66
|
| Rate for Payer: Healthscope Commercial |
$137.64
|
| Rate for Payer: Healthscope Commercial |
$191.02
|
| Rate for Payer: Healthscope Commercial |
$213.28
|
| Rate for Payer: Healthscope Commercial |
$274.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.58
|
| 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 |
$213.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.19
|
| 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 |
$114.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.74
|
| 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: Multiplan/Beech St/PHCS Commercial |
$259.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.99
|
| Rate for Payer: PHP Commercial |
$259.28
|
| Rate for Payer: PHP Commercial |
$208.40
|
| Rate for Payer: PHP Commercial |
$180.41
|
| Rate for Payer: PHP Commercial |
$129.99
|
| Rate for Payer: PHP Commercial |
$201.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.96
|
| Rate for Payer: Priority Health SBD |
$133.72
|
| Rate for Payer: Priority Health SBD |
$192.18
|
| Rate for Payer: Priority Health SBD |
$154.46
|
| Rate for Payer: Priority Health SBD |
$96.35
|
| Rate for Payer: Priority Health SBD |
$149.30
|
| Rate for Payer: UMR Bronson Commercial |
$56.58
|
| Rate for Payer: UMR Bronson Commercial |
$87.68
|
| Rate for Payer: UMR Bronson Commercial |
$78.53
|
| Rate for Payer: UMR Bronson Commercial |
$90.72
|
| Rate for Payer: UMR Bronson Commercial |
$112.86
|
| 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 |
$228.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.74
|
| 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: Cofinity Commercial |
$165.89
|
| Rate for Payer: Cofinity Commercial |
$203.80
|
| Rate for Payer: Cofinity Commercial |
$210.85
|
| Rate for Payer: Cofinity Commercial |
$182.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.58
|
| 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 |
$208.40
|
| Rate for Payer: Aetna Commercial |
$259.28
|
| Rate for Payer: Aetna Commercial |
$201.43
|
| Rate for Payer: Aetna Commercial |
$180.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.37
|
| 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 Commercial |
$148.58
|
| Rate for Payer: Cofinity Commercial |
$262.33
|
| Rate for Payer: Cofinity Commercial |
$213.53
|
| Rate for Payer: Cofinity Commercial |
$171.63
|
| 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 |
$196.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.58
|
| Rate for Payer: Healthscope Commercial |
$220.66
|
| Rate for Payer: Healthscope Commercial |
$191.02
|
| Rate for Payer: Healthscope Commercial |
$213.28
|
| Rate for Payer: Healthscope Commercial |
$274.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.58
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$171.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.78
|
| 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: PHP Commercial |
$208.40
|
| Rate for Payer: PHP Commercial |
$259.28
|
| Rate for Payer: PHP Commercial |
$180.41
|
| Rate for Payer: PHP Commercial |
$201.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.96
|
| Rate for Payer: Priority Health SBD |
$192.18
|
| Rate for Payer: Priority Health SBD |
$133.72
|
| Rate for Payer: Priority Health SBD |
$149.30
|
| Rate for Payer: Priority Health SBD |
$154.46
|
| Rate for Payer: UMR Bronson Commercial |
$107.88
|
| Rate for Payer: UMR Bronson Commercial |
$134.22
|
| Rate for Payer: UMR Bronson Commercial |
$104.27
|
| Rate for Payer: UMR Bronson Commercial |
$93.39
|
| 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 |
$177.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.88
|
|
|
DABIGATRAN ETEXILATE 150 MG CAPSULE
|
Facility
|
OP
|
$679.99
|
|
|
Service Code
|
NDC 00597036082
|
| Hospital Charge Code |
106491
|
|
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 Commercial |
$475.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$475.99
|
| 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: PHP Commercial |
$577.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.99
|
| Rate for Payer: Priority Health SBD |
$428.39
|
| Rate for Payer: UMR Bronson Commercial |
$251.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.99
|
|
|
DABIGATRAN ETEXILATE 150 MG CAPSULE
|
Facility
|
IP
|
$679.99
|
|
|
Service Code
|
NDC 00597036082
|
| Hospital Charge Code |
106491
|
|
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 Commercial |
$475.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$475.99
|
| 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: PHP Commercial |
$577.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.99
|
| 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 Commercial |
$475.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$475.99
|
| 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: PHP Commercial |
$577.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.99
|
| Rate for Payer: Priority Health SBD |
$428.39
|
| Rate for Payer: UMR Bronson Commercial |
$251.60
|
| 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 Commercial |
$475.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$475.99
|
| 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: PHP Commercial |
$577.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.99
|
| 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
|
|
|
DACARBAZINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$233.75
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
2090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.85 |
| Max. Negotiated Rate |
$210.38 |
| Rate for Payer: Aetna American Axle |
$151.94
|
| Rate for Payer: Aetna Commercial |
$198.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.94
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cofinity Commercial |
$163.62
|
| Rate for Payer: Cofinity Commercial |
$201.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.00
|
| Rate for Payer: Healthscope Commercial |
$210.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.69
|
| Rate for Payer: PHP Commercial |
$198.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.94
|
| Rate for Payer: Priority Health SBD |
$147.26
|
| Rate for Payer: UMR Bronson Commercial |
$102.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.31
|
|
|
DACARBAZINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$233.75
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
2090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$210.38 |
| Rate for Payer: Aetna American Axle |
$151.94
|
| Rate for Payer: Aetna Commercial |
$198.69
|
| Rate for Payer: Aetna Medicare |
$116.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.94
|
| Rate for Payer: BCBS Complete |
$93.50
|
| Rate for Payer: BCBS Trust/PPO |
$11.27
|
| Rate for Payer: BCN Commercial |
$11.27
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cofinity Commercial |
$163.62
|
| Rate for Payer: Cofinity Commercial |
$201.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.00
|
| Rate for Payer: Healthscope Commercial |
$210.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.69
|
| Rate for Payer: PHP Commercial |
$198.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.94
|
| Rate for Payer: Priority Health SBD |
$147.26
|
| Rate for Payer: UMR Bronson Commercial |
$86.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.31
|
|
|
DACARBAZINE 200 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$66.86
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
2091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$60.17 |
| Rate for Payer: Aetna American Axle |
$43.46
|
| Rate for Payer: Aetna American Axle |
$123.99
|
| Rate for Payer: Aetna Commercial |
$162.14
|
| Rate for Payer: Aetna Commercial |
$56.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.46
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: Cofinity Commercial |
$133.52
|
| Rate for Payer: Cofinity Commercial |
$57.50
|
| Rate for Payer: Cofinity Commercial |
$46.80
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.60
|
| Rate for Payer: Healthscope Commercial |
$171.68
|
| Rate for Payer: Healthscope Commercial |
$60.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.83
|
| Rate for Payer: PHP Commercial |
$56.83
|
| Rate for Payer: PHP Commercial |
$162.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.46
|
| Rate for Payer: Priority Health SBD |
$120.17
|
| Rate for Payer: Priority Health SBD |
$42.12
|
| Rate for Payer: UMR Bronson Commercial |
$83.93
|
| Rate for Payer: UMR Bronson Commercial |
$29.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.14
|
|
