|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$638.58
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$280.98 |
| Max. Negotiated Rate |
$574.72 |
| Rate for Payer: Aetna American Axle |
$415.08
|
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna American Axle |
$95.71
|
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: Aetna Commercial |
$125.16
|
| Rate for Payer: Aetna Commercial |
$542.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.71
|
| Rate for Payer: Cash Price |
$117.80
|
| Rate for Payer: Cash Price |
$510.86
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Cofinity Commercial |
$126.64
|
| Rate for Payer: Cofinity Commercial |
$447.01
|
| Rate for Payer: Cofinity Commercial |
$549.18
|
| Rate for Payer: Cofinity Commercial |
$21.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.86
|
| Rate for Payer: Healthscope Commercial |
$574.72
|
| Rate for Payer: Healthscope Commercial |
$132.52
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$447.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$478.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$542.79
|
| Rate for Payer: PHP Commercial |
$542.79
|
| Rate for Payer: PHP Commercial |
$21.06
|
| Rate for Payer: PHP Commercial |
$125.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.01
|
| Rate for Payer: Priority Health SBD |
$15.61
|
| Rate for Payer: Priority Health SBD |
$92.77
|
| Rate for Payer: Priority Health SBD |
$402.31
|
| Rate for Payer: UMR Bronson Commercial |
$64.79
|
| Rate for Payer: UMR Bronson Commercial |
$280.98
|
| Rate for Payer: UMR Bronson Commercial |
$10.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$478.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.58
|
|
|
OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
115673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
IP
|
$463.82
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
10843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.08 |
| Max. Negotiated Rate |
$417.44 |
| Rate for Payer: Aetna American Axle |
$301.48
|
| Rate for Payer: Aetna American Axle |
$159.50
|
| Rate for Payer: Aetna American Axle |
$307.54
|
| Rate for Payer: Aetna American Axle |
$267.59
|
| Rate for Payer: Aetna American Axle |
$397.43
|
| Rate for Payer: Aetna Commercial |
$519.72
|
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna Commercial |
$394.25
|
| Rate for Payer: Aetna Commercial |
$208.58
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.59
|
| Rate for Payer: Cash Price |
$371.06
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cash Price |
$196.31
|
| Rate for Payer: Cash Price |
$489.14
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cofinity Commercial |
$288.18
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Cofinity Commercial |
$211.04
|
| Rate for Payer: Cofinity Commercial |
$171.77
|
| Rate for Payer: Cofinity Commercial |
$324.67
|
| Rate for Payer: Cofinity Commercial |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$525.83
|
| Rate for Payer: Cofinity Commercial |
$428.00
|
| Rate for Payer: Cofinity Commercial |
$398.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.14
|
| Rate for Payer: Healthscope Commercial |
$550.29
|
| Rate for Payer: Healthscope Commercial |
$417.44
|
| Rate for Payer: Healthscope Commercial |
$220.85
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$519.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$349.93
|
| Rate for Payer: PHP Commercial |
$519.72
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: PHP Commercial |
$394.25
|
| Rate for Payer: PHP Commercial |
$208.58
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.67
|
| Rate for Payer: Priority Health SBD |
$154.60
|
| Rate for Payer: Priority Health SBD |
$259.36
|
| Rate for Payer: Priority Health SBD |
$292.21
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$385.20
|
| Rate for Payer: UMR Bronson Commercial |
$107.97
|
| Rate for Payer: UMR Bronson Commercial |
$181.14
|
| Rate for Payer: UMR Bronson Commercial |
$208.18
|
| Rate for Payer: UMR Bronson Commercial |
$204.08
|
| Rate for Payer: UMR Bronson Commercial |
$269.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.86
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
OP
|
$1,112.32
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
10843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1,001.09 |
| Rate for Payer: Aetna American Axle |
$723.01
|
| Rate for Payer: Aetna American Axle |
$307.54
|
| Rate for Payer: Aetna American Axle |
$296.82
|
| Rate for Payer: Aetna American Axle |
$173.13
|
| Rate for Payer: Aetna American Axle |
$204.21
|
| Rate for Payer: Aetna American Axle |
$328.30
|
| Rate for Payer: Aetna American Axle |
$301.48
|
| Rate for Payer: Aetna Commercial |
$226.40
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna Commercial |
$388.14
|
| Rate for Payer: Aetna Commercial |
$429.31
|
| Rate for Payer: Aetna Commercial |
$945.47
|
| Rate for Payer: Aetna Commercial |
$267.04
|
| Rate for Payer: Aetna Commercial |
$394.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$723.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.48
|
| Rate for Payer: BCBS Complete |
$185.53
|
| Rate for Payer: BCBS Complete |
$182.66
|
| Rate for Payer: BCBS Complete |
$444.93
|
| Rate for Payer: BCBS Complete |
$202.03
|
| Rate for Payer: BCBS Complete |
$189.26
|
| Rate for Payer: BCBS Complete |
$106.54
|
| Rate for Payer: BCBS Complete |
$125.67
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: Cash Price |
$251.34
|
| Rate for Payer: Cash Price |
$889.86
|
| Rate for Payer: Cash Price |
$889.86
|
| Rate for Payer: Cash Price |
$251.34
|
| Rate for Payer: Cash Price |
$365.31
|
| Rate for Payer: Cash Price |
$371.06
|
| Rate for Payer: Cash Price |
$213.08
|
| Rate for Payer: Cash Price |
$213.08
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$371.06
|
| Rate for Payer: Cash Price |
$365.31
|
| Rate for Payer: Cash Price |
$404.06
|
| Rate for Payer: Cash Price |
$404.06
|
| Rate for Payer: Cofinity Commercial |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$778.62
|
| Rate for Payer: Cofinity Commercial |
$956.60
|
| Rate for Payer: Cofinity Commercial |
$186.44
|
| Rate for Payer: Cofinity Commercial |
$229.06
|
| Rate for Payer: Cofinity Commercial |
$219.92
|
| Rate for Payer: Cofinity Commercial |
$270.19
|
| Rate for Payer: Cofinity Commercial |
$319.65
|
| Rate for Payer: Cofinity Commercial |
$392.71
|
| Rate for Payer: Cofinity Commercial |
$434.36
|
| Rate for Payer: Cofinity Commercial |
$324.67
|
| Rate for Payer: Cofinity Commercial |
$398.89
|
| Rate for Payer: Cofinity Commercial |
$353.55
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.08
|
| Rate for Payer: Healthscope Commercial |
$1,001.09
|
| Rate for Payer: Healthscope Commercial |
$417.44
|
| Rate for Payer: Healthscope Commercial |
$454.56
|
| Rate for Payer: Healthscope Commercial |
$282.75
|
| Rate for Payer: Healthscope Commercial |
$410.98
|
| Rate for Payer: Healthscope Commercial |
$239.72
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$834.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$388.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$945.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$429.31
|
| Rate for Payer: PHP Commercial |
$394.25
|
| Rate for Payer: PHP Commercial |
$429.31
|
| Rate for Payer: PHP Commercial |
$388.14
|
| Rate for Payer: PHP Commercial |
$226.40
|
| Rate for Payer: PHP Commercial |
$267.04
|
| Rate for Payer: PHP Commercial |
$945.47
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.44
|
| Rate for Payer: Priority Health SBD |
$700.76
|
| Rate for Payer: Priority Health SBD |
$318.19
|
| Rate for Payer: Priority Health SBD |
$197.93
|
| Rate for Payer: Priority Health SBD |
$167.80
|
| Rate for Payer: Priority Health SBD |
$292.21
|
| Rate for Payer: Priority Health SBD |
$287.68
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: UMR Bronson Commercial |
$98.55
|
| Rate for Payer: UMR Bronson Commercial |
$411.56
|
| Rate for Payer: UMR Bronson Commercial |
$116.24
|
| Rate for Payer: UMR Bronson Commercial |
$168.96
|
| Rate for Payer: UMR Bronson Commercial |
$171.61
|
| Rate for Payer: UMR Bronson Commercial |
$175.06
|
| Rate for Payer: UMR Bronson Commercial |
$186.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$834.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.80
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$6,917.12
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
40475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$6,225.41 |
| Rate for Payer: Aetna American Axle |
$4,496.13
|
| Rate for Payer: Aetna American Axle |
$3,911.20
|
| Rate for Payer: Aetna Commercial |
$5,114.65
|
| Rate for Payer: Aetna Commercial |
$5,879.55
|
| Rate for Payer: Aetna Medicare |
$14.87
|
| Rate for Payer: Aetna Medicare |
$14.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,911.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,496.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.87
|
| Rate for Payer: BCBS Complete |
$8.21
|
| Rate for Payer: BCBS Complete |
$8.21
|
| Rate for Payer: BCBS MAPPO |
$14.29
|
| Rate for Payer: BCBS MAPPO |
$14.29
|
| Rate for Payer: BCBS Trust/PPO |
$46.18
|
| Rate for Payer: BCBS Trust/PPO |
$46.18
|
| Rate for Payer: BCN Medicare Advantage |
$14.29
|
| Rate for Payer: BCN Medicare Advantage |
$14.29
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cash Price |
$4,813.78
|
| Rate for Payer: Cash Price |
$4,813.78
|
| Rate for Payer: Cofinity Commercial |
$5,174.82
|
| Rate for Payer: Cofinity Commercial |
$4,212.06
|
| Rate for Payer: Cofinity Commercial |
$4,841.98
|
| Rate for Payer: Cofinity Commercial |
$5,948.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,533.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.29
|
| Rate for Payer: Healthscope Commercial |
$5,415.51
|
| Rate for Payer: Healthscope Commercial |
$6,225.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,841.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,212.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,512.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,187.84
|
| Rate for Payer: Mclaren Medicaid |
$7.82
|
| Rate for Payer: Mclaren Medicaid |
$7.82
|
| Rate for Payer: Mclaren Medicare |
$14.29
|
| Rate for Payer: Mclaren Medicare |
$14.29
|
| Rate for Payer: Meridian Medicaid |
$8.21
|
| Rate for Payer: Meridian Medicaid |
$8.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,114.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,879.55
|
| Rate for Payer: PACE Medicare |
$13.58
|
| Rate for Payer: PACE Medicare |
$13.58
|
| Rate for Payer: PACE SWMI |
$14.29
|
| Rate for Payer: PACE SWMI |
$14.29
|
| Rate for Payer: PHP Commercial |
$5,879.55
|
| Rate for Payer: PHP Commercial |
$5,114.65
|
| Rate for Payer: PHP Medicare Advantage |
$14.29
|
| Rate for Payer: PHP Medicare Advantage |
$14.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,212.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,841.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.42
|
| Rate for Payer: Priority Health Medicare |
$14.29
|
| Rate for Payer: Priority Health Medicare |
$14.29
|
| Rate for Payer: Priority Health Narrow Network |
$34.74
|
| Rate for Payer: Priority Health Narrow Network |
$34.74
|
| Rate for Payer: Priority Health SBD |
$3,790.85
|
| Rate for Payer: Priority Health SBD |
$4,357.79
|
| Rate for Payer: Railroad Medicare Medicare |
$14.29
|
| Rate for Payer: Railroad Medicare Medicare |
$14.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.29
|
| Rate for Payer: UHC Medicare Advantage |
$14.72
|
| Rate for Payer: UHC Medicare Advantage |
$14.72
|
| Rate for Payer: UMR Bronson Commercial |
$2,226.38
|
| Rate for Payer: UMR Bronson Commercial |
$2,559.33
|
| Rate for Payer: VA VA |
$14.29
|
| Rate for Payer: VA VA |
$14.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,512.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,187.84
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION
|
Facility
|
IP
|
$6,917.12
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
40475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,043.53 |
| Max. Negotiated Rate |
$6,225.41 |
| Rate for Payer: Aetna American Axle |
$4,496.13
|
| Rate for Payer: Aetna Commercial |
$5,879.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,496.13
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cofinity Commercial |
$5,948.72
|
| Rate for Payer: Cofinity Commercial |
$4,841.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,533.70
|
| Rate for Payer: Healthscope Commercial |
$6,225.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,841.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,187.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,879.55
|
| Rate for Payer: PHP Commercial |
$5,879.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,841.98
|
| Rate for Payer: Priority Health SBD |
$4,357.79
|
| Rate for Payer: UMR Bronson Commercial |
$3,043.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,187.84
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$6,363.77
|
|
|
Service Code
|
HCPCS J9259
|
| Hospital Charge Code |
40475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$5,727.39 |
| Rate for Payer: Aetna American Axle |
$4,136.45
|
| Rate for Payer: Aetna Commercial |
$5,409.20
|
| Rate for Payer: Aetna Medicare |
$16.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,136.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.32
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS MAPPO |
$15.45
|
| Rate for Payer: BCBS Trust/PPO |
$49.92
|
| Rate for Payer: BCN Medicare Advantage |
$15.45
|
| Rate for Payer: Cash Price |
$5,091.02
|
| Rate for Payer: Cash Price |
$5,091.02
|
| Rate for Payer: Cofinity Commercial |
$5,472.84
|
| Rate for Payer: Cofinity Commercial |
$4,454.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,091.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.45
|
| Rate for Payer: Healthscope Commercial |
$5,727.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,454.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,772.83
|
| Rate for Payer: Mclaren Medicaid |
$8.45
|
| Rate for Payer: Mclaren Medicare |
$15.45
|
| Rate for Payer: Meridian Medicaid |
$8.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,409.20
|
| Rate for Payer: PACE Medicare |
$14.68
|
| Rate for Payer: PACE SWMI |
$15.45
|
| Rate for Payer: PHP Commercial |
$5,409.20
|
| Rate for Payer: PHP Medicare Advantage |
$15.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,454.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.66
|
| Rate for Payer: Priority Health Medicare |
$15.45
|
| Rate for Payer: Priority Health Narrow Network |
$38.13
|
| Rate for Payer: Priority Health SBD |
$4,009.18
|
| Rate for Payer: Railroad Medicare Medicare |
$15.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.45
|
| Rate for Payer: UHC Medicare Advantage |
$15.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,354.59
|
| Rate for Payer: VA VA |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,772.83
|
|
|
PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY)
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 42145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$680.75 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$4,913.47
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.82
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$680.75
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
PALATOPLASTY FOR CLEFT PALATE; ATTACHMENT PHARYNGEAL FLAP
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 42225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$965.30 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,027.02
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,061.83
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$965.30
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; SOFT TISSUE ONLY
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 42205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$947.94 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,016.84
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,042.73
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$947.94
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; WITH BONE GRAFT TO ALVEOLAR RIDGE (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 42210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,057.97 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,531.52
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,163.77
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,057.97
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2,523.92
|
|
|
Service Code
|
NDC 0378-3978-93
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,110.52 |
| Max. Negotiated Rate |
$2,271.53 |
| Rate for Payer: Aetna American Axle |
$1,640.55
|
| Rate for Payer: Aetna Commercial |
$2,145.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,640.55
|
| Rate for Payer: Cash Price |
$2,019.14
|
| Rate for Payer: Cofinity Commercial |
$1,766.74
|
| Rate for Payer: Cofinity Commercial |
$2,170.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,019.14
|
| Rate for Payer: Healthscope Commercial |
$2,271.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,766.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,892.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,145.33
|
| Rate for Payer: PHP Commercial |
$2,145.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,766.74
|
| Rate for Payer: Priority Health SBD |
$1,590.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,110.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,892.94
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458-554-01
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$556.68 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna American Axle |
$822.37
|
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.14
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$885.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$948.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.63
|
| Rate for Payer: Priority Health SBD |
$797.06
|
| Rate for Payer: UMR Bronson Commercial |
$556.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$948.88
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458-550-01
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$556.68 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna American Axle |
$822.37
|
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.14
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$885.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$948.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.63
|
| Rate for Payer: Priority Health SBD |
$797.06
|
| Rate for Payer: UMR Bronson Commercial |
$556.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$948.88
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$223.67
|
|
|
Service Code
|
NDC 65162-281-03
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna American Axle |
$145.39
|
| 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: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.57
|
| Rate for Payer: Priority Health SBD |
$140.91
|
| Rate for Payer: UMR Bronson Commercial |
$98.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.75
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$232.13
|
|
|
Service Code
|
NDC 47335-765-83
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.14 |
| Max. Negotiated Rate |
$208.92 |
| Rate for Payer: Aetna American Axle |
$150.88
|
| Rate for Payer: Aetna Commercial |
$197.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.88
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cofinity Commercial |
$162.49
|
| Rate for Payer: Cofinity Commercial |
$199.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.70
|
| Rate for Payer: Healthscope Commercial |
$208.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.31
|
| Rate for Payer: PHP Commercial |
$197.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.49
|
| Rate for Payer: Priority Health SBD |
$146.24
|
| Rate for Payer: UMR Bronson Commercial |
$102.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.10
|
|
|
PALIPERIDONE PALMITATE 117 MG/0.75 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$4,882.31
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
119133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,148.22 |
| Max. Negotiated Rate |
$4,394.08 |
| Rate for Payer: Aetna American Axle |
$3,173.50
|
| Rate for Payer: Aetna Commercial |
$4,149.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,173.50
|
| Rate for Payer: Cash Price |
$3,905.85
|
| Rate for Payer: Cofinity Commercial |
$3,417.62
|
| Rate for Payer: Cofinity Commercial |
$4,198.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,905.85
|
| Rate for Payer: Healthscope Commercial |
$4,394.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,417.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,661.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,149.96
|
| Rate for Payer: PHP Commercial |
$4,149.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,417.62
|
| Rate for Payer: Priority Health SBD |
$3,075.86
|
| Rate for Payer: UMR Bronson Commercial |
$2,148.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,661.73
|
|
|
PALIPERIDONE PALMITATE 117 MG/0.75 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$4,882.31
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
119133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$4,394.08 |
| Rate for Payer: Aetna American Axle |
$3,173.50
|
| Rate for Payer: Aetna Commercial |
$4,149.96
|
| Rate for Payer: Aetna Medicare |
$14.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,173.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.90
|
| Rate for Payer: BCBS Complete |
$8.22
|
| Rate for Payer: BCBS MAPPO |
$14.32
|
| Rate for Payer: BCBS Trust/PPO |
$46.24
|
| Rate for Payer: BCN Medicare Advantage |
$14.32
|
| Rate for Payer: Cash Price |
$3,905.85
|
| Rate for Payer: Cash Price |
$3,905.85
|
| Rate for Payer: Cofinity Commercial |
$4,198.79
|
| Rate for Payer: Cofinity Commercial |
$3,417.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,905.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.32
|
| Rate for Payer: Healthscope Commercial |
$4,394.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,417.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,661.73
|
| Rate for Payer: Mclaren Medicaid |
$7.83
|
| Rate for Payer: Mclaren Medicare |
$14.32
|
| Rate for Payer: Meridian Medicaid |
$8.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,149.96
|
| Rate for Payer: PACE Medicare |
$13.60
|
| Rate for Payer: PACE SWMI |
$14.32
|
| Rate for Payer: PHP Commercial |
$4,149.96
|
| Rate for Payer: PHP Medicare Advantage |
$14.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,417.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.11
|
| Rate for Payer: Priority Health Medicare |
$14.32
|
| Rate for Payer: Priority Health Narrow Network |
$33.69
|
| Rate for Payer: Priority Health SBD |
$3,075.86
|
| Rate for Payer: Railroad Medicare Medicare |
$14.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.32
|
| Rate for Payer: UHC Medicare Advantage |
$14.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,806.45
|
| Rate for Payer: VA VA |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,661.73
|
|
|
PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$8,553.69
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
41675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,763.62 |
| Max. Negotiated Rate |
$7,698.32 |
| Rate for Payer: Aetna American Axle |
$5,559.90
|
| Rate for Payer: Aetna Commercial |
$7,270.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,559.90
|
| Rate for Payer: Cash Price |
$6,842.95
|
| Rate for Payer: Cofinity Commercial |
$5,987.58
|
| Rate for Payer: Cofinity Commercial |
$7,356.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,842.95
|
| Rate for Payer: Healthscope Commercial |
$7,698.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,987.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,415.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,270.64
|
| Rate for Payer: PHP Commercial |
$7,270.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,987.58
|
| Rate for Payer: Priority Health SBD |
$5,388.82
|
| Rate for Payer: UMR Bronson Commercial |
$3,763.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,415.27
|
|
|
PALIVIZUMAB 50 MG/0.5 ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$5,826.12
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
115944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,563.49 |
| Max. Negotiated Rate |
$5,243.51 |
| Rate for Payer: Aetna American Axle |
$3,786.98
|
| Rate for Payer: Aetna Commercial |
$4,952.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,786.98
|
| Rate for Payer: Cash Price |
$4,660.90
|
| Rate for Payer: Cofinity Commercial |
$4,078.28
|
| Rate for Payer: Cofinity Commercial |
$5,010.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,660.90
|
| Rate for Payer: Healthscope Commercial |
$5,243.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,078.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,369.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,952.20
|
| Rate for Payer: PHP Commercial |
$4,952.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,078.28
|
| Rate for Payer: Priority Health SBD |
$3,670.46
|
| Rate for Payer: UMR Bronson Commercial |
$2,563.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,369.59
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$223.04
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
36591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$200.74 |
| Rate for Payer: Aetna American Axle |
$144.98
|
| Rate for Payer: Aetna Commercial |
$189.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.98
|
| Rate for Payer: Cash Price |
$178.43
|
| Rate for Payer: Cofinity Commercial |
$156.13
|
| Rate for Payer: Cofinity Commercial |
$191.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.43
|
| Rate for Payer: Healthscope Commercial |
$200.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.58
|
| Rate for Payer: PHP Commercial |
$189.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.13
|
| Rate for Payer: Priority Health SBD |
$140.52
|
| Rate for Payer: UMR Bronson Commercial |
$98.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.28
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$223.04
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
36591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$200.74 |
| Rate for Payer: Aetna American Axle |
$144.98
|
| Rate for Payer: Aetna American Axle |
$121.39
|
| Rate for Payer: Aetna American Axle |
$67.29
|
| Rate for Payer: Aetna American Axle |
$103.80
|
| Rate for Payer: Aetna American Axle |
$151.12
|
| Rate for Payer: Aetna American Axle |
$179.76
|
| Rate for Payer: Aetna American Axle |
$301.95
|
| Rate for Payer: Aetna American Axle |
$607.82
|
| Rate for Payer: Aetna American Axle |
$89.68
|
| Rate for Payer: Aetna Commercial |
$235.07
|
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna Commercial |
$88.00
|
| Rate for Payer: Aetna Commercial |
$794.84
|
| Rate for Payer: Aetna Commercial |
$394.86
|
| Rate for Payer: Aetna Commercial |
$117.27
|
| Rate for Payer: Aetna Commercial |
$197.62
|
| Rate for Payer: Aetna Commercial |
$189.58
|
| Rate for Payer: Aetna Commercial |
$135.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.39
|
| Rate for Payer: BCBS Complete |
$41.41
|
| Rate for Payer: BCBS Complete |
$93.00
|
| Rate for Payer: BCBS Complete |
$110.62
|
| Rate for Payer: BCBS Complete |
$89.22
|
| Rate for Payer: BCBS Complete |
$185.82
|
| Rate for Payer: BCBS Complete |
$63.88
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS Complete |
$55.19
|
| Rate for Payer: BCBS Complete |
$374.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: Cash Price |
$127.76
|
| Rate for Payer: Cash Price |
$82.82
|
| Rate for Payer: Cash Price |
$82.82
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$127.76
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cash Price |
$178.43
|
| Rate for Payer: Cash Price |
$178.43
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$221.24
|
| Rate for Payer: Cash Price |
$221.24
|
| Rate for Payer: Cash Price |
$371.63
|
| Rate for Payer: Cash Price |
$371.63
|
| Rate for Payer: Cash Price |
$748.08
|
| Rate for Payer: Cash Price |
$748.08
|
| Rate for Payer: Cofinity Commercial |
$199.95
|
| Rate for Payer: Cofinity Commercial |
$162.75
|
| Rate for Payer: Cofinity Commercial |
$111.79
|
| Rate for Payer: Cofinity Commercial |
$654.57
|
| Rate for Payer: Cofinity Commercial |
$804.19
|
| Rate for Payer: Cofinity Commercial |
$160.61
|
| Rate for Payer: Cofinity Commercial |
$118.65
|
| Rate for Payer: Cofinity Commercial |
$156.13
|
| Rate for Payer: Cofinity Commercial |
$191.81
|
| Rate for Payer: Cofinity Commercial |
$399.50
|
| Rate for Payer: Cofinity Commercial |
$96.58
|
| Rate for Payer: Cofinity Commercial |
$325.18
|
| Rate for Payer: Cofinity Commercial |
$89.04
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Cofinity Commercial |
$237.83
|
| Rate for Payer: Cofinity Commercial |
$193.58
|
| Rate for Payer: Cofinity Commercial |
$130.73
|
| Rate for Payer: Cofinity Commercial |
$137.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$748.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Healthscope Commercial |
$418.09
|
| Rate for Payer: Healthscope Commercial |
$143.73
|
| Rate for Payer: Healthscope Commercial |
$200.74
|
| Rate for Payer: Healthscope Commercial |
$124.17
|
| Rate for Payer: Healthscope Commercial |
$209.25
|
| Rate for Payer: Healthscope Commercial |
$841.59
|
| Rate for Payer: Healthscope Commercial |
$248.90
|
| Rate for Payer: Healthscope Commercial |
$168.08
|
| Rate for Payer: Healthscope Commercial |
$93.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$654.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$701.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$794.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.58
|
| Rate for Payer: PHP Commercial |
$197.62
|
| Rate for Payer: PHP Commercial |
$117.27
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: PHP Commercial |
$235.07
|
| Rate for Payer: PHP Commercial |
$189.58
|
| Rate for Payer: PHP Commercial |
$794.84
|
| Rate for Payer: PHP Commercial |
$88.00
|
| Rate for Payer: PHP Commercial |
$135.74
|
| Rate for Payer: PHP Commercial |
$394.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$654.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.18
|
| Rate for Payer: Priority Health SBD |
$146.48
|
| Rate for Payer: Priority Health SBD |
$117.66
|
| Rate for Payer: Priority Health SBD |
$86.92
|
| Rate for Payer: Priority Health SBD |
$140.52
|
| Rate for Payer: Priority Health SBD |
$174.23
|
| Rate for Payer: Priority Health SBD |
$65.22
|
| Rate for Payer: Priority Health SBD |
$292.66
|
| Rate for Payer: Priority Health SBD |
$589.11
|
| Rate for Payer: Priority Health SBD |
$100.61
|
| Rate for Payer: UMR Bronson Commercial |
$171.88
|
| Rate for Payer: UMR Bronson Commercial |
$51.05
|
| Rate for Payer: UMR Bronson Commercial |
$86.02
|
| Rate for Payer: UMR Bronson Commercial |
$59.09
|
| Rate for Payer: UMR Bronson Commercial |
$69.10
|
| Rate for Payer: UMR Bronson Commercial |
$82.52
|
| Rate for Payer: UMR Bronson Commercial |
$38.31
|
| Rate for Payer: UMR Bronson Commercial |
$345.99
|
| Rate for Payer: UMR Bronson Commercial |
$102.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$701.32
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$129.64
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
188040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.04 |
| Max. Negotiated Rate |
$116.68 |
| Rate for Payer: Aetna American Axle |
$84.27
|
| Rate for Payer: Aetna American Axle |
$158.60
|
| Rate for Payer: Aetna Commercial |
$207.40
|
| Rate for Payer: Aetna Commercial |
$110.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.60
|
| Rate for Payer: Cash Price |
$103.71
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$111.49
|
| Rate for Payer: Cofinity Commercial |
$90.75
|
| Rate for Payer: Cofinity Commercial |
$209.84
|
| Rate for Payer: Cofinity Commercial |
$170.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.20
|
| Rate for Payer: Healthscope Commercial |
$219.60
|
| Rate for Payer: Healthscope Commercial |
$116.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.40
|
| Rate for Payer: PHP Commercial |
$207.40
|
| Rate for Payer: PHP Commercial |
$110.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health SBD |
$81.67
|
| Rate for Payer: Priority Health SBD |
$153.72
|
| Rate for Payer: UMR Bronson Commercial |
$57.04
|
| Rate for Payer: UMR Bronson Commercial |
$107.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.00
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
188040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna American Axle |
$158.60
|
| Rate for Payer: Aetna American Axle |
$84.27
|
| Rate for Payer: Aetna Commercial |
$207.40
|
| Rate for Payer: Aetna Commercial |
$110.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.60
|
| Rate for Payer: BCBS Complete |
$97.60
|
| Rate for Payer: BCBS Complete |
$51.86
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$103.71
|
| Rate for Payer: Cash Price |
$103.71
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$209.84
|
| Rate for Payer: Cofinity Commercial |
$90.75
|
| Rate for Payer: Cofinity Commercial |
$170.80
|
| Rate for Payer: Cofinity Commercial |
$111.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$219.60
|
| Rate for Payer: Healthscope Commercial |
$116.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.40
|
| Rate for Payer: PHP Commercial |
$207.40
|
| Rate for Payer: PHP Commercial |
$110.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health SBD |
$153.72
|
| Rate for Payer: Priority Health SBD |
$81.67
|
| Rate for Payer: UMR Bronson Commercial |
$47.97
|
| Rate for Payer: UMR Bronson Commercial |
$90.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.23
|
|
|
PALONOSETRON 250 MCG + DEXAMETHASONE 10 MG IVPB
|
Facility
|
OP
|
$298.74
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
301168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$268.87 |
| Rate for Payer: Aetna American Axle |
$194.18
|
| Rate for Payer: Aetna Commercial |
$253.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.18
|
| Rate for Payer: BCBS Complete |
$119.50
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cofinity Commercial |
$256.92
|
| Rate for Payer: Cofinity Commercial |
$209.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.99
|
| Rate for Payer: Healthscope Commercial |
$268.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.93
|
| Rate for Payer: PHP Commercial |
$253.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.12
|
| Rate for Payer: Priority Health SBD |
$188.21
|
| Rate for Payer: UMR Bronson Commercial |
$110.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.06
|
|
