|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,459.86
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$2,213.87 |
| Rate for Payer: Aetna American Axle |
$1,598.91
|
| Rate for Payer: Aetna American Axle |
$1,642.44
|
| Rate for Payer: Aetna Commercial |
$2,090.88
|
| Rate for Payer: Aetna Commercial |
$2,147.81
|
| Rate for Payer: Aetna Medicare |
$20.96
|
| Rate for Payer: Aetna Medicare |
$20.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,598.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,642.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.19
|
| Rate for Payer: BCBS Complete |
$11.58
|
| Rate for Payer: BCBS Complete |
$11.58
|
| Rate for Payer: BCBS MAPPO |
$20.15
|
| Rate for Payer: BCBS MAPPO |
$20.15
|
| Rate for Payer: BCBS Trust/PPO |
$65.12
|
| Rate for Payer: BCBS Trust/PPO |
$65.12
|
| Rate for Payer: BCN Medicare Advantage |
$20.15
|
| Rate for Payer: BCN Medicare Advantage |
$20.15
|
| Rate for Payer: Cash Price |
$1,967.89
|
| Rate for Payer: Cash Price |
$1,967.89
|
| Rate for Payer: Cash Price |
$2,021.46
|
| Rate for Payer: Cash Price |
$2,021.46
|
| Rate for Payer: Cofinity Commercial |
$2,115.48
|
| Rate for Payer: Cofinity Commercial |
$1,721.90
|
| Rate for Payer: Cofinity Commercial |
$2,173.07
|
| Rate for Payer: Cofinity Commercial |
$1,768.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,967.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,021.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$2,274.15
|
| Rate for Payer: Healthscope Commercial |
$2,213.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,721.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,768.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,844.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,895.12
|
| Rate for Payer: Mclaren Medicaid |
$11.02
|
| Rate for Payer: Mclaren Medicaid |
$11.02
|
| Rate for Payer: Mclaren Medicare |
$20.15
|
| Rate for Payer: Mclaren Medicare |
$20.15
|
| Rate for Payer: Meridian Medicaid |
$11.58
|
| Rate for Payer: Meridian Medicaid |
$11.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,147.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,090.88
|
| Rate for Payer: PACE Medicare |
$19.15
|
| Rate for Payer: PACE Medicare |
$19.15
|
| Rate for Payer: PACE SWMI |
$20.15
|
| Rate for Payer: PACE SWMI |
$20.15
|
| Rate for Payer: PHP Commercial |
$2,147.81
|
| Rate for Payer: PHP Commercial |
$2,090.88
|
| Rate for Payer: PHP Medicare Advantage |
$20.15
|
| Rate for Payer: PHP Medicare Advantage |
$20.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,721.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,768.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.69
|
| Rate for Payer: Priority Health Medicare |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$20.15
|
| Rate for Payer: Priority Health Narrow Network |
$42.15
|
| Rate for Payer: Priority Health Narrow Network |
$42.15
|
| Rate for Payer: Priority Health SBD |
$1,549.71
|
| Rate for Payer: Priority Health SBD |
$1,591.90
|
| Rate for Payer: Railroad Medicare Medicare |
$20.15
|
| Rate for Payer: Railroad Medicare Medicare |
$20.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.15
|
| Rate for Payer: UHC Medicare Advantage |
$20.76
|
| Rate for Payer: UHC Medicare Advantage |
$20.76
|
| Rate for Payer: UMR Bronson Commercial |
$910.15
|
| Rate for Payer: UMR Bronson Commercial |
$934.93
|
| Rate for Payer: VA VA |
$20.15
|
| Rate for Payer: VA VA |
$20.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,844.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,895.12
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,526.83
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
194691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,111.81 |
| Max. Negotiated Rate |
$2,274.15 |
| Rate for Payer: Aetna American Axle |
$1,642.44
|
| Rate for Payer: Aetna American Axle |
$1,598.91
|
| Rate for Payer: Aetna Commercial |
$2,090.88
|
| Rate for Payer: Aetna Commercial |
$2,147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,598.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,642.44
|
| Rate for Payer: Cash Price |
$1,967.89
|
| Rate for Payer: Cash Price |
$2,021.46
|
| Rate for Payer: Cofinity Commercial |
$1,721.90
|
| Rate for Payer: Cofinity Commercial |
$1,768.78
|
| Rate for Payer: Cofinity Commercial |
$2,115.48
|
| Rate for Payer: Cofinity Commercial |
$2,173.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,967.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,021.46
|
| Rate for Payer: Healthscope Commercial |
$2,213.87
|
| Rate for Payer: Healthscope Commercial |
$2,274.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,768.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,721.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,895.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,844.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,147.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,090.88
|
| Rate for Payer: PHP Commercial |
$2,147.81
|
| Rate for Payer: PHP Commercial |
$2,090.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,768.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,721.90
|
| Rate for Payer: Priority Health SBD |
$1,591.90
|
| Rate for Payer: Priority Health SBD |
$1,549.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,082.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,111.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,895.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,844.90
|
|
|
CYCLOPHOSPHAMIDE 50 MG CAPSULE
|
Facility
|
IP
|
$2,157.10
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
171088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$949.12 |
| Max. Negotiated Rate |
$1,941.39 |
| Rate for Payer: Aetna American Axle |
$1,402.12
|
| Rate for Payer: Aetna Commercial |
$1,833.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,402.12
|
| Rate for Payer: Cash Price |
$1,725.68
|
| Rate for Payer: Cofinity Commercial |
$1,509.97
|
| Rate for Payer: Cofinity Commercial |
$1,855.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.68
|
| Rate for Payer: Healthscope Commercial |
$1,941.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,509.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,617.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,833.54
|
| Rate for Payer: PHP Commercial |
$1,833.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.97
|
| Rate for Payer: Priority Health SBD |
$1,358.97
|
| Rate for Payer: UMR Bronson Commercial |
$949.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,617.82
|
|
|
CYCLOSPORINE 100 MG CAPSULE
|
Facility
|
IP
|
$58.05
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
9706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna American Axle |
$37.73
|
| Rate for Payer: Aetna American Axle |
$1,131.96
|
| Rate for Payer: Aetna Commercial |
$1,480.26
|
| Rate for Payer: Aetna Commercial |
$49.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.73
|
| Rate for Payer: Cash Price |
$1,393.18
|
| Rate for Payer: Cash Price |
$46.44
|
| Rate for Payer: Cofinity Commercial |
$49.92
|
| Rate for Payer: Cofinity Commercial |
$40.64
|
| Rate for Payer: Cofinity Commercial |
$1,497.67
|
| Rate for Payer: Cofinity Commercial |
$1,219.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.18
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Healthscope Commercial |
$1,567.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,219.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,306.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,480.26
|
| Rate for Payer: PHP Commercial |
$1,480.26
|
| Rate for Payer: PHP Commercial |
$49.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,219.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.64
|
| Rate for Payer: Priority Health SBD |
$1,097.13
|
| Rate for Payer: Priority Health SBD |
$36.57
|
| Rate for Payer: UMR Bronson Commercial |
$25.54
|
| Rate for Payer: UMR Bronson Commercial |
$766.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,306.11
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$161.85
|
|
|
Service Code
|
HCPCS J7516
|
| Hospital Charge Code |
9705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.21 |
| Max. Negotiated Rate |
$145.66 |
| Rate for Payer: Aetna American Axle |
$105.20
|
| Rate for Payer: Aetna American Axle |
$141.11
|
| Rate for Payer: Aetna Commercial |
$137.57
|
| Rate for Payer: Aetna Commercial |
$184.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.20
|
| Rate for Payer: Cash Price |
$173.67
|
| Rate for Payer: Cash Price |
$129.48
|
| Rate for Payer: Cofinity Commercial |
$151.96
|
| Rate for Payer: Cofinity Commercial |
$186.70
|
| Rate for Payer: Cofinity Commercial |
$139.19
|
| Rate for Payer: Cofinity Commercial |
$113.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.48
|
| Rate for Payer: Healthscope Commercial |
$195.38
|
| Rate for Payer: Healthscope Commercial |
$145.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.57
|
| Rate for Payer: PHP Commercial |
$184.53
|
| Rate for Payer: PHP Commercial |
$137.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.30
|
| Rate for Payer: Priority Health SBD |
$101.97
|
| Rate for Payer: Priority Health SBD |
$136.77
|
| Rate for Payer: UMR Bronson Commercial |
$71.21
|
| Rate for Payer: UMR Bronson Commercial |
$95.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.82
|
|
|
CYCLOSPORINE 25 MG CAPSULE
|
Facility
|
IP
|
$267.41
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
9707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.66 |
| Max. Negotiated Rate |
$240.67 |
| Rate for Payer: Aetna American Axle |
$173.82
|
| Rate for Payer: Aetna American Axle |
$283.63
|
| Rate for Payer: Aetna Commercial |
$370.90
|
| Rate for Payer: Aetna Commercial |
$227.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.63
|
| Rate for Payer: Cash Price |
$213.93
|
| Rate for Payer: Cash Price |
$349.08
|
| Rate for Payer: Cofinity Commercial |
$187.19
|
| Rate for Payer: Cofinity Commercial |
$229.97
|
| Rate for Payer: Cofinity Commercial |
$305.44
|
| Rate for Payer: Cofinity Commercial |
$375.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.08
|
| Rate for Payer: Healthscope Commercial |
$392.72
|
| Rate for Payer: Healthscope Commercial |
$240.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$370.90
|
| Rate for Payer: PHP Commercial |
$227.30
|
| Rate for Payer: PHP Commercial |
$370.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.44
|
| Rate for Payer: Priority Health SBD |
$168.47
|
| Rate for Payer: Priority Health SBD |
$274.90
|
| Rate for Payer: UMR Bronson Commercial |
$191.99
|
| Rate for Payer: UMR Bronson Commercial |
$117.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.26
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE
|
Facility
|
IP
|
$1,072.38
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$471.85 |
| Max. Negotiated Rate |
$965.14 |
| Rate for Payer: Aetna American Axle |
$697.05
|
| Rate for Payer: Aetna American Axle |
$239.40
|
| Rate for Payer: Aetna Commercial |
$313.06
|
| Rate for Payer: Aetna Commercial |
$911.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.40
|
| Rate for Payer: Cash Price |
$857.90
|
| Rate for Payer: Cash Price |
$294.64
|
| Rate for Payer: Cofinity Commercial |
$750.67
|
| Rate for Payer: Cofinity Commercial |
$922.25
|
| Rate for Payer: Cofinity Commercial |
$316.74
|
| Rate for Payer: Cofinity Commercial |
$257.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$857.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.64
|
| Rate for Payer: Healthscope Commercial |
$331.47
|
| Rate for Payer: Healthscope Commercial |
$965.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$750.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$804.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$313.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$911.52
|
| Rate for Payer: PHP Commercial |
$313.06
|
| Rate for Payer: PHP Commercial |
$911.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.81
|
| Rate for Payer: Priority Health SBD |
$232.03
|
| Rate for Payer: Priority Health SBD |
$675.60
|
| Rate for Payer: UMR Bronson Commercial |
$471.85
|
| Rate for Payer: UMR Bronson Commercial |
$162.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$804.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.22
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,842.93
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
28844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$810.89 |
| Max. Negotiated Rate |
$1,658.64 |
| Rate for Payer: Aetna American Axle |
$1,197.90
|
| Rate for Payer: Aetna Commercial |
$1,566.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,474.34
|
| Rate for Payer: Cofinity Commercial |
$1,290.05
|
| Rate for Payer: Cofinity Commercial |
$1,584.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,474.34
|
| Rate for Payer: Healthscope Commercial |
$1,658.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,290.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,382.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,566.49
|
| Rate for Payer: PHP Commercial |
$1,566.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.05
|
| Rate for Payer: Priority Health SBD |
$1,161.05
|
| Rate for Payer: UMR Bronson Commercial |
$810.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,382.20
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
IP
|
$268.40
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.10 |
| Max. Negotiated Rate |
$241.56 |
| Rate for Payer: Aetna American Axle |
$174.46
|
| Rate for Payer: Aetna American Axle |
$77.79
|
| Rate for Payer: Aetna Commercial |
$101.72
|
| Rate for Payer: Aetna Commercial |
$228.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.46
|
| Rate for Payer: Cash Price |
$95.74
|
| Rate for Payer: Cash Price |
$214.72
|
| Rate for Payer: Cofinity Commercial |
$230.82
|
| Rate for Payer: Cofinity Commercial |
$83.77
|
| Rate for Payer: Cofinity Commercial |
$102.92
|
| Rate for Payer: Cofinity Commercial |
$187.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.72
|
| Rate for Payer: Healthscope Commercial |
$241.56
|
| Rate for Payer: Healthscope Commercial |
$107.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.14
|
| Rate for Payer: PHP Commercial |
$228.14
|
| Rate for Payer: PHP Commercial |
$101.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.77
|
| Rate for Payer: Priority Health SBD |
$75.39
|
| Rate for Payer: Priority Health SBD |
$169.09
|
| Rate for Payer: UMR Bronson Commercial |
$52.65
|
| Rate for Payer: UMR Bronson Commercial |
$118.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.30
|
|
|
CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$1,111.55
|
|
|
Service Code
|
NDC 0527-1949-47
|
| Hospital Charge Code |
2032
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$489.08 |
| Max. Negotiated Rate |
$1,000.40 |
| Rate for Payer: Aetna American Axle |
$722.51
|
| Rate for Payer: Aetna Commercial |
$944.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.51
|
| Rate for Payer: Cash Price |
$889.24
|
| Rate for Payer: Cofinity Commercial |
$778.08
|
| Rate for Payer: Cofinity Commercial |
$955.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.24
|
| Rate for Payer: Healthscope Commercial |
$1,000.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$833.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$944.82
|
| Rate for Payer: PHP Commercial |
$944.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.08
|
| Rate for Payer: Priority Health SBD |
$700.28
|
| Rate for Payer: UMR Bronson Commercial |
$489.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$833.66
|
|
|
CYPROHEPTADINE 4 MG TABLET
|
Facility
|
IP
|
$162.15
|
|
|
Service Code
|
NDC 70752-107-10
|
| Hospital Charge Code |
2033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna American Axle |
$105.40
|
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.83
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.50
|
| Rate for Payer: Priority Health SBD |
$102.15
|
| Rate for Payer: UMR Bronson Commercial |
$71.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
CYPROHEPTADINE 4 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 52817-210-10
|
| Hospital Charge Code |
2033
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna American Axle |
$149.44
|
| Rate for Payer: Aetna Commercial |
$195.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.42
|
| Rate for Payer: PHP Commercial |
$195.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.93
|
| Rate for Payer: Priority Health SBD |
$144.84
|
| Rate for Payer: UMR Bronson Commercial |
$101.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.42
|
|
|
CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$123.30
|
|
|
Service Code
|
NDC 51754-1007-1
|
| Hospital Charge Code |
4294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.25 |
| Max. Negotiated Rate |
$110.97 |
| Rate for Payer: Aetna American Axle |
$80.14
|
| Rate for Payer: Aetna Commercial |
$104.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.14
|
| Rate for Payer: Cash Price |
$98.64
|
| Rate for Payer: Cofinity Commercial |
$106.04
|
| Rate for Payer: Cofinity Commercial |
$86.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.64
|
| Rate for Payer: Healthscope Commercial |
$110.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.80
|
| Rate for Payer: PHP Commercial |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.31
|
| Rate for Payer: Priority Health SBD |
$77.68
|
| Rate for Payer: UMR Bronson Commercial |
$54.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.48
|
|
|
CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$123.30
|
|
|
Service Code
|
NDC 51754-1007-3
|
| Hospital Charge Code |
4294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.25 |
| Max. Negotiated Rate |
$110.97 |
| Rate for Payer: Aetna American Axle |
$80.14
|
| Rate for Payer: Aetna Commercial |
$104.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.14
|
| Rate for Payer: Cash Price |
$98.64
|
| Rate for Payer: Cofinity Commercial |
$106.04
|
| Rate for Payer: Cofinity Commercial |
$86.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.64
|
| Rate for Payer: Healthscope Commercial |
$110.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.80
|
| Rate for Payer: PHP Commercial |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.31
|
| Rate for Payer: Priority Health SBD |
$77.68
|
| Rate for Payer: UMR Bronson Commercial |
$54.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.48
|
|
|
CYSTOLITHOTOMY, CYSTOTOMY WITH REMOVAL OF CALCULUS, WITHOUT VESICAL NECK RESECTION
|
Facility
|
OP
|
$14,479.04
|
|
|
Service Code
|
CPT 51050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$464.31 |
| Max. Negotiated Rate |
$14,479.04 |
| Rate for Payer: Aetna Medicare |
$4,783.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,749.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,749.21
|
| Rate for Payer: BCBS Complete |
$2,641.88
|
| Rate for Payer: BCBS MAPPO |
$4,599.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,584.37
|
| Rate for Payer: BCN Medicare Advantage |
$4,599.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,599.37
|
| Rate for Payer: Mclaren Medicaid |
$2,515.86
|
| Rate for Payer: Mclaren Medicare |
$4,599.37
|
| Rate for Payer: Meridian Medicaid |
$2,641.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,829.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,289.28
|
| Rate for Payer: PACE Medicare |
$4,369.40
|
| Rate for Payer: PACE SWMI |
$4,599.37
|
| Rate for Payer: PHP Medicare Advantage |
$4,599.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,515.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,479.04
|
| Rate for Payer: Priority Health Medicare |
$4,599.37
|
| Rate for Payer: Priority Health Narrow Network |
$11,583.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4,599.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.74
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,599.37
|
| Rate for Payer: UHC Exchange |
$464.31
|
| Rate for Payer: UHC Medicare Advantage |
$4,737.35
|
| Rate for Payer: VA VA |
$4,599.37
|
|
|
CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE
|
Facility
|
OP
|
$5,699.47
|
|
|
Service Code
|
CPT 51040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$288.15 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,583.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.96
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$288.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
CYSTOTOMY FOR EXCISION, INCISION, OR REPAIR OF URETEROCELE
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 51535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$762.28 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,094.72
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$838.51
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$762.28
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
CYSTOTOMY OR CYSTOSTOMY; WITH FULGURATION AND/OR INSERTION OF RADIOACTIVE MATERIAL
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 51020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$463.66 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.61
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.03
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$463.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH MANIPULATION, WITHOUT REMOVAL OF URETERAL CALCULUS
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 52330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$254.09 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.18
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.50
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$254.09
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH REMOVAL OF URETERAL CALCULUS
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 52320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,677.24
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.14
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$237.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
CYSTOURETHROSCOPY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,911.48
|
|
|
Service Code
|
CPT 52000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.93 |
| Max. Negotiated Rate |
$1,911.48 |
| Rate for Payer: Aetna Medicare |
$631.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.00
|
| Rate for Payer: BCBS Complete |
$348.78
|
| Rate for Payer: BCBS MAPPO |
$607.20
|
| Rate for Payer: BCBS Trust/PPO |
$728.68
|
| Rate for Payer: BCN Medicare Advantage |
$607.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.20
|
| Rate for Payer: Mclaren Medicaid |
$332.14
|
| Rate for Payer: Mclaren Medicare |
$607.20
|
| Rate for Payer: Meridian Medicaid |
$348.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$698.28
|
| Rate for Payer: PACE Medicare |
$576.84
|
| Rate for Payer: PACE SWMI |
$607.20
|
| Rate for Payer: PHP Medicare Advantage |
$607.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,911.48
|
| Rate for Payer: Priority Health Medicare |
$607.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,529.18
|
| Rate for Payer: Railroad Medicare Medicare |
$607.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.72
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.20
|
| Rate for Payer: UHC Exchange |
$77.93
|
| Rate for Payer: UHC Medicare Advantage |
$625.42
|
| Rate for Payer: VA VA |
$607.20
|
|
|
CYSTOURETHROSCOPY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,911.48
|
|
|
Service Code
|
CPT 52000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$77.93 |
| Max. Negotiated Rate |
$1,911.48 |
| Rate for Payer: Aetna Medicare |
$631.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.00
|
| Rate for Payer: BCBS Complete |
$348.78
|
| Rate for Payer: BCBS MAPPO |
$607.20
|
| Rate for Payer: BCBS Trust/PPO |
$728.68
|
| Rate for Payer: BCN Medicare Advantage |
$607.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.20
|
| Rate for Payer: Mclaren Medicaid |
$332.14
|
| Rate for Payer: Mclaren Medicare |
$607.20
|
| Rate for Payer: Meridian Medicaid |
$348.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$698.28
|
| Rate for Payer: PACE Medicare |
$576.84
|
| Rate for Payer: PACE SWMI |
$607.20
|
| Rate for Payer: PHP Medicare Advantage |
$607.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,911.48
|
| Rate for Payer: Priority Health Medicare |
$607.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,529.18
|
| Rate for Payer: Railroad Medicare Medicare |
$607.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.72
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.20
|
| Rate for Payer: UHC Exchange |
$77.93
|
| Rate for Payer: UHC Medicare Advantage |
$625.42
|
| Rate for Payer: VA VA |
$607.20
|
|
|
CYSTOURETHROSCOPY, WITH BIOPSY(S)
|
Facility
|
OP
|
$5,699.47
|
|
|
Service Code
|
CPT 52204
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,354.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.92
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$137.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OF URETHRAL STRICTURE OR STENOSIS, WITH OR WITHOUT MEATOTOMY, WITH OR WITHOUT INJECTION PROCEDURE FOR CYSTOGRAPHY, MALE OR FEMALE
|
Facility
|
OP
|
$5,699.47
|
|
|
Service Code
|
CPT 52281
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$147.35 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,047.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.08
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$147.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; GENERAL OR CONDUCTION (SPINAL) ANESTHESIA
|
Facility
|
OP
|
$5,699.47
|
|
|
Service Code
|
CPT 52260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$203.67 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,562.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.04
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$203.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
