Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,136.76

Service Code	NDC 10147095303
Hospital Charge Code	78065
Hospital Revenue Code	637
Min. Negotiated Rate	$716.16
Max. Negotiated Rate	$1,023.08
Rate for Payer: Aetna Commercial	$966.25
Rate for Payer: Aetna New Business (MI Preferred)	$738.89
Rate for Payer: Cash Price	$909.41
Rate for Payer: Cofinity Commercial	$795.73
Rate for Payer: Cofinity Commercial	$977.61
Rate for Payer: Cofinity Medicare Advantage	$795.73
Rate for Payer: Encore Health Key Benefits Commercial	$909.41
Rate for Payer: Healthscope Commercial	$1,023.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$966.25
Rate for Payer: PHP Commercial	$966.25
Rate for Payer: Priority Health Cigna Priority Health	$738.89
Rate for Payer: Priority Health SBD	$716.16

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$213.84

Service Code	NDC 65162028203
Hospital Charge Code	78065
Hospital Revenue Code	637
Min. Negotiated Rate	$85.54
Max. Negotiated Rate	$192.46
Rate for Payer: Aetna Commercial	$181.76
Rate for Payer: Aetna Medicare	$106.92
Rate for Payer: Aetna New Business (MI Preferred)	$139.00
Rate for Payer: BCBS Complete	$85.54
Rate for Payer: Cash Price	$171.07
Rate for Payer: Cofinity Commercial	$149.69
Rate for Payer: Cofinity Commercial	$183.90
Rate for Payer: Cofinity Medicare Advantage	$149.69
Rate for Payer: Encore Health Key Benefits Commercial	$171.07
Rate for Payer: Healthscope Commercial	$192.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$181.76
Rate for Payer: PHP Commercial	$181.76
Rate for Payer: Priority Health Cigna Priority Health	$139.00
Rate for Payer: Priority Health SBD	$134.72

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$213.84

Service Code	NDC 65162028203
Hospital Charge Code	78065
Hospital Revenue Code	637
Min. Negotiated Rate	$134.72
Max. Negotiated Rate	$192.46
Rate for Payer: Aetna Commercial	$181.76
Rate for Payer: Aetna New Business (MI Preferred)	$139.00
Rate for Payer: Cash Price	$171.07
Rate for Payer: Cofinity Commercial	$149.69
Rate for Payer: Cofinity Commercial	$183.90
Rate for Payer: Cofinity Medicare Advantage	$149.69
Rate for Payer: Encore Health Key Benefits Commercial	$171.07
Rate for Payer: Healthscope Commercial	$192.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$181.76
Rate for Payer: PHP Commercial	$181.76
Rate for Payer: Priority Health Cigna Priority Health	$139.00
Rate for Payer: Priority Health SBD	$134.72

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$344.10

Service Code	NDC 47335076683
Hospital Charge Code	78065
Hospital Revenue Code	637
Min. Negotiated Rate	$137.64
Max. Negotiated Rate	$309.69
Rate for Payer: Aetna Commercial	$292.49
Rate for Payer: Aetna Medicare	$172.05
Rate for Payer: Aetna New Business (MI Preferred)	$223.66
Rate for Payer: BCBS Complete	$137.64
Rate for Payer: Cash Price	$275.28
Rate for Payer: Cofinity Commercial	$240.87
Rate for Payer: Cofinity Commercial	$295.93
Rate for Payer: Cofinity Medicare Advantage	$240.87
Rate for Payer: Encore Health Key Benefits Commercial	$275.28
Rate for Payer: Healthscope Commercial	$309.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$292.49
Rate for Payer: PHP Commercial	$292.49
Rate for Payer: Priority Health Cigna Priority Health	$223.66
Rate for Payer: Priority Health SBD	$216.78

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$344.10

Service Code	NDC 47335076683
Hospital Charge Code	78065
Hospital Revenue Code	637
Min. Negotiated Rate	$216.78
Max. Negotiated Rate	$309.69
Rate for Payer: Aetna Commercial	$292.49
Rate for Payer: Aetna New Business (MI Preferred)	$223.66
Rate for Payer: Cash Price	$275.28
Rate for Payer: Cofinity Commercial	$240.87
Rate for Payer: Cofinity Commercial	$295.93
Rate for Payer: Cofinity Medicare Advantage	$240.87
Rate for Payer: Encore Health Key Benefits Commercial	$275.28
Rate for Payer: Healthscope Commercial	$309.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$292.49
Rate for Payer: PHP Commercial	$292.49
Rate for Payer: Priority Health Cigna Priority Health	$223.66
Rate for Payer: Priority Health SBD	$216.78

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$223.67

Service Code	NDC 43975035103
Hospital Charge Code	78065
Hospital Revenue Code	637
Min. Negotiated Rate	$89.47
Max. Negotiated Rate	$201.30
Rate for Payer: Aetna Commercial	$190.12
Rate for Payer: Aetna Medicare	$111.83
Rate for Payer: Aetna New Business (MI Preferred)	$145.39
Rate for Payer: BCBS Complete	$89.47
Rate for Payer: Cash Price	$178.94
Rate for Payer: Cofinity Commercial	$156.57
Rate for Payer: Cofinity Commercial	$192.36
Rate for Payer: Cofinity Medicare Advantage	$156.57
Rate for Payer: Encore Health Key Benefits Commercial	$178.94
Rate for Payer: Healthscope Commercial	$201.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$190.12
Rate for Payer: PHP Commercial	$190.12
Rate for Payer: Priority Health Cigna Priority Health	$145.39
Rate for Payer: Priority Health SBD	$140.91

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$223.67

Service Code	NDC 43975035103
Hospital Charge Code	78065
Hospital Revenue Code	637
Min. Negotiated Rate	$140.91
Max. Negotiated Rate	$201.30
Rate for Payer: Aetna Commercial	$190.12
Rate for Payer: Aetna New Business (MI Preferred)	$145.39
Rate for Payer: Cash Price	$178.94
Rate for Payer: Cofinity Commercial	$156.57
Rate for Payer: Cofinity Commercial	$192.36
Rate for Payer: Cofinity Medicare Advantage	$156.57
Rate for Payer: Encore Health Key Benefits Commercial	$178.94
Rate for Payer: Healthscope Commercial	$201.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$190.12
Rate for Payer: PHP Commercial	$190.12
Rate for Payer: Priority Health Cigna Priority Health	$145.39
Rate for Payer: Priority Health SBD	$140.91

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,136.76

Service Code	NDC 10147095303
Hospital Charge Code	78065
Hospital Revenue Code	637
Min. Negotiated Rate	$454.70
Max. Negotiated Rate	$1,023.08
Rate for Payer: Aetna Commercial	$966.25
Rate for Payer: Aetna Medicare	$568.38
Rate for Payer: Aetna New Business (MI Preferred)	$738.89
Rate for Payer: BCBS Complete	$454.70
Rate for Payer: Cash Price	$909.41
Rate for Payer: Cofinity Commercial	$795.73
Rate for Payer: Cofinity Commercial	$977.61
Rate for Payer: Cofinity Medicare Advantage	$795.73
Rate for Payer: Encore Health Key Benefits Commercial	$909.41
Rate for Payer: Healthscope Commercial	$1,023.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$966.25
Rate for Payer: PHP Commercial	$966.25
Rate for Payer: Priority Health Cigna Priority Health	$738.89
Rate for Payer: Priority Health SBD	$716.16

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,705.08

Service Code	NDC 10147095403
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$1,074.20
Max. Negotiated Rate	$1,534.57
Rate for Payer: Aetna Commercial	$1,449.32
Rate for Payer: Aetna New Business (MI Preferred)	$1,108.30
Rate for Payer: Cash Price	$1,364.06
Rate for Payer: Cofinity Commercial	$1,193.56
Rate for Payer: Cofinity Commercial	$1,466.37
Rate for Payer: Cofinity Medicare Advantage	$1,193.56
Rate for Payer: Encore Health Key Benefits Commercial	$1,364.06
Rate for Payer: Healthscope Commercial	$1,534.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,449.32
Rate for Payer: PHP Commercial	$1,449.32
Rate for Payer: Priority Health Cigna Priority Health	$1,108.30
Rate for Payer: Priority Health SBD	$1,074.20

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$5,887.07

Service Code	NDC 00904693761
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$3,708.85
Max. Negotiated Rate	$5,298.36
Rate for Payer: Aetna Commercial	$5,004.01
Rate for Payer: Aetna New Business (MI Preferred)	$3,826.60
Rate for Payer: Cash Price	$4,709.66
Rate for Payer: Cofinity Commercial	$4,120.95
Rate for Payer: Cofinity Commercial	$5,062.88
Rate for Payer: Cofinity Medicare Advantage	$4,120.95
Rate for Payer: Encore Health Key Benefits Commercial	$4,709.66
Rate for Payer: Healthscope Commercial	$5,298.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,004.01
Rate for Payer: PHP Commercial	$5,004.01
Rate for Payer: Priority Health Cigna Priority Health	$3,826.60
Rate for Payer: Priority Health SBD	$3,708.85

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$516.15

Service Code	NDC 47335076783
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$206.46
Max. Negotiated Rate	$464.54
Rate for Payer: Aetna Commercial	$438.73
Rate for Payer: Aetna Medicare	$258.07
Rate for Payer: Aetna New Business (MI Preferred)	$335.50
Rate for Payer: BCBS Complete	$206.46
Rate for Payer: Cash Price	$412.92
Rate for Payer: Cofinity Commercial	$361.31
Rate for Payer: Cofinity Commercial	$443.89
Rate for Payer: Cofinity Medicare Advantage	$361.31
Rate for Payer: Encore Health Key Benefits Commercial	$412.92
Rate for Payer: Healthscope Commercial	$464.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$438.73
Rate for Payer: PHP Commercial	$438.73
Rate for Payer: Priority Health Cigna Priority Health	$335.50
Rate for Payer: Priority Health SBD	$325.17

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,705.08

Service Code	NDC 10147095403
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$682.03
Max. Negotiated Rate	$1,534.57
Rate for Payer: Aetna Commercial	$1,449.32
Rate for Payer: Aetna Medicare	$852.54
Rate for Payer: Aetna New Business (MI Preferred)	$1,108.30
Rate for Payer: BCBS Complete	$682.03
Rate for Payer: Cash Price	$1,364.06
Rate for Payer: Cofinity Commercial	$1,193.56
Rate for Payer: Cofinity Commercial	$1,466.37
Rate for Payer: Cofinity Medicare Advantage	$1,193.56
Rate for Payer: Encore Health Key Benefits Commercial	$1,364.06
Rate for Payer: Healthscope Commercial	$1,534.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,449.32
Rate for Payer: PHP Commercial	$1,449.32
Rate for Payer: Priority Health Cigna Priority Health	$1,108.30
Rate for Payer: Priority Health SBD	$1,074.20

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$379.07

Service Code	NDC 65162028303
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$238.81
Max. Negotiated Rate	$341.16
Rate for Payer: Aetna Commercial	$322.21
Rate for Payer: Aetna New Business (MI Preferred)	$246.40
Rate for Payer: Cash Price	$303.26
Rate for Payer: Cofinity Commercial	$265.35
Rate for Payer: Cofinity Commercial	$326.00
Rate for Payer: Cofinity Medicare Advantage	$265.35
Rate for Payer: Encore Health Key Benefits Commercial	$303.26
Rate for Payer: Healthscope Commercial	$341.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$322.21
Rate for Payer: PHP Commercial	$322.21
Rate for Payer: Priority Health Cigna Priority Health	$246.40
Rate for Payer: Priority Health SBD	$238.81

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$379.07

Service Code	NDC 65162028303
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$151.63
Max. Negotiated Rate	$341.16
Rate for Payer: Aetna Commercial	$322.21
Rate for Payer: Aetna Medicare	$189.53
Rate for Payer: Aetna New Business (MI Preferred)	$246.40
Rate for Payer: BCBS Complete	$151.63
Rate for Payer: Cash Price	$303.26
Rate for Payer: Cofinity Commercial	$265.35
Rate for Payer: Cofinity Commercial	$326.00
Rate for Payer: Cofinity Medicare Advantage	$265.35
Rate for Payer: Encore Health Key Benefits Commercial	$303.26
Rate for Payer: Healthscope Commercial	$341.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$322.21
Rate for Payer: PHP Commercial	$322.21
Rate for Payer: Priority Health Cigna Priority Health	$246.40
Rate for Payer: Priority Health SBD	$238.81

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$516.15

Service Code	NDC 47335076783
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$325.17
Max. Negotiated Rate	$464.54
Rate for Payer: Aetna Commercial	$438.73
Rate for Payer: Aetna New Business (MI Preferred)	$335.50
Rate for Payer: Cash Price	$412.92
Rate for Payer: Cofinity Commercial	$361.31
Rate for Payer: Cofinity Commercial	$443.89
Rate for Payer: Cofinity Medicare Advantage	$361.31
Rate for Payer: Encore Health Key Benefits Commercial	$412.92
Rate for Payer: Healthscope Commercial	$464.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$438.73
Rate for Payer: PHP Commercial	$438.73
Rate for Payer: Priority Health Cigna Priority Health	$335.50
Rate for Payer: Priority Health SBD	$325.17

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$5,887.07

Service Code	NDC 00904693761
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$2,354.83
Max. Negotiated Rate	$5,298.36
Rate for Payer: Aetna Commercial	$5,004.01
Rate for Payer: Aetna Medicare	$2,943.53
Rate for Payer: Aetna New Business (MI Preferred)	$3,826.60
Rate for Payer: BCBS Complete	$2,354.83
Rate for Payer: Cash Price	$4,709.66
Rate for Payer: Cofinity Commercial	$4,120.95
Rate for Payer: Cofinity Commercial	$5,062.88
Rate for Payer: Cofinity Medicare Advantage	$4,120.95
Rate for Payer: Encore Health Key Benefits Commercial	$4,709.66
Rate for Payer: Healthscope Commercial	$5,298.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,004.01
Rate for Payer: PHP Commercial	$5,004.01
Rate for Payer: Priority Health Cigna Priority Health	$3,826.60
Rate for Payer: Priority Health SBD	$3,708.85

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE

Facility

$129.64

Service Code	HCPCS J2469
Hospital Charge Code	188040
Hospital Revenue Code	636
Min. Negotiated Rate	$81.67
Max. Negotiated Rate	$116.68
Rate for Payer: Aetna Commercial	$110.19
Rate for Payer: Aetna Commercial	$224.03
Rate for Payer: Aetna New Business (MI Preferred)	$84.27
Rate for Payer: Aetna New Business (MI Preferred)	$171.32
Rate for Payer: Cash Price	$103.71
Rate for Payer: Cash Price	$210.86
Rate for Payer: Cofinity Commercial	$111.49
Rate for Payer: Cofinity Commercial	$184.50
Rate for Payer: Cofinity Commercial	$226.67
Rate for Payer: Cofinity Commercial	$90.75
Rate for Payer: Cofinity Medicare Advantage	$184.50
Rate for Payer: Cofinity Medicare Advantage	$90.75
Rate for Payer: Encore Health Key Benefits Commercial	$103.71
Rate for Payer: Encore Health Key Benefits Commercial	$210.86
Rate for Payer: Healthscope Commercial	$116.68
Rate for Payer: Healthscope Commercial	$237.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$224.03
Rate for Payer: PHP Commercial	$110.19
Rate for Payer: PHP Commercial	$224.03
Rate for Payer: Priority Health Cigna Priority Health	$171.32
Rate for Payer: Priority Health Cigna Priority Health	$84.27
Rate for Payer: Priority Health SBD	$166.05
Rate for Payer: Priority Health SBD	$81.67

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE

Facility

$263.57

Service Code	HCPCS J2469
Hospital Charge Code	188040
Hospital Revenue Code	636
Min. Negotiated Rate	$105.43
Max. Negotiated Rate	$237.21
Rate for Payer: Aetna Commercial	$224.03
Rate for Payer: Aetna Commercial	$110.19
Rate for Payer: Aetna Medicare	$64.82
Rate for Payer: Aetna Medicare	$131.78
Rate for Payer: Aetna New Business (MI Preferred)	$171.32
Rate for Payer: Aetna New Business (MI Preferred)	$84.27
Rate for Payer: BCBS Complete	$105.43
Rate for Payer: BCBS Complete	$51.86
Rate for Payer: Cash Price	$210.86
Rate for Payer: Cash Price	$103.71
Rate for Payer: Cofinity Commercial	$226.67
Rate for Payer: Cofinity Commercial	$111.49
Rate for Payer: Cofinity Commercial	$90.75
Rate for Payer: Cofinity Commercial	$184.50
Rate for Payer: Cofinity Medicare Advantage	$90.75
Rate for Payer: Cofinity Medicare Advantage	$184.50
Rate for Payer: Encore Health Key Benefits Commercial	$103.71
Rate for Payer: Encore Health Key Benefits Commercial	$210.86
Rate for Payer: Healthscope Commercial	$237.21
Rate for Payer: Healthscope Commercial	$116.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$224.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.19
Rate for Payer: PHP Commercial	$224.03
Rate for Payer: PHP Commercial	$110.19
Rate for Payer: Priority Health Cigna Priority Health	$84.27
Rate for Payer: Priority Health Cigna Priority Health	$171.32
Rate for Payer: Priority Health SBD	$81.67
Rate for Payer: Priority Health SBD	$166.05

PALONOSETRON 250 MCG + DEXAMETHASONE 10 MG IVPB (PREMIX)

Facility

$298.74

Service Code	HCPCS J2469
Hospital Charge Code	301168
Hospital Revenue Code	636
Min. Negotiated Rate	$188.21
Max. Negotiated Rate	$268.87
Rate for Payer: Aetna Commercial	$253.93
Rate for Payer: Aetna New Business (MI Preferred)	$194.18
Rate for Payer: Cash Price	$238.99
Rate for Payer: Cofinity Commercial	$209.12
Rate for Payer: Cofinity Commercial	$256.92
Rate for Payer: Cofinity Medicare Advantage	$209.12
Rate for Payer: Encore Health Key Benefits Commercial	$238.99
Rate for Payer: Healthscope Commercial	$268.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$253.93
Rate for Payer: PHP Commercial	$253.93
Rate for Payer: Priority Health Cigna Priority Health	$194.18
Rate for Payer: Priority Health SBD	$188.21

PALONOSETRON 250 MCG + DEXAMETHASONE 10 MG IVPB (PREMIX)

Facility

$298.74

Service Code	HCPCS J2469
Hospital Charge Code	301168
Hospital Revenue Code	636
Min. Negotiated Rate	$119.50
Max. Negotiated Rate	$268.87
Rate for Payer: Aetna Commercial	$253.93
Rate for Payer: Aetna Medicare	$149.37
Rate for Payer: Aetna New Business (MI Preferred)	$194.18
Rate for Payer: BCBS Complete	$119.50
Rate for Payer: Cash Price	$238.99
Rate for Payer: Cofinity Commercial	$209.12
Rate for Payer: Cofinity Commercial	$256.92
Rate for Payer: Cofinity Medicare Advantage	$209.12
Rate for Payer: Encore Health Key Benefits Commercial	$238.99
Rate for Payer: Healthscope Commercial	$268.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$253.93
Rate for Payer: PHP Commercial	$253.93
Rate for Payer: Priority Health Cigna Priority Health	$194.18
Rate for Payer: Priority Health SBD	$188.21

PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION

Facility

$59.55

Service Code	HCPCS J2430
Hospital Charge Code	32589
Hospital Revenue Code	250
Min. Negotiated Rate	$23.82
Max. Negotiated Rate	$53.59
Rate for Payer: Aetna Commercial	$50.62
Rate for Payer: Aetna Commercial	$32.42
Rate for Payer: Aetna Medicare	$19.07
Rate for Payer: Aetna Medicare	$29.77
Rate for Payer: Aetna New Business (MI Preferred)	$38.71
Rate for Payer: Aetna New Business (MI Preferred)	$24.79
Rate for Payer: BCBS Complete	$23.82
Rate for Payer: BCBS Complete	$15.26
Rate for Payer: Cash Price	$47.64
Rate for Payer: Cash Price	$30.51
Rate for Payer: Cofinity Commercial	$51.21
Rate for Payer: Cofinity Commercial	$26.70
Rate for Payer: Cofinity Commercial	$32.80
Rate for Payer: Cofinity Commercial	$41.69
Rate for Payer: Cofinity Medicare Advantage	$26.70
Rate for Payer: Cofinity Medicare Advantage	$41.69
Rate for Payer: Encore Health Key Benefits Commercial	$30.51
Rate for Payer: Encore Health Key Benefits Commercial	$47.64
Rate for Payer: Healthscope Commercial	$53.59
Rate for Payer: Healthscope Commercial	$34.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.42
Rate for Payer: PHP Commercial	$50.62
Rate for Payer: PHP Commercial	$32.42
Rate for Payer: Priority Health Cigna Priority Health	$24.79
Rate for Payer: Priority Health Cigna Priority Health	$38.71
Rate for Payer: Priority Health SBD	$24.03
Rate for Payer: Priority Health SBD	$37.52

PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION

Facility

$38.14

Service Code	HCPCS J2430
Hospital Charge Code	32589
Hospital Revenue Code	250
Min. Negotiated Rate	$24.03
Max. Negotiated Rate	$34.33
Rate for Payer: Aetna Commercial	$32.42
Rate for Payer: Aetna Commercial	$50.62
Rate for Payer: Aetna New Business (MI Preferred)	$24.79
Rate for Payer: Aetna New Business (MI Preferred)	$38.71
Rate for Payer: Cash Price	$30.51
Rate for Payer: Cash Price	$47.64
Rate for Payer: Cofinity Commercial	$26.70
Rate for Payer: Cofinity Commercial	$41.69
Rate for Payer: Cofinity Commercial	$51.21
Rate for Payer: Cofinity Commercial	$32.80
Rate for Payer: Cofinity Medicare Advantage	$41.69
Rate for Payer: Cofinity Medicare Advantage	$26.70
Rate for Payer: Encore Health Key Benefits Commercial	$30.51
Rate for Payer: Encore Health Key Benefits Commercial	$47.64
Rate for Payer: Healthscope Commercial	$34.33
Rate for Payer: Healthscope Commercial	$53.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.62
Rate for Payer: PHP Commercial	$32.42
Rate for Payer: PHP Commercial	$50.62
Rate for Payer: Priority Health Cigna Priority Health	$38.71
Rate for Payer: Priority Health Cigna Priority Health	$24.79
Rate for Payer: Priority Health SBD	$37.52
Rate for Payer: Priority Health SBD	$24.03

PAMIDRONATE 30 MG INTRAVENOUS SOLUTION

Facility

$64.05

Service Code	HCPCS J2430
Hospital Charge Code	10845
Hospital Revenue Code	636
Min. Negotiated Rate	$25.62
Max. Negotiated Rate	$57.65
Rate for Payer: Aetna Commercial	$54.44
Rate for Payer: Aetna Medicare	$32.02
Rate for Payer: Aetna New Business (MI Preferred)	$41.63
Rate for Payer: BCBS Complete	$25.62
Rate for Payer: Cash Price	$51.24
Rate for Payer: Cofinity Commercial	$44.84
Rate for Payer: Cofinity Commercial	$55.08
Rate for Payer: Cofinity Medicare Advantage	$44.84
Rate for Payer: Encore Health Key Benefits Commercial	$51.24
Rate for Payer: Healthscope Commercial	$57.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.44
Rate for Payer: PHP Commercial	$54.44
Rate for Payer: Priority Health Cigna Priority Health	$41.63
Rate for Payer: Priority Health SBD	$40.35

PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION

Facility

$7,930.15

Service Code	HCPCS J9303
Hospital Charge Code	77484
Hospital Revenue Code	636
Min. Negotiated Rate	$92.74
Max. Negotiated Rate	$7,137.14
Rate for Payer: Aetna Commercial	$6,740.63
Rate for Payer: Aetna Medicare	$179.95
Rate for Payer: Aetna New Business (MI Preferred)	$5,154.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$216.29
Rate for Payer: Amish Plain Church Group Commercial	$216.29
Rate for Payer: BCBS Complete	$97.38
Rate for Payer: BCBS MAPPO	$173.03
Rate for Payer: BCN Medicare Advantage	$173.03
Rate for Payer: Cash Price	$6,344.12
Rate for Payer: Cash Price	$6,344.12
Rate for Payer: Cofinity Commercial	$5,551.10
Rate for Payer: Cofinity Commercial	$6,819.93
Rate for Payer: Cofinity Medicare Advantage	$5,551.10
Rate for Payer: Encore Health Key Benefits Commercial	$6,344.12
Rate for Payer: Health Alliance Plan Medicare Advantage	$173.03
Rate for Payer: Healthscope Commercial	$7,137.14
Rate for Payer: Mclaren Medicaid	$92.74
Rate for Payer: Mclaren Medicare	$173.03
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$181.68
Rate for Payer: Meridian Medicaid	$97.38
Rate for Payer: MI Amish Medical Board Commercial	$198.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,740.63
Rate for Payer: PACE Medicare	$164.38
Rate for Payer: PACE SWMI	$173.03
Rate for Payer: PHP Commercial	$6,740.63
Rate for Payer: PHP Medicare Advantage	$173.03
Rate for Payer: Priority Health Choice Medicaid	$92.74
Rate for Payer: Priority Health Cigna Priority Health	$5,154.60
Rate for Payer: Priority Health Medicare	$173.03
Rate for Payer: Priority Health SBD	$4,995.99
Rate for Payer: Railroad Medicare Medicare	$173.03
Rate for Payer: UHC All Payor (Choice/PPO)	$487.06
Rate for Payer: UHC Dual Complete DSNP	$173.03
Rate for Payer: UHC Medicare Advantage	$173.03
Rate for Payer: UHCCP Medicaid	$97.42
Rate for Payer: VA VA	$173.03

PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION

Facility

$7,930.15

Service Code	HCPCS J9303
Hospital Charge Code	77484
Hospital Revenue Code	636
Min. Negotiated Rate	$4,995.99
Max. Negotiated Rate	$7,137.14
Rate for Payer: Aetna Commercial	$6,740.63
Rate for Payer: Aetna New Business (MI Preferred)	$5,154.60
Rate for Payer: Cash Price	$6,344.12
Rate for Payer: Cofinity Commercial	$5,551.10
Rate for Payer: Cofinity Commercial	$6,819.93
Rate for Payer: Cofinity Medicare Advantage	$5,551.10
Rate for Payer: Encore Health Key Benefits Commercial	$6,344.12
Rate for Payer: Healthscope Commercial	$7,137.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,740.63
Rate for Payer: PHP Commercial	$6,740.63
Rate for Payer: Priority Health Cigna Priority Health	$5,154.60
Rate for Payer: Priority Health SBD	$4,995.99

Know your out-of-pocket cost for care.

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