|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 65862-175-01
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.64
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$65.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
IP
|
$244.32
|
|
|
Service Code
|
NDC 0781-1205-01
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.50 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna American Axle |
$158.81
|
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.81
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Commercial |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$210.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.46
|
| Rate for Payer: Healthscope Commercial |
$219.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.67
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.02
|
| Rate for Payer: Priority Health SBD |
$153.92
|
| Rate for Payer: UMR Bronson Commercial |
$107.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.24
|
|
|
PENIS PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$39,085.65
|
|
|
Service Code
|
MS-DRG 709
|
| Min. Negotiated Rate |
$16,378.58 |
| Max. Negotiated Rate |
$39,085.65 |
| Rate for Payer: Aetna Medicare |
$17,930.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,550.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,550.76
|
| Rate for Payer: BCBS MAPPO |
$17,240.61
|
| Rate for Payer: BCBS Trust/PPO |
$39,085.65
|
| Rate for Payer: BCN Medicare Advantage |
$17,240.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,240.61
|
| Rate for Payer: Mclaren Medicare |
$17,240.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,102.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,826.70
|
| Rate for Payer: PACE Medicare |
$16,378.58
|
| Rate for Payer: PACE SWMI |
$17,240.61
|
| Rate for Payer: PHP Medicare Advantage |
$17,240.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,421.83
|
| Rate for Payer: Priority Health Medicare |
$17,240.61
|
| Rate for Payer: Priority Health Narrow Network |
$24,337.46
|
| Rate for Payer: Railroad Medicare Medicare |
$17,240.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,338.48
|
| Rate for Payer: UHC Core |
$26,516.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,240.61
|
| Rate for Payer: UHC Exchange |
$21,081.28
|
| Rate for Payer: UHC Medicare Advantage |
$17,757.83
|
| Rate for Payer: VA VA |
$17,240.61
|
|
|
PENIS PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,828.01
|
|
|
Service Code
|
MS-DRG 710
|
| Min. Negotiated Rate |
$9,983.91 |
| Max. Negotiated Rate |
$18,828.01 |
| Rate for Payer: Aetna Medicare |
$10,929.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,136.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,136.72
|
| Rate for Payer: BCBS MAPPO |
$10,509.38
|
| Rate for Payer: BCBS Trust/PPO |
$12,901.23
|
| Rate for Payer: BCN Medicare Advantage |
$10,509.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,509.38
|
| Rate for Payer: Mclaren Medicare |
$10,509.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,034.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,085.79
|
| Rate for Payer: PACE Medicare |
$9,983.91
|
| Rate for Payer: PACE SWMI |
$10,509.38
|
| Rate for Payer: PHP Medicare Advantage |
$10,509.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,712.11
|
| Rate for Payer: Priority Health Medicare |
$10,509.38
|
| Rate for Payer: Priority Health Narrow Network |
$14,169.69
|
| Rate for Payer: Railroad Medicare Medicare |
$10,509.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,828.01
|
| Rate for Payer: UHC Core |
$15,438.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,509.38
|
| Rate for Payer: UHC Exchange |
$12,273.88
|
| Rate for Payer: UHC Medicare Advantage |
$10,824.66
|
| Rate for Payer: VA VA |
$10,509.38
|
|
|
PENTAMIDINE 300 MG IM INJECTION
|
Facility
|
IP
|
$168.58
|
|
|
Service Code
|
NDC 63323-113-10
|
| Hospital Charge Code |
299999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.18 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna American Axle |
$109.58
|
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.01
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$74.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.44
|
|
|
PENTAMIDINE 300 MG IM INJECTION
|
Facility
|
IP
|
$168.58
|
|
|
Service Code
|
NDC 63323-113-01
|
| Hospital Charge Code |
299999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.18 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna American Axle |
$109.58
|
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.01
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$74.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.44
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$347.95
|
|
|
Service Code
|
NDC 13925-522-01
|
| Hospital Charge Code |
28235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$153.10 |
| Max. Negotiated Rate |
$313.16 |
| Rate for Payer: Aetna American Axle |
$226.17
|
| Rate for Payer: Aetna Commercial |
$295.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.17
|
| Rate for Payer: Cash Price |
$278.36
|
| Rate for Payer: Cofinity Commercial |
$243.56
|
| Rate for Payer: Cofinity Commercial |
$299.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.36
|
| Rate for Payer: Healthscope Commercial |
$313.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$295.76
|
| Rate for Payer: PHP Commercial |
$295.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.56
|
| Rate for Payer: Priority Health SBD |
$219.21
|
| Rate for Payer: UMR Bronson Commercial |
$153.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.96
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$574.28
|
|
|
Service Code
|
NDC 63323-877-15
|
| Hospital Charge Code |
28235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$252.68 |
| Max. Negotiated Rate |
$516.85 |
| Rate for Payer: Aetna American Axle |
$373.28
|
| Rate for Payer: Aetna Commercial |
$488.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.28
|
| Rate for Payer: Cash Price |
$459.42
|
| Rate for Payer: Cofinity Commercial |
$402.00
|
| Rate for Payer: Cofinity Commercial |
$493.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$459.42
|
| Rate for Payer: Healthscope Commercial |
$516.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$402.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$488.14
|
| Rate for Payer: PHP Commercial |
$488.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.00
|
| Rate for Payer: Priority Health SBD |
$361.80
|
| Rate for Payer: UMR Bronson Commercial |
$252.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.71
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$374.10
|
|
|
Service Code
|
NDC 13925-515-10
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.60 |
| Max. Negotiated Rate |
$336.69 |
| Rate for Payer: Aetna American Axle |
$243.16
|
| Rate for Payer: Aetna Commercial |
$317.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.16
|
| Rate for Payer: Cash Price |
$299.28
|
| Rate for Payer: Cofinity Commercial |
$321.73
|
| Rate for Payer: Cofinity Commercial |
$261.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.28
|
| Rate for Payer: Healthscope Commercial |
$336.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$317.98
|
| Rate for Payer: PHP Commercial |
$317.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.87
|
| Rate for Payer: Priority Health SBD |
$235.68
|
| Rate for Payer: UMR Bronson Commercial |
$164.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.58
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$168.58
|
|
|
Service Code
|
NDC 63323-113-10
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.18 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna American Axle |
$109.58
|
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.01
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$74.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.44
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$168.58
|
|
|
Service Code
|
NDC 63323-113-01
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.18 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna American Axle |
$109.58
|
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.01
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$74.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.44
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$374.10
|
|
|
Service Code
|
NDC 13925-515-01
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.60 |
| Max. Negotiated Rate |
$336.69 |
| Rate for Payer: Aetna American Axle |
$243.16
|
| Rate for Payer: Aetna Commercial |
$317.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.16
|
| Rate for Payer: Cash Price |
$299.28
|
| Rate for Payer: Cofinity Commercial |
$261.87
|
| Rate for Payer: Cofinity Commercial |
$321.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.28
|
| Rate for Payer: Healthscope Commercial |
$336.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$317.98
|
| Rate for Payer: PHP Commercial |
$317.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.87
|
| Rate for Payer: Priority Health SBD |
$235.68
|
| Rate for Payer: UMR Bronson Commercial |
$164.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.58
|
|
|
PENTAZOCINE 50 MG-NALOXONE 0.5 MG TABLET
|
Facility
|
IP
|
$1,342.60
|
|
|
Service Code
|
NDC 0591-0395-01
|
| Hospital Charge Code |
10908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$590.74 |
| Max. Negotiated Rate |
$1,208.34 |
| Rate for Payer: Aetna American Axle |
$872.69
|
| Rate for Payer: Aetna Commercial |
$1,141.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.69
|
| Rate for Payer: Cash Price |
$1,074.08
|
| Rate for Payer: Cofinity Commercial |
$1,154.64
|
| Rate for Payer: Cofinity Commercial |
$939.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.08
|
| Rate for Payer: Healthscope Commercial |
$1,208.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$939.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,141.21
|
| Rate for Payer: PHP Commercial |
$1,141.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.82
|
| Rate for Payer: Priority Health SBD |
$845.84
|
| Rate for Payer: UMR Bronson Commercial |
$590.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.95
|
|
|
PENTOBARBITAL SODIUM 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$3,348.00
|
|
|
Service Code
|
HCPCS J2515
|
| Hospital Charge Code |
6097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,473.12 |
| Max. Negotiated Rate |
$3,013.20 |
| Rate for Payer: Aetna American Axle |
$2,176.20
|
| Rate for Payer: Aetna American Axle |
$3,035.99
|
| Rate for Payer: Aetna American Axle |
$2,173.21
|
| Rate for Payer: Aetna American Axle |
$120.15
|
| Rate for Payer: Aetna American Axle |
$2,184.84
|
| Rate for Payer: Aetna American Axle |
$3,173.62
|
| Rate for Payer: Aetna Commercial |
$2,841.89
|
| Rate for Payer: Aetna Commercial |
$157.12
|
| Rate for Payer: Aetna Commercial |
$2,845.80
|
| Rate for Payer: Aetna Commercial |
$4,150.12
|
| Rate for Payer: Aetna Commercial |
$2,857.10
|
| Rate for Payer: Aetna Commercial |
$3,970.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,173.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,184.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,173.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,035.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,176.20
|
| Rate for Payer: Cash Price |
$2,674.72
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$3,906.00
|
| Rate for Payer: Cash Price |
$3,736.60
|
| Rate for Payer: Cash Price |
$2,689.04
|
| Rate for Payer: Cash Price |
$147.88
|
| Rate for Payer: Cofinity Commercial |
$2,879.28
|
| Rate for Payer: Cofinity Commercial |
$4,198.95
|
| Rate for Payer: Cofinity Commercial |
$3,417.75
|
| Rate for Payer: Cofinity Commercial |
$3,269.52
|
| Rate for Payer: Cofinity Commercial |
$158.97
|
| Rate for Payer: Cofinity Commercial |
$129.40
|
| Rate for Payer: Cofinity Commercial |
$2,352.91
|
| Rate for Payer: Cofinity Commercial |
$2,340.38
|
| Rate for Payer: Cofinity Commercial |
$2,875.32
|
| Rate for Payer: Cofinity Commercial |
$2,890.72
|
| Rate for Payer: Cofinity Commercial |
$2,343.60
|
| Rate for Payer: Cofinity Commercial |
$4,016.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,736.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,906.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,689.04
|
| Rate for Payer: Healthscope Commercial |
$3,025.17
|
| Rate for Payer: Healthscope Commercial |
$3,009.06
|
| Rate for Payer: Healthscope Commercial |
$4,394.25
|
| Rate for Payer: Healthscope Commercial |
$3,013.20
|
| Rate for Payer: Healthscope Commercial |
$4,203.68
|
| Rate for Payer: Healthscope Commercial |
$166.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,269.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,352.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,343.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,340.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,417.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,511.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,507.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,503.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,661.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,520.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,970.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,150.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,841.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,845.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,857.10
|
| Rate for Payer: PHP Commercial |
$4,150.12
|
| Rate for Payer: PHP Commercial |
$3,970.14
|
| Rate for Payer: PHP Commercial |
$2,841.89
|
| Rate for Payer: PHP Commercial |
$157.12
|
| Rate for Payer: PHP Commercial |
$2,857.10
|
| Rate for Payer: PHP Commercial |
$2,845.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,417.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,352.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,343.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,340.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.40
|
| Rate for Payer: Priority Health SBD |
$3,075.98
|
| Rate for Payer: Priority Health SBD |
$2,117.62
|
| Rate for Payer: Priority Health SBD |
$2,106.34
|
| Rate for Payer: Priority Health SBD |
$2,109.24
|
| Rate for Payer: Priority Health SBD |
$116.46
|
| Rate for Payer: Priority Health SBD |
$2,942.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,478.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,473.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,148.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,471.10
|
| Rate for Payer: UMR Bronson Commercial |
$2,055.13
|
| Rate for Payer: UMR Bronson Commercial |
$81.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,520.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,507.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,511.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,503.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,661.88
|
|
|
PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$3,755.87
|
|
|
Service Code
|
NDC 50458-098-01
|
| Hospital Charge Code |
12912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,652.58 |
| Max. Negotiated Rate |
$3,380.28 |
| Rate for Payer: Aetna American Axle |
$2,441.32
|
| Rate for Payer: Aetna Commercial |
$3,192.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,441.32
|
| Rate for Payer: Cash Price |
$3,004.70
|
| Rate for Payer: Cofinity Commercial |
$3,230.05
|
| Rate for Payer: Cofinity Commercial |
$2,629.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,004.70
|
| Rate for Payer: Healthscope Commercial |
$3,380.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,629.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,816.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,192.49
|
| Rate for Payer: PHP Commercial |
$3,192.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.11
|
| Rate for Payer: Priority Health SBD |
$2,366.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,652.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,816.90
|
|
|
PENTOSTATIN 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11,130.54
|
|
|
Service Code
|
HCPCS J9268
|
| Hospital Charge Code |
10910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,897.44 |
| Max. Negotiated Rate |
$10,017.49 |
| Rate for Payer: Aetna American Axle |
$7,234.85
|
| Rate for Payer: Aetna Commercial |
$9,460.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,234.85
|
| Rate for Payer: Cash Price |
$8,904.43
|
| Rate for Payer: Cofinity Commercial |
$7,791.38
|
| Rate for Payer: Cofinity Commercial |
$9,572.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,904.43
|
| Rate for Payer: Healthscope Commercial |
$10,017.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,791.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,347.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,460.96
|
| Rate for Payer: PHP Commercial |
$9,460.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,791.38
|
| Rate for Payer: Priority Health SBD |
$7,012.24
|
| Rate for Payer: UMR Bronson Commercial |
$4,897.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,347.90
|
|
|
PENTOSTATIN 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,130.54
|
|
|
Service Code
|
HCPCS J9268
|
| Hospital Charge Code |
10910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,243.41 |
| Max. Negotiated Rate |
$10,017.49 |
| Rate for Payer: Aetna American Axle |
$7,234.85
|
| Rate for Payer: Aetna Commercial |
$9,460.96
|
| Rate for Payer: Aetna Medicare |
$2,364.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,234.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,841.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,841.44
|
| Rate for Payer: BCBS Complete |
$1,305.70
|
| Rate for Payer: BCBS MAPPO |
$2,273.15
|
| Rate for Payer: BCBS Trust/PPO |
$7,345.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,273.15
|
| Rate for Payer: Cash Price |
$8,904.43
|
| Rate for Payer: Cash Price |
$8,904.43
|
| Rate for Payer: Cofinity Commercial |
$9,572.26
|
| Rate for Payer: Cofinity Commercial |
$7,791.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,904.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,273.15
|
| Rate for Payer: Healthscope Commercial |
$10,017.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,791.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,347.90
|
| Rate for Payer: Mclaren Medicaid |
$1,243.41
|
| Rate for Payer: Mclaren Medicare |
$2,273.15
|
| Rate for Payer: Meridian Medicaid |
$1,305.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,386.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,614.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,460.96
|
| Rate for Payer: PACE Medicare |
$2,159.50
|
| Rate for Payer: PACE SWMI |
$2,273.15
|
| Rate for Payer: PHP Commercial |
$9,460.96
|
| Rate for Payer: PHP Medicare Advantage |
$2,273.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,243.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,791.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,863.42
|
| Rate for Payer: Priority Health Medicare |
$2,273.15
|
| Rate for Payer: Priority Health Narrow Network |
$5,490.74
|
| Rate for Payer: Priority Health SBD |
$7,012.24
|
| Rate for Payer: Railroad Medicare Medicare |
$2,273.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,273.15
|
| Rate for Payer: UHC Medicare Advantage |
$2,341.35
|
| Rate for Payer: UMR Bronson Commercial |
$4,118.30
|
| Rate for Payer: VA VA |
$2,273.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,347.90
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$254.60
|
|
|
Service Code
|
NDC 60505-0033-6
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.02 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.41
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.22
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: UMR Bronson Commercial |
$112.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$387.75
|
|
|
Service Code
|
NDC 0904-5448-61
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna American Axle |
$252.04
|
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.04
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$271.42
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.59
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.42
|
| Rate for Payer: Priority Health SBD |
$244.28
|
| Rate for Payer: UMR Bronson Commercial |
$170.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
PEPTAMEN AF BOLUS FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 9871666360
|
| Hospital Charge Code |
150863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.36
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF CONTINUOUS FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 9871666360
|
| Hospital Charge Code |
168955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.36
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF CYCLIC FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 9871666360
|
| Hospital Charge Code |
200079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.36
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 9871666360
|
| Hospital Charge Code |
200078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.36
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN INTENSE VHP BOLUS FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 4390072395
|
| Hospital Charge Code |
300293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.21
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.72
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 4390072395
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.21
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.72
|
|
