|
PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 57410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,692.96
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.90
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$104.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
PELVIC FIXATION (ATTACHMENT OF CAUDAL END OF INSTRUMENTATION TO PELVIC BONY STRUCTURES) OTHER THAN SACRUM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,267.32
|
|
|
Service Code
|
CPT 22848
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$351.67 |
| Max. Negotiated Rate |
$1,267.32 |
| Rate for Payer: BCBS Trust/PPO |
$1,267.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.84
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$351.67
|
|
|
PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, HYPOGASTRIC, AND OBTURATOR NODES (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,816.51
|
|
|
Service Code
|
CPT 38770
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$791.75 |
| Max. Negotiated Rate |
$2,816.51 |
| Rate for Payer: BCBS Trust/PPO |
$2,816.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$870.92
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$791.75
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,953.27
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$22,457.94 |
| Rate for Payer: Aetna American Axle |
$16,219.63
|
| Rate for Payer: Aetna Commercial |
$21,210.28
|
| Rate for Payer: Aetna Medicare |
$57.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,219.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.66
|
| Rate for Payer: BCBS Complete |
$32.01
|
| Rate for Payer: BCBS MAPPO |
$55.73
|
| Rate for Payer: BCBS Trust/PPO |
$180.09
|
| Rate for Payer: BCN Medicare Advantage |
$55.73
|
| Rate for Payer: Cash Price |
$19,962.62
|
| Rate for Payer: Cash Price |
$19,962.62
|
| Rate for Payer: Cofinity Commercial |
$21,459.81
|
| Rate for Payer: Cofinity Commercial |
$17,467.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,962.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.73
|
| Rate for Payer: Healthscope Commercial |
$22,457.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,467.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,714.95
|
| Rate for Payer: Mclaren Medicaid |
$30.48
|
| Rate for Payer: Mclaren Medicare |
$55.73
|
| Rate for Payer: Meridian Medicaid |
$32.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,210.28
|
| Rate for Payer: PACE Medicare |
$52.94
|
| Rate for Payer: PACE SWMI |
$55.73
|
| Rate for Payer: PHP Commercial |
$21,210.28
|
| Rate for Payer: PHP Medicare Advantage |
$55.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,467.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.68
|
| Rate for Payer: Priority Health Medicare |
$55.73
|
| Rate for Payer: Priority Health Narrow Network |
$132.54
|
| Rate for Payer: Priority Health SBD |
$15,720.56
|
| Rate for Payer: Railroad Medicare Medicare |
$55.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.73
|
| Rate for Payer: UHC Medicare Advantage |
$57.40
|
| Rate for Payer: UMR Bronson Commercial |
$9,232.71
|
| Rate for Payer: VA VA |
$55.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,714.95
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,953.27
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,979.44 |
| Max. Negotiated Rate |
$22,457.94 |
| Rate for Payer: Aetna American Axle |
$16,219.63
|
| Rate for Payer: Aetna Commercial |
$21,210.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,219.63
|
| Rate for Payer: Cash Price |
$19,962.62
|
| Rate for Payer: Cofinity Commercial |
$17,467.29
|
| Rate for Payer: Cofinity Commercial |
$21,459.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,962.62
|
| Rate for Payer: Healthscope Commercial |
$22,457.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,467.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,714.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,210.28
|
| Rate for Payer: PHP Commercial |
$21,210.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,467.29
|
| Rate for Payer: Priority Health SBD |
$15,720.56
|
| Rate for Payer: UMR Bronson Commercial |
$10,979.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,714.95
|
|
|
PEMETREXED DISODIUM 1,000 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$696.98
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
200483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$306.67 |
| Max. Negotiated Rate |
$627.28 |
| Rate for Payer: Aetna American Axle |
$453.04
|
| Rate for Payer: Aetna Commercial |
$592.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.04
|
| Rate for Payer: Cash Price |
$557.58
|
| Rate for Payer: Cofinity Commercial |
$487.89
|
| Rate for Payer: Cofinity Commercial |
$599.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.58
|
| Rate for Payer: Healthscope Commercial |
$627.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$487.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.43
|
| Rate for Payer: PHP Commercial |
$592.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.89
|
| Rate for Payer: Priority Health SBD |
$439.10
|
| Rate for Payer: UMR Bronson Commercial |
$306.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.74
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$105.69
|
|
|
Service Code
|
HCPCS J9296
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$95.12 |
| Rate for Payer: Aetna American Axle |
$68.70
|
| Rate for Payer: Aetna Commercial |
$89.84
|
| Rate for Payer: Aetna Medicare |
$10.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.07
|
| Rate for Payer: BCBS Complete |
$5.55
|
| Rate for Payer: BCBS MAPPO |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$31.18
|
| Rate for Payer: BCN Medicare Advantage |
$9.66
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: Cofinity Commercial |
$90.89
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.66
|
| Rate for Payer: Healthscope Commercial |
$95.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.27
|
| Rate for Payer: Mclaren Medicaid |
$5.28
|
| Rate for Payer: Mclaren Medicare |
$9.66
|
| Rate for Payer: Meridian Medicaid |
$5.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.84
|
| Rate for Payer: PACE Medicare |
$9.17
|
| Rate for Payer: PACE SWMI |
$9.66
|
| Rate for Payer: PHP Commercial |
$89.84
|
| Rate for Payer: PHP Medicare Advantage |
$9.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.36
|
| Rate for Payer: Priority Health Medicare |
$9.66
|
| Rate for Payer: Priority Health Narrow Network |
$22.69
|
| Rate for Payer: Priority Health SBD |
$66.58
|
| Rate for Payer: Railroad Medicare Medicare |
$9.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.66
|
| Rate for Payer: UHC Medicare Advantage |
$9.95
|
| Rate for Payer: UMR Bronson Commercial |
$39.11
|
| Rate for Payer: VA VA |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.27
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$87.94
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$79.15 |
| Rate for Payer: Aetna American Axle |
$57.16
|
| Rate for Payer: Aetna American Axle |
$52.18
|
| Rate for Payer: Aetna American Axle |
$39.14
|
| Rate for Payer: Aetna American Axle |
$30.61
|
| Rate for Payer: Aetna American Axle |
$1,639.85
|
| Rate for Payer: Aetna American Axle |
$65.92
|
| Rate for Payer: Aetna Commercial |
$86.21
|
| Rate for Payer: Aetna Commercial |
$2,144.42
|
| Rate for Payer: Aetna Commercial |
$40.03
|
| Rate for Payer: Aetna Commercial |
$51.18
|
| Rate for Payer: Aetna Commercial |
$68.24
|
| Rate for Payer: Aetna Commercial |
$74.75
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,639.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: Cash Price |
$48.17
|
| Rate for Payer: Cash Price |
$37.67
|
| Rate for Payer: Cash Price |
$70.35
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cash Price |
$2,018.28
|
| Rate for Payer: Cash Price |
$2,018.28
|
| Rate for Payer: Cash Price |
$37.67
|
| Rate for Payer: Cash Price |
$70.35
|
| Rate for Payer: Cash Price |
$48.17
|
| Rate for Payer: Cash Price |
$64.22
|
| Rate for Payer: Cash Price |
$64.22
|
| Rate for Payer: Cofinity Commercial |
$75.63
|
| Rate for Payer: Cofinity Commercial |
$42.15
|
| Rate for Payer: Cofinity Commercial |
$40.50
|
| Rate for Payer: Cofinity Commercial |
$56.20
|
| Rate for Payer: Cofinity Commercial |
$69.04
|
| Rate for Payer: Cofinity Commercial |
$32.96
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$61.56
|
| Rate for Payer: Cofinity Commercial |
$1,766.00
|
| Rate for Payer: Cofinity Commercial |
$2,169.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,018.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$42.38
|
| Rate for Payer: Healthscope Commercial |
$72.25
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Healthscope Commercial |
$54.19
|
| Rate for Payer: Healthscope Commercial |
$2,270.56
|
| Rate for Payer: Healthscope Commercial |
$79.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,766.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,892.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.06
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,144.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.03
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PHP Commercial |
$2,144.42
|
| Rate for Payer: PHP Commercial |
$40.03
|
| Rate for Payer: PHP Commercial |
$68.24
|
| Rate for Payer: PHP Commercial |
$74.75
|
| Rate for Payer: PHP Commercial |
$86.21
|
| Rate for Payer: PHP Commercial |
$51.18
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.47
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health Narrow Network |
$7.58
|
| Rate for Payer: Priority Health Narrow Network |
$7.58
|
| Rate for Payer: Priority Health Narrow Network |
$7.58
|
| Rate for Payer: Priority Health Narrow Network |
$7.58
|
| Rate for Payer: Priority Health Narrow Network |
$7.58
|
| Rate for Payer: Priority Health Narrow Network |
$7.58
|
| Rate for Payer: Priority Health SBD |
$55.40
|
| Rate for Payer: Priority Health SBD |
$1,589.40
|
| Rate for Payer: Priority Health SBD |
$63.89
|
| Rate for Payer: Priority Health SBD |
$50.58
|
| Rate for Payer: Priority Health SBD |
$37.93
|
| Rate for Payer: Priority Health SBD |
$29.67
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UMR Bronson Commercial |
$32.54
|
| Rate for Payer: UMR Bronson Commercial |
$37.53
|
| Rate for Payer: UMR Bronson Commercial |
$17.42
|
| Rate for Payer: UMR Bronson Commercial |
$29.70
|
| Rate for Payer: UMR Bronson Commercial |
$22.28
|
| Rate for Payer: UMR Bronson Commercial |
$933.45
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,892.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.32
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$47.09
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$42.38 |
| Rate for Payer: Aetna American Axle |
$30.61
|
| Rate for Payer: Aetna Commercial |
$40.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.61
|
| Rate for Payer: Cash Price |
$37.67
|
| Rate for Payer: Cofinity Commercial |
$32.96
|
| Rate for Payer: Cofinity Commercial |
$40.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.67
|
| Rate for Payer: Healthscope Commercial |
$42.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.03
|
| Rate for Payer: PHP Commercial |
$40.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.96
|
| Rate for Payer: Priority Health SBD |
$29.67
|
| Rate for Payer: UMR Bronson Commercial |
$20.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.32
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$927.32
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
37894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$834.59 |
| Rate for Payer: Aetna American Axle |
$602.76
|
| Rate for Payer: Aetna American Axle |
$11,504.53
|
| Rate for Payer: Aetna American Axle |
$738.28
|
| Rate for Payer: Aetna American Axle |
$406.81
|
| Rate for Payer: Aetna American Axle |
$304.08
|
| Rate for Payer: Aetna Commercial |
$15,044.38
|
| Rate for Payer: Aetna Commercial |
$965.44
|
| Rate for Payer: Aetna Commercial |
$788.22
|
| Rate for Payer: Aetna Commercial |
$397.64
|
| Rate for Payer: Aetna Commercial |
$531.98
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,504.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cash Price |
$908.65
|
| Rate for Payer: Cash Price |
$908.65
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cash Price |
$374.25
|
| Rate for Payer: Cash Price |
$374.25
|
| Rate for Payer: Cash Price |
$500.69
|
| Rate for Payer: Cash Price |
$500.69
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cofinity Commercial |
$12,389.49
|
| Rate for Payer: Cofinity Commercial |
$15,221.37
|
| Rate for Payer: Cofinity Commercial |
$402.32
|
| Rate for Payer: Cofinity Commercial |
$795.07
|
| Rate for Payer: Cofinity Commercial |
$438.10
|
| Rate for Payer: Cofinity Commercial |
$538.24
|
| Rate for Payer: Cofinity Commercial |
$976.80
|
| Rate for Payer: Cofinity Commercial |
$649.12
|
| Rate for Payer: Cofinity Commercial |
$797.50
|
| Rate for Payer: Cofinity Commercial |
$327.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,159.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$500.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$1,022.23
|
| Rate for Payer: Healthscope Commercial |
$563.27
|
| Rate for Payer: Healthscope Commercial |
$421.03
|
| Rate for Payer: Healthscope Commercial |
$834.59
|
| Rate for Payer: Healthscope Commercial |
$15,929.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$795.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$438.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,389.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,274.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$469.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.86
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,044.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$965.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$531.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$788.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.64
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PHP Commercial |
$15,044.38
|
| Rate for Payer: PHP Commercial |
$788.22
|
| Rate for Payer: PHP Commercial |
$965.44
|
| Rate for Payer: PHP Commercial |
$531.98
|
| Rate for Payer: PHP Commercial |
$397.64
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,389.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.47
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health Narrow Network |
$7.58
|
| Rate for Payer: Priority Health Narrow Network |
$7.58
|
| Rate for Payer: Priority Health Narrow Network |
$7.58
|
| Rate for Payer: Priority Health Narrow Network |
$7.58
|
| Rate for Payer: Priority Health Narrow Network |
$7.58
|
| Rate for Payer: Priority Health SBD |
$394.29
|
| Rate for Payer: Priority Health SBD |
$294.72
|
| Rate for Payer: Priority Health SBD |
$715.56
|
| Rate for Payer: Priority Health SBD |
$584.21
|
| Rate for Payer: Priority Health SBD |
$11,150.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UMR Bronson Commercial |
$231.57
|
| Rate for Payer: UMR Bronson Commercial |
$173.09
|
| Rate for Payer: UMR Bronson Commercial |
$420.25
|
| Rate for Payer: UMR Bronson Commercial |
$6,548.73
|
| Rate for Payer: UMR Bronson Commercial |
$343.11
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$469.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,274.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.49
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$17,699.27
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
37894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,787.68 |
| Max. Negotiated Rate |
$15,929.34 |
| Rate for Payer: Aetna American Axle |
$11,504.53
|
| Rate for Payer: Aetna Commercial |
$15,044.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,504.53
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cofinity Commercial |
$12,389.49
|
| Rate for Payer: Cofinity Commercial |
$15,221.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,159.42
|
| Rate for Payer: Healthscope Commercial |
$15,929.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,389.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,274.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,044.38
|
| Rate for Payer: PHP Commercial |
$15,044.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,389.49
|
| Rate for Payer: Priority Health SBD |
$11,150.54
|
| Rate for Payer: UMR Bronson Commercial |
$7,787.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,274.45
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$915.30
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$402.73 |
| Max. Negotiated Rate |
$823.77 |
| Rate for Payer: Aetna American Axle |
$594.94
|
| Rate for Payer: Aetna Commercial |
$778.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$594.94
|
| Rate for Payer: Cash Price |
$732.24
|
| Rate for Payer: Cofinity Commercial |
$640.71
|
| Rate for Payer: Cofinity Commercial |
$787.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$732.24
|
| Rate for Payer: Healthscope Commercial |
$823.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$640.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$686.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$778.00
|
| Rate for Payer: PHP Commercial |
$778.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.71
|
| Rate for Payer: Priority Health SBD |
$576.64
|
| Rate for Payer: UMR Bronson Commercial |
$402.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$686.48
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$915.30
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$823.77 |
| Rate for Payer: Aetna American Axle |
$594.94
|
| Rate for Payer: Aetna Commercial |
$778.00
|
| Rate for Payer: Aetna Medicare |
$22.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$594.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.16
|
| Rate for Payer: BCBS Complete |
$12.48
|
| Rate for Payer: BCBS MAPPO |
$21.73
|
| Rate for Payer: BCBS Trust/PPO |
$70.22
|
| Rate for Payer: BCN Medicare Advantage |
$21.73
|
| Rate for Payer: Cash Price |
$732.24
|
| Rate for Payer: Cash Price |
$732.24
|
| Rate for Payer: Cofinity Commercial |
$640.71
|
| Rate for Payer: Cofinity Commercial |
$787.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$732.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.73
|
| Rate for Payer: Healthscope Commercial |
$823.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$640.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$686.48
|
| Rate for Payer: Mclaren Medicaid |
$11.89
|
| Rate for Payer: Mclaren Medicare |
$21.73
|
| Rate for Payer: Meridian Medicaid |
$12.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$778.00
|
| Rate for Payer: PACE Medicare |
$20.64
|
| Rate for Payer: PACE SWMI |
$21.73
|
| Rate for Payer: PHP Commercial |
$778.00
|
| Rate for Payer: PHP Medicare Advantage |
$21.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.20
|
| Rate for Payer: Priority Health Medicare |
$21.73
|
| Rate for Payer: Priority Health Narrow Network |
$47.36
|
| Rate for Payer: Priority Health SBD |
$576.64
|
| Rate for Payer: Railroad Medicare Medicare |
$21.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.73
|
| Rate for Payer: UHC Medicare Advantage |
$22.38
|
| Rate for Payer: UMR Bronson Commercial |
$338.66
|
| Rate for Payer: VA VA |
$21.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$686.48
|
|
|
PENICILLIN G IV 16,000 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$162.50
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna American Axle |
$105.62
|
| Rate for Payer: Aetna Commercial |
$138.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.62
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cofinity Commercial |
$113.75
|
| Rate for Payer: Cofinity Commercial |
$139.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.00
|
| Rate for Payer: Healthscope Commercial |
$146.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.12
|
| Rate for Payer: PHP Commercial |
$138.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health SBD |
$102.38
|
| Rate for Payer: UMR Bronson Commercial |
$71.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.88
|
|
|
PENICILLIN G IV 1,600 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$18.75
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna American Axle |
$12.19
|
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.19
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.94
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.12
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: UMR Bronson Commercial |
$8.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
|
|
PENICILLIN G IV 160 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$6.25
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna American Axle |
$4.06
|
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$5.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.31
|
| Rate for Payer: PHP Commercial |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.38
|
| Rate for Payer: Priority Health SBD |
$3.94
|
| Rate for Payer: UMR Bronson Commercial |
$2.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.69
|
|
|
PENICILLIN G IV 3 MILLION UNITS IVPB 100 ML (IV PREMIX)
|
Facility
|
IP
|
$82.80
|
|
|
Service Code
|
NDC 9900-0001-60
|
| Hospital Charge Code |
500537
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna American Axle |
$53.82
|
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.82
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Commercial |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.38
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.96
|
| Rate for Payer: Priority Health SBD |
$52.16
|
| Rate for Payer: UMR Bronson Commercial |
$36.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.10
|
|
|
PENICILLIN G IV 5 MILLION UNITS IVPB 250 ML (IV PREMIX)
|
Facility
|
IP
|
$116.96
|
|
|
Service Code
|
NDC 9900-0001-61
|
| Hospital Charge Code |
500538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.46 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna American Axle |
$76.02
|
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.02
|
| Rate for Payer: Cash Price |
$93.57
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Cofinity Commercial |
$81.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.57
|
| Rate for Payer: Healthscope Commercial |
$105.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.42
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.87
|
| Rate for Payer: Priority Health SBD |
$73.68
|
| Rate for Payer: UMR Bronson Commercial |
$51.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.72
|
|
|
PENICILLIN G POT 3 MILLION UNIT/50 ML-DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$104.66
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
15960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.05 |
| Max. Negotiated Rate |
$94.19 |
| Rate for Payer: Aetna American Axle |
$68.03
|
| Rate for Payer: Aetna Commercial |
$88.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.03
|
| Rate for Payer: Cash Price |
$83.73
|
| Rate for Payer: Cofinity Commercial |
$73.26
|
| Rate for Payer: Cofinity Commercial |
$90.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.73
|
| Rate for Payer: Healthscope Commercial |
$94.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.96
|
| Rate for Payer: PHP Commercial |
$88.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.26
|
| Rate for Payer: Priority Health SBD |
$65.94
|
| Rate for Payer: UMR Bronson Commercial |
$46.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.50
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$99.64
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$89.68 |
| Rate for Payer: Aetna American Axle |
$64.77
|
| Rate for Payer: Aetna Commercial |
$84.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.77
|
| Rate for Payer: BCBS Complete |
$39.86
|
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cofinity Commercial |
$85.69
|
| Rate for Payer: Cofinity Commercial |
$69.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.71
|
| Rate for Payer: Healthscope Commercial |
$89.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.69
|
| Rate for Payer: PHP Commercial |
$84.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.75
|
| Rate for Payer: Priority Health SBD |
$62.77
|
| Rate for Payer: UMR Bronson Commercial |
$36.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.73
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$86.88
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.23 |
| Max. Negotiated Rate |
$78.19 |
| Rate for Payer: Aetna American Axle |
$56.47
|
| Rate for Payer: Aetna American Axle |
$64.88
|
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna American Axle |
$64.77
|
| Rate for Payer: Aetna Commercial |
$84.69
|
| Rate for Payer: Aetna Commercial |
$73.85
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$84.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.77
|
| Rate for Payer: Cash Price |
$79.86
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$74.72
|
| Rate for Payer: Cofinity Commercial |
$60.82
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$85.69
|
| Rate for Payer: Cofinity Commercial |
$85.85
|
| Rate for Payer: Cofinity Commercial |
$69.87
|
| Rate for Payer: Cofinity Commercial |
$69.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$78.19
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Healthscope Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$89.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.85
|
| Rate for Payer: PHP Commercial |
$73.85
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$84.85
|
| Rate for Payer: PHP Commercial |
$84.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.82
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: Priority Health SBD |
$62.77
|
| Rate for Payer: Priority Health SBD |
$54.73
|
| Rate for Payer: Priority Health SBD |
$62.89
|
| Rate for Payer: UMR Bronson Commercial |
$38.23
|
| Rate for Payer: UMR Bronson Commercial |
$43.84
|
| Rate for Payer: UMR Bronson Commercial |
$43.92
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$18.34
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna American Axle |
$11.92
|
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.92
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Cofinity Commercial |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$16.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.59
|
| Rate for Payer: PHP Commercial |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health SBD |
$11.55
|
| Rate for Payer: UMR Bronson Commercial |
$6.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.76
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$18.34
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna American Axle |
$11.92
|
| Rate for Payer: Aetna American Axle |
$14.36
|
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.92
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cash Price |
$17.67
|
| Rate for Payer: Cofinity Commercial |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Cofinity Commercial |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$16.51
|
| Rate for Payer: Healthscope Commercial |
$19.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.59
|
| Rate for Payer: PHP Commercial |
$18.78
|
| Rate for Payer: PHP Commercial |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.46
|
| Rate for Payer: Priority Health SBD |
$13.92
|
| Rate for Payer: Priority Health SBD |
$11.55
|
| Rate for Payer: UMR Bronson Commercial |
$9.72
|
| Rate for Payer: UMR Bronson Commercial |
$8.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.76
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 0093-4127-73
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.07 |
| Max. Negotiated Rate |
$129.02 |
| Rate for Payer: Aetna American Axle |
$93.18
|
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.85
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.34
|
| Rate for Payer: Priority Health SBD |
$90.31
|
| Rate for Payer: UMR Bronson Commercial |
$63.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 57237-040-01
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna American Axle |
$114.56
|
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.81
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.38
|
| Rate for Payer: Priority Health SBD |
$111.04
|
| Rate for Payer: UMR Bronson Commercial |
$77.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
