|
PEDS ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$1,356.97
|
|
|
Service Code
|
HCPCS C8922
|
| Hospital Charge Code |
48000029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$597.07 |
| Max. Negotiated Rate |
$1,221.27 |
| Rate for Payer: Aetna American Axle |
$882.03
|
| Rate for Payer: Aetna Commercial |
$1,153.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.03
|
| Rate for Payer: Cash Price |
$1,085.58
|
| Rate for Payer: Cofinity Commercial |
$1,166.99
|
| Rate for Payer: Cofinity Commercial |
$949.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,085.58
|
| Rate for Payer: Healthscope Commercial |
$1,221.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$949.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,017.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,153.42
|
| Rate for Payer: PHP Commercial |
$1,153.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.88
|
| Rate for Payer: Priority Health SBD |
$854.89
|
| Rate for Payer: UMR Bronson Commercial |
$597.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,017.73
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
NDC 52268-101-01
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna American Axle |
$18.20
|
| Rate for Payer: Aetna Commercial |
$23.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$24.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.40
|
| Rate for Payer: Healthscope Commercial |
$25.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.80
|
| Rate for Payer: PHP Commercial |
$23.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.60
|
| Rate for Payer: Priority Health SBD |
$17.64
|
| Rate for Payer: UMR Bronson Commercial |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.00
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
NDC 43386-090-19
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna American Axle |
$36.40
|
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health SBD |
$35.28
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
NDC 52268-100-01
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
IP
|
$9.52
|
|
|
Service Code
|
NDC 57896-181-05
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna American Axle |
$6.19
|
| Rate for Payer: Aetna Commercial |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.19
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cofinity Commercial |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.62
|
| Rate for Payer: Healthscope Commercial |
$8.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.09
|
| Rate for Payer: PHP Commercial |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.66
|
| Rate for Payer: Priority Health SBD |
$6.00
|
| Rate for Payer: UMR Bronson Commercial |
$4.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.14
|
|
|
PEG 400-PROPYLENE GLYCOL 0.4 %-0.3 % EYE GEL DROPS
|
Facility
|
IP
|
$34.34
|
|
|
Service Code
|
NDC 70000-0088-1
|
| Hospital Charge Code |
152517
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$30.91 |
| Rate for Payer: Aetna American Axle |
$22.32
|
| Rate for Payer: Aetna Commercial |
$29.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.32
|
| Rate for Payer: Cash Price |
$27.47
|
| Rate for Payer: Cofinity Commercial |
$24.04
|
| Rate for Payer: Cofinity Commercial |
$29.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.47
|
| Rate for Payer: Healthscope Commercial |
$30.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.19
|
| Rate for Payer: PHP Commercial |
$29.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.04
|
| Rate for Payer: Priority Health SBD |
$21.63
|
| Rate for Payer: UMR Bronson Commercial |
$15.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.76
|
|
|
PEGASPARGASE 750 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$114,666.70
|
|
|
Service Code
|
HCPCS J9266
|
| Hospital Charge Code |
12519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,102.46 |
| Max. Negotiated Rate |
$103,200.03 |
| Rate for Payer: Aetna American Axle |
$74,533.36
|
| Rate for Payer: Aetna Commercial |
$97,466.70
|
| Rate for Payer: Aetna Medicare |
$26,812.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74,533.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,226.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,226.82
|
| Rate for Payer: BCBS Complete |
$14,808.87
|
| Rate for Payer: BCBS MAPPO |
$25,781.46
|
| Rate for Payer: BCBS Trust/PPO |
$83,313.90
|
| Rate for Payer: BCN Medicare Advantage |
$25,781.46
|
| Rate for Payer: Cash Price |
$91,733.36
|
| Rate for Payer: Cash Price |
$91,733.36
|
| Rate for Payer: Cofinity Commercial |
$98,613.36
|
| Rate for Payer: Cofinity Commercial |
$80,266.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91,733.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,781.46
|
| Rate for Payer: Healthscope Commercial |
$103,200.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80,266.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86,000.02
|
| Rate for Payer: Mclaren Medicaid |
$14,102.46
|
| Rate for Payer: Mclaren Medicare |
$25,781.46
|
| Rate for Payer: Meridian Medicaid |
$14,808.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27,070.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,648.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97,466.70
|
| Rate for Payer: PACE Medicare |
$24,492.39
|
| Rate for Payer: PACE SWMI |
$25,781.46
|
| Rate for Payer: PHP Commercial |
$97,466.70
|
| Rate for Payer: PHP Medicare Advantage |
$25,781.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,102.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80,266.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75,716.91
|
| Rate for Payer: Priority Health Medicare |
$25,781.46
|
| Rate for Payer: Priority Health Narrow Network |
$60,573.53
|
| Rate for Payer: Priority Health SBD |
$72,240.02
|
| Rate for Payer: Railroad Medicare Medicare |
$25,781.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,781.46
|
| Rate for Payer: UHC Medicare Advantage |
$26,554.90
|
| Rate for Payer: UMR Bronson Commercial |
$42,426.68
|
| Rate for Payer: VA VA |
$25,781.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86,000.02
|
|
|
PEGASPARGASE 750 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$114,666.70
|
|
|
Service Code
|
HCPCS J9266
|
| Hospital Charge Code |
12519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50,453.35 |
| Max. Negotiated Rate |
$103,200.03 |
| Rate for Payer: Aetna American Axle |
$74,533.36
|
| Rate for Payer: Aetna Commercial |
$97,466.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74,533.36
|
| Rate for Payer: Cash Price |
$91,733.36
|
| Rate for Payer: Cofinity Commercial |
$80,266.69
|
| Rate for Payer: Cofinity Commercial |
$98,613.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91,733.36
|
| Rate for Payer: Healthscope Commercial |
$103,200.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80,266.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86,000.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97,466.70
|
| Rate for Payer: PHP Commercial |
$97,466.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80,266.69
|
| Rate for Payer: Priority Health SBD |
$72,240.02
|
| Rate for Payer: UMR Bronson Commercial |
$50,453.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86,000.02
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR
|
Facility
|
OP
|
$11,749.74
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
173747
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$10,574.77 |
| Rate for Payer: Aetna American Axle |
$7,637.33
|
| Rate for Payer: Aetna Commercial |
$9,987.28
|
| Rate for Payer: Aetna Medicare |
$52.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,637.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.35
|
| Rate for Payer: BCBS Complete |
$29.11
|
| Rate for Payer: BCBS MAPPO |
$50.68
|
| Rate for Payer: BCBS Trust/PPO |
$713.63
|
| Rate for Payer: BCN Medicare Advantage |
$50.68
|
| Rate for Payer: Cash Price |
$9,399.79
|
| Rate for Payer: Cash Price |
$9,399.79
|
| Rate for Payer: Cofinity Commercial |
$8,224.82
|
| Rate for Payer: Cofinity Commercial |
$10,104.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,399.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.68
|
| Rate for Payer: Healthscope Commercial |
$10,574.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,224.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,812.30
|
| Rate for Payer: Mclaren Medicaid |
$27.72
|
| Rate for Payer: Mclaren Medicare |
$50.68
|
| Rate for Payer: Meridian Medicaid |
$29.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,987.28
|
| Rate for Payer: PACE Medicare |
$48.14
|
| Rate for Payer: PACE SWMI |
$50.68
|
| Rate for Payer: PHP Commercial |
$9,987.28
|
| Rate for Payer: PHP Medicare Advantage |
$50.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,224.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.11
|
| Rate for Payer: Priority Health Medicare |
$50.68
|
| Rate for Payer: Priority Health Narrow Network |
$176.09
|
| Rate for Payer: Priority Health SBD |
$7,402.34
|
| Rate for Payer: Railroad Medicare Medicare |
$50.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.68
|
| Rate for Payer: UHC Medicare Advantage |
$52.20
|
| Rate for Payer: UMR Bronson Commercial |
$4,347.40
|
| Rate for Payer: VA VA |
$50.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,812.30
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR
|
Facility
|
IP
|
$11,749.74
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
173747
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,169.89 |
| Max. Negotiated Rate |
$10,574.77 |
| Rate for Payer: Aetna American Axle |
$7,637.33
|
| Rate for Payer: Aetna Commercial |
$9,987.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,637.33
|
| Rate for Payer: Cash Price |
$9,399.79
|
| Rate for Payer: Cofinity Commercial |
$10,104.78
|
| Rate for Payer: Cofinity Commercial |
$8,224.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,399.79
|
| Rate for Payer: Healthscope Commercial |
$10,574.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,224.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,812.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,987.28
|
| Rate for Payer: PHP Commercial |
$9,987.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,224.82
|
| Rate for Payer: Priority Health SBD |
$7,402.34
|
| Rate for Payer: UMR Bronson Commercial |
$5,169.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,812.30
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$9,392.27
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,132.60 |
| Max. Negotiated Rate |
$8,453.04 |
| Rate for Payer: Aetna American Axle |
$6,104.98
|
| Rate for Payer: Aetna Commercial |
$7,983.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,104.98
|
| Rate for Payer: Cash Price |
$7,513.82
|
| Rate for Payer: Cofinity Commercial |
$6,574.59
|
| Rate for Payer: Cofinity Commercial |
$8,077.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,513.82
|
| Rate for Payer: Healthscope Commercial |
$8,453.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,574.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,044.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,983.43
|
| Rate for Payer: PHP Commercial |
$7,983.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,574.59
|
| Rate for Payer: Priority Health SBD |
$5,917.13
|
| Rate for Payer: UMR Bronson Commercial |
$4,132.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,044.20
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$9,392.27
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$8,453.04 |
| Rate for Payer: Aetna American Axle |
$6,104.98
|
| Rate for Payer: Aetna Commercial |
$7,983.43
|
| Rate for Payer: Aetna Medicare |
$52.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,104.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.35
|
| Rate for Payer: BCBS Complete |
$29.11
|
| Rate for Payer: BCBS MAPPO |
$50.68
|
| Rate for Payer: BCBS Trust/PPO |
$713.63
|
| Rate for Payer: BCN Medicare Advantage |
$50.68
|
| Rate for Payer: Cash Price |
$7,513.82
|
| Rate for Payer: Cash Price |
$7,513.82
|
| Rate for Payer: Cofinity Commercial |
$8,077.35
|
| Rate for Payer: Cofinity Commercial |
$6,574.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,513.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.68
|
| Rate for Payer: Healthscope Commercial |
$8,453.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,574.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,044.20
|
| Rate for Payer: Mclaren Medicaid |
$27.72
|
| Rate for Payer: Mclaren Medicare |
$50.68
|
| Rate for Payer: Meridian Medicaid |
$29.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,983.43
|
| Rate for Payer: PACE Medicare |
$48.14
|
| Rate for Payer: PACE SWMI |
$50.68
|
| Rate for Payer: PHP Commercial |
$7,983.43
|
| Rate for Payer: PHP Medicare Advantage |
$50.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,574.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.11
|
| Rate for Payer: Priority Health Medicare |
$50.68
|
| Rate for Payer: Priority Health Narrow Network |
$176.09
|
| Rate for Payer: Priority Health SBD |
$5,917.13
|
| Rate for Payer: Railroad Medicare Medicare |
$50.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.68
|
| Rate for Payer: UHC Medicare Advantage |
$52.20
|
| Rate for Payer: UMR Bronson Commercial |
$3,475.14
|
| Rate for Payer: VA VA |
$50.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,044.20
|
|
|
PEGFILGRASTIM-APGF 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$6,396.10
|
|
|
Service Code
|
HCPCS Q5122
|
| Hospital Charge Code |
195654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,814.28 |
| Max. Negotiated Rate |
$5,756.49 |
| Rate for Payer: Aetna American Axle |
$4,157.46
|
| Rate for Payer: Aetna Commercial |
$5,436.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,157.46
|
| Rate for Payer: Cash Price |
$5,116.88
|
| Rate for Payer: Cofinity Commercial |
$4,477.27
|
| Rate for Payer: Cofinity Commercial |
$5,500.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,116.88
|
| Rate for Payer: Healthscope Commercial |
$5,756.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,477.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,797.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,436.68
|
| Rate for Payer: PHP Commercial |
$5,436.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,477.27
|
| Rate for Payer: Priority Health SBD |
$4,029.54
|
| Rate for Payer: UMR Bronson Commercial |
$2,814.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,797.08
|
|
|
PEGFILGRASTIM-APGF 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$6,396.10
|
|
|
Service Code
|
HCPCS Q5122
|
| Hospital Charge Code |
195654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$5,756.49 |
| Rate for Payer: Aetna American Axle |
$4,157.46
|
| Rate for Payer: Aetna Commercial |
$5,436.68
|
| Rate for Payer: Aetna Medicare |
$64.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,157.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.97
|
| Rate for Payer: BCBS Complete |
$35.83
|
| Rate for Payer: BCBS MAPPO |
$62.38
|
| Rate for Payer: BCBS Trust/PPO |
$410.80
|
| Rate for Payer: BCN Medicare Advantage |
$62.38
|
| Rate for Payer: Cash Price |
$5,116.88
|
| Rate for Payer: Cash Price |
$5,116.88
|
| Rate for Payer: Cofinity Commercial |
$4,477.27
|
| Rate for Payer: Cofinity Commercial |
$5,500.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,116.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.38
|
| Rate for Payer: Healthscope Commercial |
$5,756.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,477.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,797.08
|
| Rate for Payer: Mclaren Medicaid |
$34.12
|
| Rate for Payer: Mclaren Medicare |
$62.38
|
| Rate for Payer: Meridian Medicaid |
$35.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,436.68
|
| Rate for Payer: PACE Medicare |
$59.26
|
| Rate for Payer: PACE SWMI |
$62.38
|
| Rate for Payer: PHP Commercial |
$5,436.68
|
| Rate for Payer: PHP Medicare Advantage |
$62.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,477.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.33
|
| Rate for Payer: Priority Health Medicare |
$62.38
|
| Rate for Payer: Priority Health Narrow Network |
$209.06
|
| Rate for Payer: Priority Health SBD |
$4,029.54
|
| Rate for Payer: Railroad Medicare Medicare |
$62.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.38
|
| Rate for Payer: UHC Medicare Advantage |
$64.25
|
| Rate for Payer: UMR Bronson Commercial |
$2,366.56
|
| Rate for Payer: VA VA |
$62.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,797.08
|
|
|
PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$6,368.78
|
|
|
Service Code
|
HCPCS Q5120
|
| Hospital Charge Code |
192102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.67 |
| Max. Negotiated Rate |
$5,731.90 |
| Rate for Payer: Aetna American Axle |
$4,139.71
|
| Rate for Payer: Aetna Commercial |
$5,413.46
|
| Rate for Payer: Aetna Medicare |
$360.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,139.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$433.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$433.44
|
| Rate for Payer: BCBS Complete |
$199.18
|
| Rate for Payer: BCBS MAPPO |
$346.76
|
| Rate for Payer: BCBS Trust/PPO |
$258.72
|
| Rate for Payer: BCN Medicare Advantage |
$346.76
|
| Rate for Payer: Cash Price |
$5,095.02
|
| Rate for Payer: Cash Price |
$5,095.02
|
| Rate for Payer: Cofinity Commercial |
$4,458.15
|
| Rate for Payer: Cofinity Commercial |
$5,477.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,095.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.76
|
| Rate for Payer: Healthscope Commercial |
$5,731.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,458.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,776.58
|
| Rate for Payer: Mclaren Medicaid |
$189.67
|
| Rate for Payer: Mclaren Medicare |
$346.76
|
| Rate for Payer: Meridian Medicaid |
$199.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$364.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,413.46
|
| Rate for Payer: PACE Medicare |
$329.42
|
| Rate for Payer: PACE SWMI |
$346.76
|
| Rate for Payer: PHP Commercial |
$5,413.46
|
| Rate for Payer: PHP Medicare Advantage |
$346.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$189.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,458.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,018.38
|
| Rate for Payer: Priority Health Medicare |
$346.76
|
| Rate for Payer: Priority Health Narrow Network |
$814.70
|
| Rate for Payer: Priority Health SBD |
$4,012.33
|
| Rate for Payer: Railroad Medicare Medicare |
$346.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.76
|
| Rate for Payer: UHC Medicare Advantage |
$357.16
|
| Rate for Payer: UMR Bronson Commercial |
$2,356.45
|
| Rate for Payer: VA VA |
$346.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,776.58
|
|
|
PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$6,368.78
|
|
|
Service Code
|
HCPCS Q5120
|
| Hospital Charge Code |
192102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,802.26 |
| Max. Negotiated Rate |
$5,731.90 |
| Rate for Payer: Aetna American Axle |
$4,139.71
|
| Rate for Payer: Aetna Commercial |
$5,413.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,139.71
|
| Rate for Payer: Cash Price |
$5,095.02
|
| Rate for Payer: Cofinity Commercial |
$4,458.15
|
| Rate for Payer: Cofinity Commercial |
$5,477.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,095.02
|
| Rate for Payer: Healthscope Commercial |
$5,731.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,458.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,776.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,413.46
|
| Rate for Payer: PHP Commercial |
$5,413.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,458.15
|
| Rate for Payer: Priority Health SBD |
$4,012.33
|
| Rate for Payer: UMR Bronson Commercial |
$2,802.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,776.58
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,304.00
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
189200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,333.76 |
| Max. Negotiated Rate |
$4,773.60 |
| Rate for Payer: Aetna American Axle |
$3,447.60
|
| Rate for Payer: Aetna Commercial |
$4,508.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,447.60
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cofinity Commercial |
$3,712.80
|
| Rate for Payer: Cofinity Commercial |
$4,561.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,243.20
|
| Rate for Payer: Healthscope Commercial |
$4,773.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,712.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,978.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,508.40
|
| Rate for Payer: PHP Commercial |
$4,508.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.80
|
| Rate for Payer: Priority Health SBD |
$3,341.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,333.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,978.00
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,304.00
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
189200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.79 |
| Max. Negotiated Rate |
$4,773.60 |
| Rate for Payer: Aetna American Axle |
$3,447.60
|
| Rate for Payer: Aetna Commercial |
$4,508.40
|
| Rate for Payer: Aetna Medicare |
$126.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,447.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.63
|
| Rate for Payer: BCBS Complete |
$70.14
|
| Rate for Payer: BCBS MAPPO |
$122.10
|
| Rate for Payer: BCBS Trust/PPO |
$394.56
|
| Rate for Payer: BCN Medicare Advantage |
$122.10
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cofinity Commercial |
$4,561.44
|
| Rate for Payer: Cofinity Commercial |
$3,712.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,243.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.10
|
| Rate for Payer: Healthscope Commercial |
$4,773.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,712.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,978.00
|
| Rate for Payer: Mclaren Medicaid |
$66.79
|
| Rate for Payer: Mclaren Medicare |
$122.10
|
| Rate for Payer: Meridian Medicaid |
$70.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,508.40
|
| Rate for Payer: PACE Medicare |
$116.00
|
| Rate for Payer: PACE SWMI |
$122.10
|
| Rate for Payer: PHP Commercial |
$4,508.40
|
| Rate for Payer: PHP Medicare Advantage |
$122.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$442.82
|
| Rate for Payer: Priority Health Medicare |
$122.10
|
| Rate for Payer: Priority Health Narrow Network |
$354.26
|
| Rate for Payer: Priority Health SBD |
$3,341.52
|
| Rate for Payer: Railroad Medicare Medicare |
$122.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.10
|
| Rate for Payer: UHC Medicare Advantage |
$125.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,962.48
|
| Rate for Payer: VA VA |
$122.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,978.00
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,616.00
|
|
|
Service Code
|
HCPCS Q5108
|
| Hospital Charge Code |
187520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.03 |
| Max. Negotiated Rate |
$5,054.40 |
| Rate for Payer: Aetna American Axle |
$3,650.40
|
| Rate for Payer: Aetna Commercial |
$4,773.60
|
| Rate for Payer: Aetna Medicare |
$127.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,650.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.18
|
| Rate for Payer: BCBS Complete |
$70.39
|
| Rate for Payer: BCBS MAPPO |
$122.54
|
| Rate for Payer: BCBS Trust/PPO |
$395.99
|
| Rate for Payer: BCN Medicare Advantage |
$122.54
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cofinity Commercial |
$3,931.20
|
| Rate for Payer: Cofinity Commercial |
$4,829.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,492.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.54
|
| Rate for Payer: Healthscope Commercial |
$5,054.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,931.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,212.00
|
| Rate for Payer: Mclaren Medicaid |
$67.03
|
| Rate for Payer: Mclaren Medicare |
$122.54
|
| Rate for Payer: Meridian Medicaid |
$70.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,773.60
|
| Rate for Payer: PACE Medicare |
$116.41
|
| Rate for Payer: PACE SWMI |
$122.54
|
| Rate for Payer: PHP Commercial |
$4,773.60
|
| Rate for Payer: PHP Medicare Advantage |
$122.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,931.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.29
|
| Rate for Payer: Priority Health Medicare |
$122.54
|
| Rate for Payer: Priority Health Narrow Network |
$226.63
|
| Rate for Payer: Priority Health SBD |
$3,538.08
|
| Rate for Payer: Railroad Medicare Medicare |
$122.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.54
|
| Rate for Payer: UHC Medicare Advantage |
$126.22
|
| Rate for Payer: UMR Bronson Commercial |
$2,077.92
|
| Rate for Payer: VA VA |
$122.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,212.00
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,616.00
|
|
|
Service Code
|
HCPCS Q5108
|
| Hospital Charge Code |
187520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,471.04 |
| Max. Negotiated Rate |
$5,054.40 |
| Rate for Payer: Aetna American Axle |
$3,650.40
|
| Rate for Payer: Aetna Commercial |
$4,773.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,650.40
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cofinity Commercial |
$3,931.20
|
| Rate for Payer: Cofinity Commercial |
$4,829.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,492.80
|
| Rate for Payer: Healthscope Commercial |
$5,054.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,931.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,212.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,773.60
|
| Rate for Payer: PHP Commercial |
$4,773.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,931.20
|
| Rate for Payer: Priority Health SBD |
$3,538.08
|
| Rate for Payer: UMR Bronson Commercial |
$2,471.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,212.00
|
|
|
PEGINTERFERON ALFA-2A 180 MCG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$3,187.04
|
|
|
Service Code
|
HCPCS S0145
|
| Hospital Charge Code |
34034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,402.30 |
| Max. Negotiated Rate |
$2,868.34 |
| Rate for Payer: Aetna American Axle |
$2,071.58
|
| Rate for Payer: Aetna Commercial |
$2,708.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,071.58
|
| Rate for Payer: Cash Price |
$2,549.63
|
| Rate for Payer: Cofinity Commercial |
$2,230.93
|
| Rate for Payer: Cofinity Commercial |
$2,740.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,549.63
|
| Rate for Payer: Healthscope Commercial |
$2,868.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,230.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,390.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,708.98
|
| Rate for Payer: PHP Commercial |
$2,708.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,230.93
|
| Rate for Payer: Priority Health SBD |
$2,007.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,402.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,390.28
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$72,697.46
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,843.98 |
| Max. Negotiated Rate |
$65,427.71 |
| Rate for Payer: Aetna American Axle |
$47,253.35
|
| Rate for Payer: Aetna Commercial |
$61,792.84
|
| Rate for Payer: Aetna Medicare |
$3,505.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47,253.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,213.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,213.84
|
| Rate for Payer: BCBS Complete |
$1,936.35
|
| Rate for Payer: BCBS MAPPO |
$3,371.08
|
| Rate for Payer: BCBS Trust/PPO |
$10,893.77
|
| Rate for Payer: BCN Medicare Advantage |
$3,371.08
|
| Rate for Payer: Cash Price |
$58,157.97
|
| Rate for Payer: Cash Price |
$58,157.97
|
| Rate for Payer: Cofinity Commercial |
$62,519.82
|
| Rate for Payer: Cofinity Commercial |
$50,888.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58,157.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,371.08
|
| Rate for Payer: Healthscope Commercial |
$65,427.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50,888.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54,523.10
|
| Rate for Payer: Mclaren Medicaid |
$1,843.98
|
| Rate for Payer: Mclaren Medicare |
$3,371.08
|
| Rate for Payer: Meridian Medicaid |
$1,936.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,539.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,876.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61,792.84
|
| Rate for Payer: PACE Medicare |
$3,202.52
|
| Rate for Payer: PACE SWMI |
$3,371.08
|
| Rate for Payer: PHP Commercial |
$61,792.84
|
| Rate for Payer: PHP Medicare Advantage |
$3,371.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,843.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50,888.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,712.37
|
| Rate for Payer: Priority Health Medicare |
$3,371.08
|
| Rate for Payer: Priority Health Narrow Network |
$7,769.90
|
| Rate for Payer: Priority Health SBD |
$45,799.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,371.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,371.08
|
| Rate for Payer: UHC Medicare Advantage |
$3,472.21
|
| Rate for Payer: UMR Bronson Commercial |
$26,898.06
|
| Rate for Payer: VA VA |
$3,371.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54,523.10
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72,697.46
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31,986.88 |
| Max. Negotiated Rate |
$65,427.71 |
| Rate for Payer: Aetna American Axle |
$47,253.35
|
| Rate for Payer: Aetna Commercial |
$61,792.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47,253.35
|
| Rate for Payer: Cash Price |
$58,157.97
|
| Rate for Payer: Cofinity Commercial |
$50,888.22
|
| Rate for Payer: Cofinity Commercial |
$62,519.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58,157.97
|
| Rate for Payer: Healthscope Commercial |
$65,427.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50,888.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54,523.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61,792.84
|
| Rate for Payer: PHP Commercial |
$61,792.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50,888.22
|
| Rate for Payer: Priority Health SBD |
$45,799.40
|
| Rate for Payer: UMR Bronson Commercial |
$31,986.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54,523.10
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC
|
Facility
|
IP
|
$38,226.23
|
|
|
Service Code
|
MS-DRG 734
|
| Min. Negotiated Rate |
$16,399.07 |
| Max. Negotiated Rate |
$38,226.23 |
| Rate for Payer: Aetna Medicare |
$17,952.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,577.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,577.72
|
| Rate for Payer: BCBS MAPPO |
$17,262.18
|
| Rate for Payer: BCBS Trust/PPO |
$38,226.23
|
| Rate for Payer: BCN Medicare Advantage |
$17,262.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,262.18
|
| Rate for Payer: Mclaren Medicare |
$17,262.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,125.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,851.51
|
| Rate for Payer: PACE Medicare |
$16,399.07
|
| Rate for Payer: PACE SWMI |
$17,262.18
|
| Rate for Payer: PHP Medicare Advantage |
$17,262.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,190.99
|
| Rate for Payer: Priority Health Medicare |
$17,262.18
|
| Rate for Payer: Priority Health Narrow Network |
$24,952.79
|
| Rate for Payer: Railroad Medicare Medicare |
$17,262.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,156.09
|
| Rate for Payer: UHC Core |
$27,187.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,262.18
|
| Rate for Payer: UHC Exchange |
$21,614.28
|
| Rate for Payer: UHC Medicare Advantage |
$17,780.05
|
| Rate for Payer: VA VA |
$17,262.18
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$30,514.14
|
|
|
Service Code
|
MS-DRG 735
|
| Min. Negotiated Rate |
$9,712.32 |
| Max. Negotiated Rate |
$30,514.14 |
| Rate for Payer: Aetna Medicare |
$10,632.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,779.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,779.38
|
| Rate for Payer: BCBS MAPPO |
$10,223.50
|
| Rate for Payer: BCBS Trust/PPO |
$30,514.14
|
| Rate for Payer: BCN Medicare Advantage |
$10,223.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,223.50
|
| Rate for Payer: Mclaren Medicare |
$10,223.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,734.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,757.02
|
| Rate for Payer: PACE Medicare |
$9,712.32
|
| Rate for Payer: PACE SWMI |
$10,223.50
|
| Rate for Payer: PHP Medicare Advantage |
$10,223.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,083.77
|
| Rate for Payer: Priority Health Medicare |
$10,223.50
|
| Rate for Payer: Priority Health Narrow Network |
$14,467.02
|
| Rate for Payer: Railroad Medicare Medicare |
$10,223.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,223.09
|
| Rate for Payer: UHC Core |
$15,762.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,223.50
|
| Rate for Payer: UHC Exchange |
$12,531.43
|
| Rate for Payer: UHC Medicare Advantage |
$10,530.20
|
| Rate for Payer: VA VA |
$10,223.50
|
|
