|
PALONOSETRON 250 MCG + DEXAMETHASONE 10 MG IVPB
|
Facility
|
IP
|
$298.74
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
301168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.45 |
| 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: Cash Price |
$238.99
|
| Rate for Payer: Cofinity Commercial |
$209.12
|
| Rate for Payer: Cofinity Commercial |
$256.92
|
| 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 |
$131.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.06
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.14
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
32589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.78 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna American Axle |
$24.79
|
| Rate for Payer: Aetna American Axle |
$37.58
|
| Rate for Payer: Aetna Commercial |
$49.14
|
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.58
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$46.25
|
| Rate for Payer: Cofinity Commercial |
$49.72
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$40.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Commercial |
$52.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.42
|
| Rate for Payer: PHP Commercial |
$49.14
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.47
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: Priority Health SBD |
$36.42
|
| Rate for Payer: UMR Bronson Commercial |
$16.78
|
| Rate for Payer: UMR Bronson Commercial |
$25.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.60
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.81
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
32589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.39 |
| Max. Negotiated Rate |
$52.03 |
| Rate for Payer: Aetna American Axle |
$37.58
|
| Rate for Payer: Aetna American Axle |
$24.79
|
| Rate for Payer: Aetna Commercial |
$49.14
|
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.58
|
| Rate for Payer: BCBS Complete |
$15.26
|
| Rate for Payer: BCBS Complete |
$23.12
|
| Rate for Payer: BCBS Trust/PPO |
$28.67
|
| Rate for Payer: BCBS Trust/PPO |
$28.67
|
| Rate for Payer: Cash Price |
$46.25
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$46.25
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$49.72
|
| Rate for Payer: Cofinity Commercial |
$40.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.25
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Commercial |
$52.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.14
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$49.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.70
|
| Rate for Payer: Priority Health SBD |
$36.42
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: UMR Bronson Commercial |
$14.11
|
| Rate for Payer: UMR Bronson Commercial |
$21.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.36
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$137.60
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
33886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.54 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna American Axle |
$89.44
|
| Rate for Payer: Aetna Commercial |
$116.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.44
|
| Rate for Payer: Cash Price |
$110.08
|
| Rate for Payer: Cofinity Commercial |
$118.34
|
| Rate for Payer: Cofinity Commercial |
$96.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.08
|
| Rate for Payer: Healthscope Commercial |
$123.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.96
|
| Rate for Payer: PHP Commercial |
$116.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.32
|
| Rate for Payer: Priority Health SBD |
$86.69
|
| Rate for Payer: UMR Bronson Commercial |
$60.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.20
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$67,966.41
|
|
|
Service Code
|
MS-DRG 406
|
| Min. Negotiated Rate |
$21,624.62 |
| Max. Negotiated Rate |
$67,966.41 |
| Rate for Payer: Aetna Medicare |
$23,673.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,453.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,453.45
|
| Rate for Payer: BCBS MAPPO |
$22,762.76
|
| Rate for Payer: BCBS Trust/PPO |
$67,966.41
|
| Rate for Payer: BCN Medicare Advantage |
$22,762.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,762.76
|
| Rate for Payer: Mclaren Medicare |
$22,762.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,900.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,177.17
|
| Rate for Payer: PACE Medicare |
$21,624.62
|
| Rate for Payer: PACE SWMI |
$22,762.76
|
| Rate for Payer: PHP Medicare Advantage |
$22,762.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,433.96
|
| Rate for Payer: Priority Health Medicare |
$22,762.76
|
| Rate for Payer: Priority Health Narrow Network |
$33,147.17
|
| Rate for Payer: Railroad Medicare Medicare |
$22,762.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,044.40
|
| Rate for Payer: UHC Core |
$36,115.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$22,762.76
|
| Rate for Payer: UHC Exchange |
$28,712.31
|
| Rate for Payer: UHC Medicare Advantage |
$23,445.64
|
| Rate for Payer: VA VA |
$22,762.76
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$95,427.38
|
|
|
Service Code
|
MS-DRG 405
|
| Min. Negotiated Rate |
$40,788.84 |
| Max. Negotiated Rate |
$95,427.38 |
| Rate for Payer: Aetna Medicare |
$44,653.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53,669.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53,669.52
|
| Rate for Payer: BCBS MAPPO |
$42,935.62
|
| Rate for Payer: BCBS Trust/PPO |
$95,427.38
|
| Rate for Payer: BCN Medicare Advantage |
$42,935.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,935.62
|
| Rate for Payer: Mclaren Medicare |
$42,935.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45,082.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49,375.96
|
| Rate for Payer: PACE Medicare |
$40,788.84
|
| Rate for Payer: PACE SWMI |
$42,935.62
|
| Rate for Payer: PHP Medicare Advantage |
$42,935.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78,999.18
|
| Rate for Payer: Priority Health Medicare |
$42,935.62
|
| Rate for Payer: Priority Health Narrow Network |
$63,199.34
|
| Rate for Payer: Railroad Medicare Medicare |
$42,935.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83,976.32
|
| Rate for Payer: UHC Core |
$68,859.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$42,935.62
|
| Rate for Payer: UHC Exchange |
$54,743.71
|
| Rate for Payer: UHC Medicare Advantage |
$44,223.69
|
| Rate for Payer: VA VA |
$42,935.62
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$45,136.71
|
|
|
Service Code
|
MS-DRG 407
|
| Min. Negotiated Rate |
$16,233.63 |
| Max. Negotiated Rate |
$45,136.71 |
| Rate for Payer: Aetna Medicare |
$17,771.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,360.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,360.04
|
| Rate for Payer: BCBS MAPPO |
$17,088.03
|
| Rate for Payer: BCBS Trust/PPO |
$45,136.71
|
| Rate for Payer: BCN Medicare Advantage |
$17,088.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,088.03
|
| Rate for Payer: Mclaren Medicare |
$17,088.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,942.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,651.23
|
| Rate for Payer: PACE Medicare |
$16,233.63
|
| Rate for Payer: PACE SWMI |
$17,088.03
|
| Rate for Payer: PHP Medicare Advantage |
$17,088.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,866.68
|
| Rate for Payer: Priority Health Medicare |
$17,088.03
|
| Rate for Payer: Priority Health Narrow Network |
$24,693.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17,088.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,811.35
|
| Rate for Payer: UHC Core |
$26,904.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,088.03
|
| Rate for Payer: UHC Exchange |
$21,389.54
|
| Rate for Payer: UHC Medicare Advantage |
$17,600.67
|
| Rate for Payer: VA VA |
$17,088.03
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$89,147.64
|
|
|
Service Code
|
MS-DRG 010
|
| Min. Negotiated Rate |
$35,725.80 |
| Max. Negotiated Rate |
$89,147.64 |
| Rate for Payer: Aetna Medicare |
$39,110.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47,007.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47,007.64
|
| Rate for Payer: BCBS MAPPO |
$37,606.11
|
| Rate for Payer: BCBS Trust/PPO |
$89,147.64
|
| Rate for Payer: BCN Medicare Advantage |
$37,606.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37,606.11
|
| Rate for Payer: Mclaren Medicare |
$37,606.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39,486.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43,247.03
|
| Rate for Payer: PACE Medicare |
$35,725.80
|
| Rate for Payer: PACE SWMI |
$37,606.11
|
| Rate for Payer: PHP Medicare Advantage |
$37,606.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69,074.77
|
| Rate for Payer: Priority Health Medicare |
$37,606.11
|
| Rate for Payer: Priority Health Narrow Network |
$55,259.82
|
| Rate for Payer: Railroad Medicare Medicare |
$37,606.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73,426.65
|
| Rate for Payer: UHC Core |
$60,208.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$37,606.11
|
| Rate for Payer: UHC Exchange |
$47,866.44
|
| Rate for Payer: UHC Medicare Advantage |
$38,734.29
|
| Rate for Payer: VA VA |
$37,606.11
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,213.55
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
77484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$6,492.20 |
| Rate for Payer: Aetna American Axle |
$4,688.81
|
| Rate for Payer: Aetna Commercial |
$6,131.52
|
| Rate for Payer: Aetna Medicare |
$156.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,688.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$188.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$188.32
|
| Rate for Payer: BCBS Complete |
$86.54
|
| Rate for Payer: BCBS MAPPO |
$150.66
|
| Rate for Payer: BCBS Trust/PPO |
$486.86
|
| Rate for Payer: BCN Medicare Advantage |
$150.66
|
| Rate for Payer: Cash Price |
$5,770.84
|
| Rate for Payer: Cash Price |
$5,770.84
|
| Rate for Payer: Cofinity Commercial |
$5,049.48
|
| Rate for Payer: Cofinity Commercial |
$6,203.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,770.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.66
|
| Rate for Payer: Healthscope Commercial |
$6,492.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,049.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,410.16
|
| Rate for Payer: Mclaren Medicaid |
$82.41
|
| Rate for Payer: Mclaren Medicare |
$150.66
|
| Rate for Payer: Meridian Medicaid |
$86.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,131.52
|
| Rate for Payer: PACE Medicare |
$143.13
|
| Rate for Payer: PACE SWMI |
$150.66
|
| Rate for Payer: PHP Commercial |
$6,131.52
|
| Rate for Payer: PHP Medicare Advantage |
$150.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,049.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.71
|
| Rate for Payer: Priority Health Medicare |
$150.66
|
| Rate for Payer: Priority Health Narrow Network |
$351.77
|
| Rate for Payer: Priority Health SBD |
$4,544.54
|
| Rate for Payer: Railroad Medicare Medicare |
$150.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.66
|
| Rate for Payer: UHC Medicare Advantage |
$155.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,669.01
|
| Rate for Payer: VA VA |
$150.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,410.16
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,213.55
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
77484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,173.96 |
| Max. Negotiated Rate |
$6,492.20 |
| Rate for Payer: Aetna American Axle |
$4,688.81
|
| Rate for Payer: Aetna Commercial |
$6,131.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,688.81
|
| Rate for Payer: Cash Price |
$5,770.84
|
| Rate for Payer: Cofinity Commercial |
$5,049.48
|
| Rate for Payer: Cofinity Commercial |
$6,203.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,770.84
|
| Rate for Payer: Healthscope Commercial |
$6,492.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,049.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,410.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,131.52
|
| Rate for Payer: PHP Commercial |
$6,131.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,049.48
|
| Rate for Payer: Priority Health SBD |
$4,544.54
|
| Rate for Payer: UMR Bronson Commercial |
$3,173.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,410.16
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,708.33
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
118465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$15,037.50 |
| Rate for Payer: Aetna American Axle |
$10,860.41
|
| Rate for Payer: Aetna Commercial |
$14,202.08
|
| Rate for Payer: Aetna Medicare |
$156.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,860.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$188.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$188.32
|
| Rate for Payer: BCBS Complete |
$86.54
|
| Rate for Payer: BCBS MAPPO |
$150.66
|
| Rate for Payer: BCBS Trust/PPO |
$486.86
|
| Rate for Payer: BCN Medicare Advantage |
$150.66
|
| Rate for Payer: Cash Price |
$13,366.66
|
| Rate for Payer: Cash Price |
$13,366.66
|
| Rate for Payer: Cofinity Commercial |
$14,369.16
|
| Rate for Payer: Cofinity Commercial |
$11,695.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,366.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.66
|
| Rate for Payer: Healthscope Commercial |
$15,037.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,695.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,531.25
|
| Rate for Payer: Mclaren Medicaid |
$82.41
|
| Rate for Payer: Mclaren Medicare |
$150.66
|
| Rate for Payer: Meridian Medicaid |
$86.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,202.08
|
| Rate for Payer: PACE Medicare |
$143.13
|
| Rate for Payer: PACE SWMI |
$150.66
|
| Rate for Payer: PHP Commercial |
$14,202.08
|
| Rate for Payer: PHP Medicare Advantage |
$150.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,695.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.71
|
| Rate for Payer: Priority Health Medicare |
$150.66
|
| Rate for Payer: Priority Health Narrow Network |
$351.77
|
| Rate for Payer: Priority Health SBD |
$10,526.25
|
| Rate for Payer: Railroad Medicare Medicare |
$150.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.66
|
| Rate for Payer: UHC Medicare Advantage |
$155.18
|
| Rate for Payer: UMR Bronson Commercial |
$6,182.08
|
| Rate for Payer: VA VA |
$150.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,531.25
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$123.50
|
|
|
Service Code
|
NDC 50268-636-15
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.34 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna American Axle |
$80.28
|
| Rate for Payer: Aetna Commercial |
$104.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.28
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cofinity Commercial |
$106.21
|
| Rate for Payer: Cofinity Commercial |
$86.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.80
|
| Rate for Payer: Healthscope Commercial |
$111.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.98
|
| Rate for Payer: PHP Commercial |
$104.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health SBD |
$77.80
|
| Rate for Payer: UMR Bronson Commercial |
$54.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.62
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$107.35
|
|
|
Service Code
|
NDC 50268-585-15
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$96.62 |
| Rate for Payer: Aetna American Axle |
$69.78
|
| Rate for Payer: Aetna Commercial |
$91.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.78
|
| Rate for Payer: Cash Price |
$85.88
|
| Rate for Payer: Cofinity Commercial |
$75.14
|
| Rate for Payer: Cofinity Commercial |
$92.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.88
|
| Rate for Payer: Healthscope Commercial |
$96.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.25
|
| Rate for Payer: PHP Commercial |
$91.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.14
|
| Rate for Payer: Priority Health SBD |
$67.63
|
| Rate for Payer: UMR Bronson Commercial |
$47.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.51
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$135.36
|
|
|
Service Code
|
NDC 65862-559-90
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$121.82 |
| Rate for Payer: Aetna American Axle |
$87.98
|
| Rate for Payer: Aetna Commercial |
$115.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.98
|
| Rate for Payer: Cash Price |
$108.29
|
| Rate for Payer: Cofinity Commercial |
$116.41
|
| Rate for Payer: Cofinity Commercial |
$94.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.29
|
| Rate for Payer: Healthscope Commercial |
$121.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.06
|
| Rate for Payer: PHP Commercial |
$115.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.75
|
| Rate for Payer: Priority Health SBD |
$85.28
|
| Rate for Payer: UMR Bronson Commercial |
$59.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.52
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$219.96
|
|
|
Service Code
|
NDC 0378-6688-77
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.78 |
| Max. Negotiated Rate |
$197.96 |
| Rate for Payer: Aetna American Axle |
$142.97
|
| Rate for Payer: Aetna Commercial |
$186.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.97
|
| Rate for Payer: Cash Price |
$175.97
|
| Rate for Payer: Cofinity Commercial |
$153.97
|
| Rate for Payer: Cofinity Commercial |
$189.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.97
|
| Rate for Payer: Healthscope Commercial |
$197.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.97
|
| Rate for Payer: PHP Commercial |
$186.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.97
|
| Rate for Payer: Priority Health SBD |
$138.57
|
| Rate for Payer: UMR Bronson Commercial |
$96.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.97
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 60687-585-11
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.68
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.39
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.48
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$197.60
|
|
|
Service Code
|
NDC 60687-585-01
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$177.84 |
| Rate for Payer: Aetna American Axle |
$128.44
|
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.44
|
| Rate for Payer: Cash Price |
$158.08
|
| Rate for Payer: Cofinity Commercial |
$138.32
|
| Rate for Payer: Cofinity Commercial |
$169.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.08
|
| Rate for Payer: Healthscope Commercial |
$177.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.96
|
| Rate for Payer: PHP Commercial |
$167.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.32
|
| Rate for Payer: Priority Health SBD |
$124.49
|
| Rate for Payer: UMR Bronson Commercial |
$86.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.20
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.15
|
|
|
Service Code
|
NDC 50268-585-11
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna American Axle |
$1.40
|
| Rate for Payer: Aetna Commercial |
$1.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.40
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Cofinity Commercial |
$1.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.72
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.83
|
| Rate for Payer: PHP Commercial |
$1.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.50
|
| Rate for Payer: Priority Health SBD |
$1.35
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.61
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 50268-636-11
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.10
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.73
|
|
|
Service Code
|
NDC 0143-9284-01
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$16.86 |
| Rate for Payer: Aetna American Axle |
$12.17
|
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.11
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.92
|
| Rate for Payer: PHP Commercial |
$15.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.11
|
| Rate for Payer: Priority Health SBD |
$11.80
|
| Rate for Payer: UMR Bronson Commercial |
$6.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.05
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.91
|
|
|
Service Code
|
NDC 0008-0923-51
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$19.72 |
| Rate for Payer: Aetna American Axle |
$14.24
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.24
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.53
|
| Rate for Payer: Healthscope Commercial |
$19.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.62
|
| Rate for Payer: PHP Commercial |
$18.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.34
|
| Rate for Payer: Priority Health SBD |
$13.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.43
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.91
|
|
|
Service Code
|
NDC 0008-0923-55
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$19.72 |
| Rate for Payer: Aetna American Axle |
$14.24
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.24
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.53
|
| Rate for Payer: Healthscope Commercial |
$19.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.62
|
| Rate for Payer: PHP Commercial |
$18.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.34
|
| Rate for Payer: Priority Health SBD |
$13.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.43
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.47
|
|
|
Service Code
|
NDC 0781-3232-95
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna American Axle |
$14.61
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.10
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.73
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: UMR Bronson Commercial |
$9.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 0008-0923-60
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna American Axle |
$13.65
|
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.65
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$14.70
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$18.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.85
|
| Rate for Payer: PHP Commercial |
$17.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health SBD |
$13.23
|
| Rate for Payer: UMR Bronson Commercial |
$9.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.75
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.73
|
|
|
Service Code
|
NDC 0143-9284-01
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$16.86 |
| Rate for Payer: Aetna American Axle |
$12.17
|
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.11
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.92
|
| Rate for Payer: PHP Commercial |
$15.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.11
|
| Rate for Payer: Priority Health SBD |
$11.80
|
| Rate for Payer: UMR Bronson Commercial |
$8.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.05
|
|
