|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.73
|
|
|
Service Code
|
NDC 0143-9284-10
|
| 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
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.73
|
|
|
Service Code
|
NDC 0143-9284-10
|
| 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
|
$15.77
|
|
|
Service Code
|
NDC 71839-122-01
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.40
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.04
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.77
|
|
|
Service Code
|
NDC 71839-122-25
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.40
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.04
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.77
|
|
|
Service Code
|
NDC 71839-122-10
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.40
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.04
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION FOR DRIP
|
Facility
|
IP
|
$22.47
|
|
|
Service Code
|
NDC 0781-3232-95
|
| Hospital Charge Code |
301183
|
|
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 TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$265.08
|
|
|
Service Code
|
NDC 0904-6870-45
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.64 |
| Max. Negotiated Rate |
$238.57 |
| Rate for Payer: Aetna American Axle |
$172.30
|
| Rate for Payer: Aetna Commercial |
$225.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.30
|
| Rate for Payer: Cash Price |
$212.06
|
| Rate for Payer: Cofinity Commercial |
$185.56
|
| Rate for Payer: Cofinity Commercial |
$227.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.06
|
| Rate for Payer: Healthscope Commercial |
$238.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.32
|
| Rate for Payer: PHP Commercial |
$225.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.56
|
| Rate for Payer: Priority Health SBD |
$167.00
|
| Rate for Payer: UMR Bronson Commercial |
$116.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.81
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 0904-6474-61
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.00
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UMR Bronson Commercial |
$84.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$120.56
|
|
|
Service Code
|
NDC 65862-560-90
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna American Axle |
$78.36
|
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.48
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.39
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UMR Bronson Commercial |
$53.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
PAPAVERINE 30MG/ML 2 ML IN 30ML NS IRRIGATION
|
Facility
|
IP
|
$73.16
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
500528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$65.84 |
| Rate for Payer: Aetna American Axle |
$47.55
|
| Rate for Payer: Aetna Commercial |
$62.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.55
|
| Rate for Payer: Cash Price |
$58.53
|
| Rate for Payer: Cofinity Commercial |
$51.21
|
| Rate for Payer: Cofinity Commercial |
$62.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$65.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.19
|
| Rate for Payer: PHP Commercial |
$62.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.21
|
| Rate for Payer: Priority Health SBD |
$46.09
|
| Rate for Payer: UMR Bronson Commercial |
$32.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.87
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$68.81
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
6030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Aetna American Axle |
$44.73
|
| Rate for Payer: Aetna Commercial |
$58.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.73
|
| Rate for Payer: Cash Price |
$55.05
|
| Rate for Payer: Cofinity Commercial |
$48.17
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.05
|
| Rate for Payer: Healthscope Commercial |
$61.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.49
|
| Rate for Payer: PHP Commercial |
$58.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.17
|
| Rate for Payer: Priority Health SBD |
$43.35
|
| Rate for Payer: UMR Bronson Commercial |
$30.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.61
|
|
|
PARABEN-CETYL ALCOHOL-STEARYL ALCOHOL-PROPY GLYCOL-SLS TOPICAL CLEANER
|
Facility
|
IP
|
$20.71
|
|
|
Service Code
|
NDC 299392140
|
| Hospital Charge Code |
113943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$18.64 |
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Cash Price |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.57
|
| Rate for Payer: Healthscope Commercial |
$18.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.60
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health SBD |
$13.05
|
| Rate for Payer: UMR Bronson Commercial |
$9.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
|
|
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S);
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 60500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.13 |
| 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 |
$5,976.16
|
| 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) |
$1,051.74
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$956.13
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S); RE-EXPLORATION
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 60502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,283.57 |
| 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 |
$3,678.67
|
| 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) |
$1,411.93
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,283.57
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.6 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.60
|
|
|
Service Code
|
NDC 0338-0644-06
|
| Hospital Charge Code |
117996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.86 |
| Max. Negotiated Rate |
$36.54 |
| Rate for Payer: Aetna American Axle |
$26.39
|
| Rate for Payer: Aetna Commercial |
$34.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.39
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cofinity Commercial |
$28.42
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.48
|
| Rate for Payer: Healthscope Commercial |
$36.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.51
|
| Rate for Payer: PHP Commercial |
$34.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.42
|
| Rate for Payer: Priority Health SBD |
$25.58
|
| Rate for Payer: UMR Bronson Commercial |
$17.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.45
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.7 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
NDC 0338-1130-04
|
| Hospital Charge Code |
118122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Aetna American Axle |
$568.75
|
| Rate for Payer: Aetna Commercial |
$743.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.75
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$612.50
|
| Rate for Payer: Cofinity Commercial |
$752.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.00
|
| Rate for Payer: Healthscope Commercial |
$787.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$656.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.75
|
| Rate for Payer: PHP Commercial |
$743.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.50
|
| Rate for Payer: Priority Health SBD |
$551.25
|
| Rate for Payer: UMR Bronson Commercial |
$385.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$656.25
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.2 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$60.90
|
|
|
Service Code
|
NDC 0409-7171-17
|
| Hospital Charge Code |
9050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$54.81 |
| Rate for Payer: Aetna American Axle |
$39.58
|
| Rate for Payer: Aetna Commercial |
$51.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.58
|
| Rate for Payer: Cash Price |
$48.72
|
| Rate for Payer: Cofinity Commercial |
$42.63
|
| Rate for Payer: Cofinity Commercial |
$52.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.72
|
| Rate for Payer: Healthscope Commercial |
$54.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.76
|
| Rate for Payer: PHP Commercial |
$51.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.63
|
| Rate for Payer: Priority Health SBD |
$38.37
|
| Rate for Payer: UMR Bronson Commercial |
$26.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.68
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$86.28
|
|
|
Service Code
|
NDC 0338-0502-03
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$77.65 |
| Rate for Payer: Aetna American Axle |
$56.08
|
| Rate for Payer: Aetna Commercial |
$73.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.08
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$74.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.02
|
| Rate for Payer: Healthscope Commercial |
$77.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.34
|
| Rate for Payer: PHP Commercial |
$73.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.40
|
| Rate for Payer: Priority Health SBD |
$54.36
|
| Rate for Payer: UMR Bronson Commercial |
$37.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.71
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.50
|
|
|
Service Code
|
NDC 0338-0502-06
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Aetna American Axle |
$47.12
|
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.12
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cofinity Commercial |
$50.75
|
| Rate for Payer: Cofinity Commercial |
$62.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.00
|
| Rate for Payer: Healthscope Commercial |
$65.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.62
|
| Rate for Payer: PHP Commercial |
$61.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.75
|
| Rate for Payer: Priority Health SBD |
$45.68
|
| Rate for Payer: UMR Bronson Commercial |
$31.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.38
|
|
|
PARENTERAL AMINO ACID 8.5 % COMBINATION NO.3 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11.60
|
|
|
Service Code
|
NDC 0409-4162-03
|
| Hospital Charge Code |
172719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna American Axle |
$7.54
|
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.54
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.28
|
| Rate for Payer: Healthscope Commercial |
$10.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.86
|
| Rate for Payer: PHP Commercial |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.12
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$4.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.70
|
|
|
PARENTERAL AMINO ACID 8.5 % COMBINATION NO.3 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11.60
|
|
|
Service Code
|
NDC 0409-4162-03
|
| Hospital Charge Code |
172719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna American Axle |
$7.54
|
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.54
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.28
|
| Rate for Payer: Healthscope Commercial |
$10.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.86
|
| Rate for Payer: PHP Commercial |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.12
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.70
|
|
|
PARICALCITOL 1 MCG CAPSULE
|
Facility
|
IP
|
$439.34
|
|
|
Service Code
|
NDC 69452-145-13
|
| Hospital Charge Code |
41497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.31 |
| Max. Negotiated Rate |
$395.41 |
| Rate for Payer: Aetna American Axle |
$285.57
|
| Rate for Payer: Aetna Commercial |
$373.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.57
|
| Rate for Payer: Cash Price |
$351.47
|
| Rate for Payer: Cofinity Commercial |
$307.54
|
| Rate for Payer: Cofinity Commercial |
$377.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.47
|
| Rate for Payer: Healthscope Commercial |
$395.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.44
|
| Rate for Payer: PHP Commercial |
$373.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.54
|
| Rate for Payer: Priority Health SBD |
$276.78
|
| Rate for Payer: UMR Bronson Commercial |
$193.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.50
|
|
|
PARICALCITOL 1 MCG CAPSULE
|
Facility
|
IP
|
$133.78
|
|
|
Service Code
|
NDC 49483-687-03
|
| Hospital Charge Code |
41497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.86 |
| Max. Negotiated Rate |
$120.40 |
| Rate for Payer: Aetna American Axle |
$86.96
|
| Rate for Payer: Aetna Commercial |
$113.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.96
|
| Rate for Payer: Cash Price |
$107.02
|
| Rate for Payer: Cofinity Commercial |
$115.05
|
| Rate for Payer: Cofinity Commercial |
$93.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.02
|
| Rate for Payer: Healthscope Commercial |
$120.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.71
|
| Rate for Payer: PHP Commercial |
$113.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.65
|
| Rate for Payer: Priority Health SBD |
$84.28
|
| Rate for Payer: UMR Bronson Commercial |
$58.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.34
|
|
|
PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.53
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
31688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.40
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.27
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: UMR Bronson Commercial |
$10.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
|
|
PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.53
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
31688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna American Axle |
$18.01
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.17
|
| Rate for Payer: Cofinity Commercial |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$23.83
|
| Rate for Payer: Cofinity Commercial |
$19.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$24.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.40
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.40
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$17.46
|
| Rate for Payer: UMR Bronson Commercial |
$12.11
|
| Rate for Payer: UMR Bronson Commercial |
$12.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
|
