|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 66993006851
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Aetna Medicare |
$1.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.40
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS MAPPO |
$1.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.67
|
| Rate for Payer: BCN Commercial |
$3.48
|
| Rate for Payer: BCN Medicare Advantage |
$1.12
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.12
|
| Rate for Payer: Healthscope Commercial |
$4.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.80
|
| Rate for Payer: Nomi Health Commercial |
$3.67
|
| Rate for Payer: PACE Senior Care Partners |
$1.06
|
| Rate for Payer: PACE SWMI |
$1.12
|
| Rate for Payer: PHP Commercial |
$3.80
|
| Rate for Payer: PHP Medicare Advantage |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.91
|
| Rate for Payer: Priority Health HMO/PPO |
$3.89
|
| Rate for Payer: Priority Health Medicare |
$1.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC Core |
$3.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.12
|
| Rate for Payer: UHC Exchange |
$1.12
|
| Rate for Payer: UHC Medicare Advantage |
$1.12
|
| Rate for Payer: VA VA |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.35
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$120.56
|
|
|
Service Code
|
NDC 65862056090
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.63 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$31.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.67
|
| Rate for Payer: BCBS Complete |
$48.22
|
| Rate for Payer: BCBS MAPPO |
$30.14
|
| Rate for Payer: BCBS Trust/PPO |
$99.11
|
| Rate for Payer: BCN Commercial |
$93.74
|
| Rate for Payer: BCN Medicare Advantage |
$30.14
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.14
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: Nomi Health Commercial |
$98.86
|
| Rate for Payer: PACE Senior Care Partners |
$28.63
|
| Rate for Payer: PACE SWMI |
$30.14
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: PHP Medicare Advantage |
$30.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| Rate for Payer: Priority Health HMO/PPO |
$104.89
|
| Rate for Payer: Priority Health Medicare |
$30.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.78
|
| Rate for Payer: Railroad Medicare Medicare |
$30.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.09
|
| Rate for Payer: UHC Core |
$100.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.14
|
| Rate for Payer: UHC Exchange |
$30.14
|
| Rate for Payer: UHC Medicare Advantage |
$30.14
|
| Rate for Payer: VA VA |
$30.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 63739056410
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna Medicare |
$57.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.47
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: BCBS MAPPO |
$55.58
|
| Rate for Payer: BCBS Trust/PPO |
$182.75
|
| Rate for Payer: BCN Commercial |
$172.84
|
| Rate for Payer: BCN Medicare Advantage |
$55.58
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.58
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Nomi Health Commercial |
$182.29
|
| Rate for Payer: PACE Senior Care Partners |
$52.80
|
| Rate for Payer: PACE SWMI |
$55.58
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: PHP Medicare Advantage |
$55.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health HMO/PPO |
$193.40
|
| Rate for Payer: Priority Health Medicare |
$56.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.94
|
| Rate for Payer: Railroad Medicare Medicare |
$55.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.62
|
| Rate for Payer: UHC Core |
$185.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.58
|
| Rate for Payer: UHC Exchange |
$55.58
|
| Rate for Payer: UHC Medicare Advantage |
$55.58
|
| Rate for Payer: VA VA |
$55.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$270.72
|
|
|
Service Code
|
NDC 00904687045
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.97 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: BCBS Trust/PPO |
$220.99
|
| Rate for Payer: BCN Commercial |
$209.21
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Nomi Health Commercial |
$221.99
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.97
|
| Rate for Payer: Priority Health HMO/PPO |
$235.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.23
|
| Rate for Payer: UHC Core |
$226.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
OP
|
$357.20
|
|
|
Service Code
|
NDC 00904567661
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.83 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna Medicare |
$92.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.62
|
| Rate for Payer: BCBS Complete |
$142.88
|
| Rate for Payer: BCBS MAPPO |
$89.30
|
| Rate for Payer: BCBS Trust/PPO |
$293.65
|
| Rate for Payer: BCN Commercial |
$277.72
|
| Rate for Payer: BCN Medicare Advantage |
$89.30
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.30
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: Nomi Health Commercial |
$292.90
|
| Rate for Payer: PACE Senior Care Partners |
$84.83
|
| Rate for Payer: PACE SWMI |
$89.30
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: PHP Medicare Advantage |
$89.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health HMO/PPO |
$310.76
|
| Rate for Payer: Priority Health Medicare |
$90.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.32
|
| Rate for Payer: Railroad Medicare Medicare |
$89.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.34
|
| Rate for Payer: UHC Core |
$298.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.30
|
| Rate for Payer: UHC Exchange |
$89.30
|
| Rate for Payer: UHC Medicare Advantage |
$89.30
|
| Rate for Payer: VA VA |
$89.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
OP
|
$74.73
|
|
|
Service Code
|
NDC 00378700193
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$67.26 |
| Rate for Payer: Aetna Commercial |
$63.52
|
| Rate for Payer: Aetna Medicare |
$19.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.35
|
| Rate for Payer: BCBS Complete |
$29.89
|
| Rate for Payer: BCBS MAPPO |
$18.68
|
| Rate for Payer: BCBS Trust/PPO |
$61.44
|
| Rate for Payer: BCN Commercial |
$58.10
|
| Rate for Payer: BCN Medicare Advantage |
$18.68
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cofinity Commercial |
$64.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$67.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.52
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: PACE Senior Care Partners |
$17.75
|
| Rate for Payer: PACE SWMI |
$18.68
|
| Rate for Payer: PHP Commercial |
$63.52
|
| Rate for Payer: PHP Medicare Advantage |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.57
|
| Rate for Payer: Priority Health HMO/PPO |
$65.02
|
| Rate for Payer: Priority Health Medicare |
$18.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.07
|
| Rate for Payer: Railroad Medicare Medicare |
$18.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.76
|
| Rate for Payer: UHC Core |
$62.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.68
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$18.68
|
| Rate for Payer: VA VA |
$18.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.05
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$74.73
|
|
|
Service Code
|
NDC 00378700193
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.57 |
| Max. Negotiated Rate |
$67.26 |
| Rate for Payer: Aetna Commercial |
$63.52
|
| Rate for Payer: BCBS Trust/PPO |
$61.00
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cofinity Commercial |
$64.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.78
|
| Rate for Payer: Healthscope Commercial |
$67.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.52
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: PHP Commercial |
$63.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.57
|
| Rate for Payer: Priority Health HMO/PPO |
$65.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.76
|
| Rate for Payer: UHC Core |
$62.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.05
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 00904567661
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.18 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: BCBS Trust/PPO |
$291.58
|
| Rate for Payer: BCN Commercial |
$276.04
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: Nomi Health Commercial |
$292.90
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health HMO/PPO |
$310.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.34
|
| Rate for Payer: UHC Core |
$298.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TARSAL OR METATARSAL BONE, EXCEPT TALUS OR CALCANEUS
|
Facility
|
OP
|
$2,463.31
|
|
|
Service Code
|
CPT 28122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,345.85 |
| Max. Negotiated Rate |
$2,463.31 |
| Rate for Payer: BCBS Complete |
$2,463.31
|
| Rate for Payer: Mclaren Medicaid |
$2,345.85
|
| Rate for Payer: Meridian Medicaid |
$2,463.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,345.85
|
| Rate for Payer: UHCCP Medicaid |
$2,345.85
|
|
|
PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING
|
Facility
|
OP
|
$2,413.90
|
|
|
Service Code
|
CPT 56700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.80 |
| Max. Negotiated Rate |
$2,413.90 |
| Rate for Payer: BCBS Complete |
$2,413.90
|
| Rate for Payer: Mclaren Medicaid |
$2,298.80
|
| Rate for Payer: Meridian Medicaid |
$2,413.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.80
|
| Rate for Payer: UHCCP Medicaid |
$2,298.80
|
|
|
PEDS ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$1,384.11
|
|
|
Service Code
|
HCPCS C8922
|
| Hospital Charge Code |
48000029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$328.73 |
| Max. Negotiated Rate |
$1,245.70 |
| Rate for Payer: Aetna Commercial |
$1,176.49
|
| Rate for Payer: Aetna Medicare |
$359.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$432.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$432.53
|
| Rate for Payer: BCBS Complete |
$599.81
|
| Rate for Payer: BCBS MAPPO |
$346.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.88
|
| Rate for Payer: BCN Commercial |
$1,076.15
|
| Rate for Payer: BCN Medicare Advantage |
$346.03
|
| Rate for Payer: Cash Price |
$1,107.29
|
| Rate for Payer: Cash Price |
$1,107.29
|
| Rate for Payer: Cofinity Commercial |
$1,190.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,107.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.03
|
| Rate for Payer: Healthscope Commercial |
$1,245.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.08
|
| Rate for Payer: Mclaren Medicaid |
$571.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.33
|
| Rate for Payer: Meridian Medicaid |
$599.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$397.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,176.49
|
| Rate for Payer: Nomi Health Commercial |
$1,134.97
|
| Rate for Payer: PACE Senior Care Partners |
$328.73
|
| Rate for Payer: PACE SWMI |
$346.03
|
| Rate for Payer: PHP Commercial |
$1,176.49
|
| Rate for Payer: PHP Medicare Advantage |
$346.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.67
|
| Rate for Payer: Priority Health HMO/PPO |
$1,204.18
|
| Rate for Payer: Priority Health Medicare |
$349.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$927.35
|
| Rate for Payer: Railroad Medicare Medicare |
$346.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,218.02
|
| Rate for Payer: UHC Core |
$1,155.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.03
|
| Rate for Payer: UHC Exchange |
$346.03
|
| Rate for Payer: UHC Medicare Advantage |
$346.03
|
| Rate for Payer: UHCCP Medicaid |
$571.21
|
| Rate for Payer: VA VA |
$346.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.08
|
|
|
PEDS ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$1,384.11
|
|
|
Service Code
|
HCPCS C8922
|
| Hospital Charge Code |
48000029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$899.67 |
| Max. Negotiated Rate |
$1,245.70 |
| Rate for Payer: Aetna Commercial |
$1,176.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,129.85
|
| Rate for Payer: BCN Commercial |
$1,069.64
|
| Rate for Payer: Cash Price |
$1,107.29
|
| Rate for Payer: Cofinity Commercial |
$1,190.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,107.29
|
| Rate for Payer: Healthscope Commercial |
$1,245.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,176.49
|
| Rate for Payer: Nomi Health Commercial |
$1,134.97
|
| Rate for Payer: PHP Commercial |
$1,176.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.67
|
| Rate for Payer: Priority Health HMO/PPO |
$1,204.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$927.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,218.02
|
| Rate for Payer: UHC Core |
$1,155.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.08
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
NDC 43386009019
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: BCBS Trust/PPO |
$45.71
|
| Rate for Payer: BCN Commercial |
$43.28
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO |
$48.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$46.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
NDC 43386009019
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.50
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.04
|
| Rate for Payer: BCN Commercial |
$43.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.00
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.00
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: PACE Senior Care Partners |
$13.30
|
| Rate for Payer: PACE SWMI |
$14.00
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: PHP Medicare Advantage |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO |
$48.72
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.52
|
| Rate for Payer: Railroad Medicare Medicare |
$14.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$46.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.00
|
| Rate for Payer: UHC Exchange |
$14.00
|
| Rate for Payer: UHC Medicare Advantage |
$14.00
|
| Rate for Payer: VA VA |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
IP
|
$9.52
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$8.09
|
| Rate for Payer: BCBS Trust/PPO |
$7.77
|
| Rate for Payer: BCN Commercial |
$7.36
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.62
|
| Rate for Payer: Healthscope Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.09
|
| Rate for Payer: Nomi Health Commercial |
$7.81
|
| Rate for Payer: PHP Commercial |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.19
|
| Rate for Payer: Priority Health HMO/PPO |
$8.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC Core |
$7.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.14
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
OP
|
$29.04
|
|
|
Service Code
|
NDC 42002020705
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna Commercial |
$24.68
|
| Rate for Payer: Aetna Medicare |
$7.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.07
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS MAPPO |
$7.26
|
| Rate for Payer: BCBS Trust/PPO |
$23.87
|
| Rate for Payer: BCN Commercial |
$22.58
|
| Rate for Payer: BCN Medicare Advantage |
$7.26
|
| Rate for Payer: Cash Price |
$23.23
|
| Rate for Payer: Cofinity Commercial |
$24.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.26
|
| Rate for Payer: Healthscope Commercial |
$26.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.68
|
| Rate for Payer: Nomi Health Commercial |
$23.81
|
| Rate for Payer: PACE Senior Care Partners |
$6.90
|
| Rate for Payer: PACE SWMI |
$7.26
|
| Rate for Payer: PHP Commercial |
$24.68
|
| Rate for Payer: PHP Medicare Advantage |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
| Rate for Payer: Priority Health HMO/PPO |
$25.26
|
| Rate for Payer: Priority Health Medicare |
$7.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.46
|
| Rate for Payer: Railroad Medicare Medicare |
$7.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.56
|
| Rate for Payer: UHC Core |
$24.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.26
|
| Rate for Payer: UHC Exchange |
$7.26
|
| Rate for Payer: UHC Medicare Advantage |
$7.26
|
| Rate for Payer: VA VA |
$7.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.78
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
IP
|
$29.04
|
|
|
Service Code
|
NDC 42002020705
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.88 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna Commercial |
$24.68
|
| Rate for Payer: BCBS Trust/PPO |
$23.71
|
| Rate for Payer: BCN Commercial |
$22.44
|
| Rate for Payer: Cash Price |
$23.23
|
| Rate for Payer: Cofinity Commercial |
$24.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.23
|
| Rate for Payer: Healthscope Commercial |
$26.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.68
|
| Rate for Payer: Nomi Health Commercial |
$23.81
|
| Rate for Payer: PHP Commercial |
$24.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
| Rate for Payer: Priority Health HMO/PPO |
$25.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.56
|
| Rate for Payer: UHC Core |
$24.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.78
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
OP
|
$9.52
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$8.09
|
| Rate for Payer: Aetna Medicare |
$2.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.98
|
| Rate for Payer: BCBS Complete |
$3.81
|
| Rate for Payer: BCBS MAPPO |
$2.38
|
| Rate for Payer: BCBS Trust/PPO |
$7.83
|
| Rate for Payer: BCN Commercial |
$7.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.38
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.09
|
| Rate for Payer: Nomi Health Commercial |
$7.81
|
| Rate for Payer: PACE Senior Care Partners |
$2.26
|
| Rate for Payer: PACE SWMI |
$2.38
|
| Rate for Payer: PHP Commercial |
$8.09
|
| Rate for Payer: PHP Medicare Advantage |
$2.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.19
|
| Rate for Payer: Priority Health HMO/PPO |
$8.28
|
| Rate for Payer: Priority Health Medicare |
$2.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC Core |
$7.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.38
|
| Rate for Payer: UHC Exchange |
$2.38
|
| Rate for Payer: UHC Medicare Advantage |
$2.38
|
| Rate for Payer: VA VA |
$2.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.14
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$9,392.27
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.59 |
| Max. Negotiated Rate |
$8,453.04 |
| Rate for Payer: Aetna Commercial |
$7,983.43
|
| Rate for Payer: Aetna Medicare |
$2,441.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,935.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,935.08
|
| Rate for Payer: BCBS Complete |
$67.83
|
| Rate for Payer: BCBS MAPPO |
$2,348.07
|
| Rate for Payer: BCBS Trust/PPO |
$7,721.39
|
| Rate for Payer: BCN Commercial |
$7,302.49
|
| Rate for Payer: BCN Medicare Advantage |
$2,348.07
|
| Rate for Payer: Cash Price |
$7,513.82
|
| Rate for Payer: Cash Price |
$7,513.82
|
| Rate for Payer: Cofinity Commercial |
$8,077.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,513.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,348.07
|
| Rate for Payer: Healthscope Commercial |
$8,453.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,044.20
|
| Rate for Payer: Mclaren Medicaid |
$64.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,465.47
|
| Rate for Payer: Meridian Medicaid |
$67.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,700.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,983.43
|
| Rate for Payer: Nomi Health Commercial |
$7,701.66
|
| Rate for Payer: PACE Senior Care Partners |
$2,230.66
|
| Rate for Payer: PACE SWMI |
$2,348.07
|
| Rate for Payer: PHP Commercial |
$7,983.43
|
| Rate for Payer: PHP Medicare Advantage |
$2,348.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,104.98
|
| Rate for Payer: Priority Health HMO/PPO |
$8,171.27
|
| Rate for Payer: Priority Health Medicare |
$2,371.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,292.82
|
| Rate for Payer: Railroad Medicare Medicare |
$2,348.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,265.20
|
| Rate for Payer: UHC Core |
$7,842.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,348.07
|
| Rate for Payer: UHC Exchange |
$2,348.07
|
| Rate for Payer: UHC Medicare Advantage |
$2,348.07
|
| Rate for Payer: UHCCP Medicaid |
$64.59
|
| Rate for Payer: VA VA |
$2,348.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,044.20
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$9,392.27
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,104.98 |
| Max. Negotiated Rate |
$8,453.04 |
| Rate for Payer: Aetna Commercial |
$7,983.43
|
| Rate for Payer: BCBS Trust/PPO |
$7,666.91
|
| Rate for Payer: BCN Commercial |
$7,258.35
|
| Rate for Payer: Cash Price |
$7,513.82
|
| Rate for Payer: Cofinity Commercial |
$8,077.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,513.82
|
| Rate for Payer: Healthscope Commercial |
$8,453.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,044.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,983.43
|
| Rate for Payer: Nomi Health Commercial |
$7,701.66
|
| Rate for Payer: PHP Commercial |
$7,983.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,104.98
|
| Rate for Payer: Priority Health HMO/PPO |
$8,171.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,292.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,265.20
|
| Rate for Payer: UHC Core |
$7,842.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,044.20
|
|
|
PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$2,413.90
|
|
|
Service Code
|
CPT 57410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.80 |
| Max. Negotiated Rate |
$2,413.90 |
| Rate for Payer: BCBS Complete |
$2,413.90
|
| Rate for Payer: Mclaren Medicaid |
$2,298.80
|
| Rate for Payer: Meridian Medicaid |
$2,413.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.80
|
| Rate for Payer: UHCCP Medicaid |
$2,298.80
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$998.34
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$648.92 |
| Max. Negotiated Rate |
$898.51 |
| Rate for Payer: Aetna Commercial |
$848.59
|
| Rate for Payer: BCBS Trust/PPO |
$814.94
|
| Rate for Payer: BCN Commercial |
$771.52
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cofinity Commercial |
$858.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$798.67
|
| Rate for Payer: Healthscope Commercial |
$898.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$748.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.59
|
| Rate for Payer: Nomi Health Commercial |
$818.64
|
| Rate for Payer: PHP Commercial |
$848.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.92
|
| Rate for Payer: Priority Health HMO/PPO |
$868.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$668.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$878.54
|
| Rate for Payer: UHC Core |
$833.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$748.75
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$998.34
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$898.51 |
| Rate for Payer: Aetna Commercial |
$848.59
|
| Rate for Payer: Aetna Medicare |
$259.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.98
|
| Rate for Payer: BCBS Complete |
$22.78
|
| Rate for Payer: BCBS MAPPO |
$249.59
|
| Rate for Payer: BCBS Trust/PPO |
$820.74
|
| Rate for Payer: BCN Commercial |
$776.21
|
| Rate for Payer: BCN Medicare Advantage |
$249.59
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cofinity Commercial |
$858.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$798.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.59
|
| Rate for Payer: Healthscope Commercial |
$898.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$748.75
|
| Rate for Payer: Mclaren Medicaid |
$21.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$262.06
|
| Rate for Payer: Meridian Medicaid |
$22.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.59
|
| Rate for Payer: Nomi Health Commercial |
$818.64
|
| Rate for Payer: PACE Senior Care Partners |
$237.11
|
| Rate for Payer: PACE SWMI |
$249.59
|
| Rate for Payer: PHP Commercial |
$848.59
|
| Rate for Payer: PHP Medicare Advantage |
$249.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.92
|
| Rate for Payer: Priority Health HMO/PPO |
$868.56
|
| Rate for Payer: Priority Health Medicare |
$252.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$668.89
|
| Rate for Payer: Railroad Medicare Medicare |
$249.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$878.54
|
| Rate for Payer: UHC Core |
$833.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.59
|
| Rate for Payer: UHC Exchange |
$249.59
|
| Rate for Payer: UHC Medicare Advantage |
$249.59
|
| Rate for Payer: UHCCP Medicaid |
$21.70
|
| Rate for Payer: VA VA |
$249.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$748.75
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$18.34
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna Medicare |
$4.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.73
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS MAPPO |
$4.58
|
| Rate for Payer: BCBS Trust/PPO |
$15.08
|
| Rate for Payer: BCN Commercial |
$14.26
|
| Rate for Payer: BCN Medicare Advantage |
$4.58
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.58
|
| Rate for Payer: Healthscope Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.59
|
| Rate for Payer: Nomi Health Commercial |
$15.04
|
| Rate for Payer: PACE Senior Care Partners |
$4.36
|
| Rate for Payer: PACE SWMI |
$4.58
|
| Rate for Payer: PHP Commercial |
$15.59
|
| Rate for Payer: PHP Medicare Advantage |
$4.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.92
|
| Rate for Payer: Priority Health HMO/PPO |
$15.96
|
| Rate for Payer: Priority Health Medicare |
$4.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.29
|
| Rate for Payer: Railroad Medicare Medicare |
$4.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.14
|
| Rate for Payer: UHC Core |
$15.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.58
|
| Rate for Payer: UHC Exchange |
$4.58
|
| Rate for Payer: UHC Medicare Advantage |
$4.58
|
| Rate for Payer: VA VA |
$4.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.76
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$18.34
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: BCBS Trust/PPO |
$14.97
|
| Rate for Payer: BCN Commercial |
$14.17
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.59
|
| Rate for Payer: Nomi Health Commercial |
$15.04
|
| Rate for Payer: PHP Commercial |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.92
|
| Rate for Payer: Priority Health HMO/PPO |
$15.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.14
|
| Rate for Payer: UHC Core |
$15.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.76
|
|
