|
PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$118.65
|
|
|
Service Code
|
NDC 49230-206-94
|
| Hospital Charge Code |
27796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna American Axle |
$77.12
|
| Rate for Payer: Aetna Commercial |
$100.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.12
|
| Rate for Payer: Cash Price |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$102.04
|
| Rate for Payer: Cofinity Commercial |
$83.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.92
|
| Rate for Payer: Healthscope Commercial |
$106.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.85
|
| Rate for Payer: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.06
|
| Rate for Payer: Priority Health SBD |
$74.75
|
| Rate for Payer: UMR Bronson Commercial |
$52.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.99
|
|
|
PERITONEAL ADHESIOLYSIS WITH CC
|
Facility
|
IP
|
$38,550.40
|
|
|
Service Code
|
MS-DRG 336
|
| Min. Negotiated Rate |
$15,899.06 |
| Max. Negotiated Rate |
$38,550.40 |
| Rate for Payer: Aetna Medicare |
$17,405.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,919.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,919.81
|
| Rate for Payer: BCBS MAPPO |
$16,735.85
|
| Rate for Payer: BCBS Trust/PPO |
$38,550.40
|
| Rate for Payer: BCN Medicare Advantage |
$16,735.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,735.85
|
| Rate for Payer: Mclaren Medicare |
$16,735.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,572.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,246.23
|
| Rate for Payer: PACE Medicare |
$15,899.06
|
| Rate for Payer: PACE SWMI |
$16,735.85
|
| Rate for Payer: PHP Medicare Advantage |
$16,735.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,210.89
|
| Rate for Payer: Priority Health Medicare |
$16,735.85
|
| Rate for Payer: Priority Health Narrow Network |
$24,168.71
|
| Rate for Payer: Railroad Medicare Medicare |
$16,735.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,114.25
|
| Rate for Payer: UHC Core |
$26,333.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,735.85
|
| Rate for Payer: UHC Exchange |
$20,935.10
|
| Rate for Payer: UHC Medicare Advantage |
$17,237.93
|
| Rate for Payer: VA VA |
$16,735.85
|
|
|
PERITONEAL ADHESIOLYSIS WITH MCC
|
Facility
|
IP
|
$59,048.12
|
|
|
Service Code
|
MS-DRG 335
|
| Min. Negotiated Rate |
$26,658.35 |
| Max. Negotiated Rate |
$59,048.12 |
| Rate for Payer: Aetna Medicare |
$29,183.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,076.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,076.78
|
| Rate for Payer: BCBS MAPPO |
$28,061.42
|
| Rate for Payer: BCBS Trust/PPO |
$59,048.12
|
| Rate for Payer: BCN Medicare Advantage |
$28,061.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,061.42
|
| Rate for Payer: Mclaren Medicare |
$28,061.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29,464.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,270.63
|
| Rate for Payer: PACE Medicare |
$26,658.35
|
| Rate for Payer: PACE SWMI |
$28,061.42
|
| Rate for Payer: PHP Medicare Advantage |
$28,061.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,300.96
|
| Rate for Payer: Priority Health Medicare |
$28,061.42
|
| Rate for Payer: Priority Health Narrow Network |
$41,040.77
|
| Rate for Payer: Railroad Medicare Medicare |
$28,061.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54,533.05
|
| Rate for Payer: UHC Core |
$44,716.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$28,061.42
|
| Rate for Payer: UHC Exchange |
$35,549.80
|
| Rate for Payer: UHC Medicare Advantage |
$28,903.26
|
| Rate for Payer: VA VA |
$28,061.42
|
|
|
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$32,426.46
|
|
|
Service Code
|
MS-DRG 337
|
| Min. Negotiated Rate |
$11,441.47 |
| Max. Negotiated Rate |
$32,426.46 |
| Rate for Payer: Aetna Medicare |
$12,525.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,054.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,054.56
|
| Rate for Payer: BCBS MAPPO |
$12,043.65
|
| Rate for Payer: BCBS Trust/PPO |
$32,426.46
|
| Rate for Payer: BCN Medicare Advantage |
$12,043.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,043.65
|
| Rate for Payer: Mclaren Medicare |
$12,043.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,645.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,850.20
|
| Rate for Payer: PACE Medicare |
$11,441.47
|
| Rate for Payer: PACE SWMI |
$12,043.65
|
| Rate for Payer: PHP Medicare Advantage |
$12,043.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,473.22
|
| Rate for Payer: Priority Health Medicare |
$12,043.65
|
| Rate for Payer: Priority Health Narrow Network |
$17,178.58
|
| Rate for Payer: Railroad Medicare Medicare |
$12,043.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,826.09
|
| Rate for Payer: UHC Core |
$18,716.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,043.65
|
| Rate for Payer: UHC Exchange |
$14,880.20
|
| Rate for Payer: UHC Medicare Advantage |
$12,404.96
|
| Rate for Payer: VA VA |
$12,043.65
|
|
|
PERITONEAL DIALYSIS DRAINAGE BAG (EMPTY BAG)
|
Facility
|
IP
|
$13.51
|
|
|
Service Code
|
NDC 9900-0010-08
|
| Hospital Charge Code |
200025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: Cofinity Commercial |
$11.62
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.81
|
| Rate for Payer: Healthscope Commercial |
$12.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.48
|
| Rate for Payer: PHP Commercial |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.46
|
| Rate for Payer: Priority Health SBD |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.13
|
|
|
PERITONEAL DIALYSIS SOLN 7-2.5 % DEXT.LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$118.65
|
|
|
Service Code
|
NDC 49230-209-94
|
| Hospital Charge Code |
27800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna American Axle |
$77.12
|
| Rate for Payer: Aetna Commercial |
$100.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.12
|
| Rate for Payer: Cash Price |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$102.04
|
| Rate for Payer: Cofinity Commercial |
$83.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.92
|
| Rate for Payer: Healthscope Commercial |
$106.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.85
|
| Rate for Payer: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.06
|
| Rate for Payer: Priority Health SBD |
$74.75
|
| Rate for Payer: UMR Bronson Commercial |
$52.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.99
|
|
|
PERITONEAL DIALYSIS SOLN 7-2.5 % DEXT.LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$135.60
|
|
|
Service Code
|
NDC 49230-209-92
|
| Hospital Charge Code |
27800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.66 |
| Max. Negotiated Rate |
$122.04 |
| Rate for Payer: Aetna American Axle |
$88.14
|
| Rate for Payer: Aetna Commercial |
$115.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.14
|
| Rate for Payer: Cash Price |
$108.48
|
| Rate for Payer: Cofinity Commercial |
$116.62
|
| Rate for Payer: Cofinity Commercial |
$94.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.48
|
| Rate for Payer: Healthscope Commercial |
$122.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.26
|
| Rate for Payer: PHP Commercial |
$115.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.92
|
| Rate for Payer: Priority Health SBD |
$85.43
|
| Rate for Payer: UMR Bronson Commercial |
$59.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.70
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC
|
Facility
|
IP
|
$47,245.03
|
|
|
Service Code
|
MS-DRG 243
|
| Min. Negotiated Rate |
$17,160.44 |
| Max. Negotiated Rate |
$47,245.03 |
| Rate for Payer: Aetna Medicare |
$18,786.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,579.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,579.52
|
| Rate for Payer: BCBS MAPPO |
$18,063.62
|
| Rate for Payer: BCBS Trust/PPO |
$47,245.03
|
| Rate for Payer: BCN Medicare Advantage |
$18,063.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,063.62
|
| Rate for Payer: Mclaren Medicare |
$18,063.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,966.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,773.16
|
| Rate for Payer: PACE Medicare |
$17,160.44
|
| Rate for Payer: PACE SWMI |
$18,063.62
|
| Rate for Payer: PHP Medicare Advantage |
$18,063.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,683.38
|
| Rate for Payer: Priority Health Medicare |
$18,063.62
|
| Rate for Payer: Priority Health Narrow Network |
$26,146.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18,063.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,742.51
|
| Rate for Payer: UHC Core |
$28,488.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,063.62
|
| Rate for Payer: UHC Exchange |
$22,648.45
|
| Rate for Payer: UHC Medicare Advantage |
$18,605.53
|
| Rate for Payer: VA VA |
$18,063.62
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC
|
Facility
|
IP
|
$74,090.34
|
|
|
Service Code
|
MS-DRG 242
|
| Min. Negotiated Rate |
$25,780.61 |
| Max. Negotiated Rate |
$74,090.34 |
| Rate for Payer: Aetna Medicare |
$28,222.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,921.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,921.85
|
| Rate for Payer: BCBS MAPPO |
$27,137.48
|
| Rate for Payer: BCBS Trust/PPO |
$74,090.34
|
| Rate for Payer: BCN Medicare Advantage |
$27,137.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,137.48
|
| Rate for Payer: Mclaren Medicare |
$27,137.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,494.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,208.10
|
| Rate for Payer: PACE Medicare |
$25,780.61
|
| Rate for Payer: PACE SWMI |
$27,137.48
|
| Rate for Payer: PHP Medicare Advantage |
$27,137.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49,580.41
|
| Rate for Payer: Priority Health Medicare |
$27,137.48
|
| Rate for Payer: Priority Health Narrow Network |
$39,664.33
|
| Rate for Payer: Railroad Medicare Medicare |
$27,137.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,704.10
|
| Rate for Payer: UHC Core |
$43,216.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,137.48
|
| Rate for Payer: UHC Exchange |
$34,357.51
|
| Rate for Payer: UHC Medicare Advantage |
$27,951.60
|
| Rate for Payer: VA VA |
$27,137.48
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$42,724.33
|
|
|
Service Code
|
MS-DRG 244
|
| Min. Negotiated Rate |
$13,880.00 |
| Max. Negotiated Rate |
$42,724.33 |
| Rate for Payer: Aetna Medicare |
$15,194.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,263.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,263.16
|
| Rate for Payer: BCBS MAPPO |
$14,610.53
|
| Rate for Payer: BCBS Trust/PPO |
$42,724.33
|
| Rate for Payer: BCN Medicare Advantage |
$14,610.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,610.53
|
| Rate for Payer: Mclaren Medicare |
$14,610.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,341.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,802.11
|
| Rate for Payer: PACE Medicare |
$13,880.00
|
| Rate for Payer: PACE SWMI |
$14,610.53
|
| Rate for Payer: PHP Medicare Advantage |
$14,610.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,253.18
|
| Rate for Payer: Priority Health Medicare |
$14,610.53
|
| Rate for Payer: Priority Health Narrow Network |
$21,002.54
|
| Rate for Payer: Railroad Medicare Medicare |
$14,610.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,907.19
|
| Rate for Payer: UHC Core |
$22,883.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,610.53
|
| Rate for Payer: UHC Exchange |
$18,192.55
|
| Rate for Payer: UHC Medicare Advantage |
$15,048.85
|
| Rate for Payer: VA VA |
$14,610.53
|
|
|
PERMETHRIN 1 % TOPICAL LIQUID
|
Facility
|
IP
|
$39.65
|
|
|
Service Code
|
NDC 6373612002
|
| Hospital Charge Code |
10918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$35.68 |
| Rate for Payer: Aetna American Axle |
$25.77
|
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.77
|
| Rate for Payer: Cash Price |
$31.72
|
| Rate for Payer: Cofinity Commercial |
$27.76
|
| Rate for Payer: Cofinity Commercial |
$34.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.72
|
| Rate for Payer: Healthscope Commercial |
$35.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.70
|
| Rate for Payer: PHP Commercial |
$33.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.76
|
| Rate for Payer: Priority Health SBD |
$24.98
|
| Rate for Payer: UMR Bronson Commercial |
$17.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.74
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$322.35
|
|
|
Service Code
|
NDC 0472-0242-60
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.83 |
| Max. Negotiated Rate |
$290.12 |
| Rate for Payer: Aetna American Axle |
$209.53
|
| Rate for Payer: Aetna Commercial |
$274.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.53
|
| Rate for Payer: Cash Price |
$257.88
|
| Rate for Payer: Cofinity Commercial |
$225.64
|
| Rate for Payer: Cofinity Commercial |
$277.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.88
|
| Rate for Payer: Healthscope Commercial |
$290.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.00
|
| Rate for Payer: PHP Commercial |
$274.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.64
|
| Rate for Payer: Priority Health SBD |
$203.08
|
| Rate for Payer: UMR Bronson Commercial |
$141.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.76
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$60.27
|
|
|
Service Code
|
NDC 21922-021-07
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$54.24 |
| Rate for Payer: Aetna American Axle |
$39.18
|
| Rate for Payer: Aetna Commercial |
$51.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.18
|
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Cofinity Commercial |
$42.19
|
| Rate for Payer: Cofinity Commercial |
$51.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.22
|
| Rate for Payer: Healthscope Commercial |
$54.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.23
|
| Rate for Payer: PHP Commercial |
$51.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.19
|
| Rate for Payer: Priority Health SBD |
$37.97
|
| Rate for Payer: UMR Bronson Commercial |
$26.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.20
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$322.35
|
|
|
Service Code
|
NDC 45802-269-37
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.83 |
| Max. Negotiated Rate |
$290.12 |
| Rate for Payer: Aetna American Axle |
$209.53
|
| Rate for Payer: Aetna Commercial |
$274.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.53
|
| Rate for Payer: Cash Price |
$257.88
|
| Rate for Payer: Cofinity Commercial |
$225.64
|
| Rate for Payer: Cofinity Commercial |
$277.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.88
|
| Rate for Payer: Healthscope Commercial |
$290.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.00
|
| Rate for Payer: PHP Commercial |
$274.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.64
|
| Rate for Payer: Priority Health SBD |
$203.08
|
| Rate for Payer: UMR Bronson Commercial |
$141.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.76
|
|
|
PERPHENAZINE 2 MG TABLET
|
Facility
|
IP
|
$301.15
|
|
|
Service Code
|
NDC 52536-162-01
|
| Hospital Charge Code |
6157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.51 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Aetna American Axle |
$195.75
|
| Rate for Payer: Aetna Commercial |
$255.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.75
|
| Rate for Payer: Cash Price |
$240.92
|
| Rate for Payer: Cofinity Commercial |
$258.99
|
| Rate for Payer: Cofinity Commercial |
$210.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.92
|
| Rate for Payer: Healthscope Commercial |
$271.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.98
|
| Rate for Payer: PHP Commercial |
$255.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.80
|
| Rate for Payer: Priority Health SBD |
$189.72
|
| Rate for Payer: UMR Bronson Commercial |
$132.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.86
|
|
|
PERPHENAZINE 2 MG TABLET
|
Facility
|
IP
|
$198.55
|
|
|
Service Code
|
NDC 0603-5060-21
|
| Hospital Charge Code |
6157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$178.70 |
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$138.98
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.77
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.98
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: UMR Bronson Commercial |
$87.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
PERPHENAZINE 4 MG TABLET
|
Facility
|
IP
|
$445.44
|
|
|
Service Code
|
HCPCS Q0175
|
| Hospital Charge Code |
6158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.99 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna American Axle |
$289.54
|
| Rate for Payer: Aetna Commercial |
$378.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.54
|
| Rate for Payer: Cash Price |
$356.35
|
| Rate for Payer: Cofinity Commercial |
$311.81
|
| Rate for Payer: Cofinity Commercial |
$383.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.35
|
| Rate for Payer: Healthscope Commercial |
$400.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$378.62
|
| Rate for Payer: PHP Commercial |
$378.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.81
|
| Rate for Payer: Priority Health SBD |
$280.63
|
| Rate for Payer: UMR Bronson Commercial |
$195.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.08
|
|
|
PERPHENAZINE 8 MG TABLET
|
Facility
|
IP
|
$513.12
|
|
|
Service Code
|
NDC 0904-6601-61
|
| Hospital Charge Code |
6159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.77 |
| Max. Negotiated Rate |
$461.81 |
| Rate for Payer: Aetna American Axle |
$333.53
|
| Rate for Payer: Aetna Commercial |
$436.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.53
|
| Rate for Payer: Cash Price |
$410.50
|
| Rate for Payer: Cofinity Commercial |
$359.18
|
| Rate for Payer: Cofinity Commercial |
$441.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.50
|
| Rate for Payer: Healthscope Commercial |
$461.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$436.15
|
| Rate for Payer: PHP Commercial |
$436.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.18
|
| Rate for Payer: Priority Health SBD |
$323.27
|
| Rate for Payer: UMR Bronson Commercial |
$225.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.84
|
|
|
PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29,305.27
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
160029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$26,374.74 |
| Rate for Payer: Aetna American Axle |
$19,048.43
|
| Rate for Payer: Aetna Commercial |
$24,909.48
|
| Rate for Payer: Aetna Medicare |
$16.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,048.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.28
|
| Rate for Payer: BCBS Complete |
$8.86
|
| Rate for Payer: BCBS MAPPO |
$15.43
|
| Rate for Payer: BCBS Trust/PPO |
$49.83
|
| Rate for Payer: BCN Medicare Advantage |
$15.43
|
| Rate for Payer: Cash Price |
$23,444.22
|
| Rate for Payer: Cash Price |
$23,444.22
|
| Rate for Payer: Cofinity Commercial |
$20,513.69
|
| Rate for Payer: Cofinity Commercial |
$25,202.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,444.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.43
|
| Rate for Payer: Healthscope Commercial |
$26,374.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,513.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,978.95
|
| Rate for Payer: Mclaren Medicaid |
$8.44
|
| Rate for Payer: Mclaren Medicare |
$15.43
|
| Rate for Payer: Meridian Medicaid |
$8.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,909.48
|
| Rate for Payer: PACE Medicare |
$14.66
|
| Rate for Payer: PACE SWMI |
$15.43
|
| Rate for Payer: PHP Commercial |
$24,909.48
|
| Rate for Payer: PHP Medicare Advantage |
$15.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,513.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.30
|
| Rate for Payer: Priority Health Medicare |
$15.43
|
| Rate for Payer: Priority Health Narrow Network |
$36.24
|
| Rate for Payer: Priority Health SBD |
$18,462.32
|
| Rate for Payer: Railroad Medicare Medicare |
$15.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.43
|
| Rate for Payer: UHC Medicare Advantage |
$15.89
|
| Rate for Payer: UMR Bronson Commercial |
$10,842.95
|
| Rate for Payer: VA VA |
$15.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,978.95
|
|
|
PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29,305.27
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
160029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,894.32 |
| Max. Negotiated Rate |
$26,374.74 |
| Rate for Payer: Aetna American Axle |
$19,048.43
|
| Rate for Payer: Aetna Commercial |
$24,909.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,048.43
|
| Rate for Payer: Cash Price |
$23,444.22
|
| Rate for Payer: Cofinity Commercial |
$20,513.69
|
| Rate for Payer: Cofinity Commercial |
$25,202.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,444.22
|
| Rate for Payer: Healthscope Commercial |
$26,374.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,513.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,978.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,909.48
|
| Rate for Payer: PHP Commercial |
$24,909.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,513.69
|
| Rate for Payer: Priority Health SBD |
$18,462.32
|
| Rate for Payer: UMR Bronson Commercial |
$12,894.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,978.95
|
|
|
PERTUZUMAB 600 MG-TRASTUZUMAB 600 MG-HYALURONID-ZZXF/10 ML SUBCUT SOLN
|
Facility
|
IP
|
$39,175.84
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
194378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17,237.37 |
| Max. Negotiated Rate |
$35,258.26 |
| Rate for Payer: Aetna American Axle |
$25,464.30
|
| Rate for Payer: Aetna Commercial |
$33,299.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,464.30
|
| Rate for Payer: Cash Price |
$31,340.67
|
| Rate for Payer: Cofinity Commercial |
$27,423.09
|
| Rate for Payer: Cofinity Commercial |
$33,691.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31,340.67
|
| Rate for Payer: Healthscope Commercial |
$35,258.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27,423.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29,381.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33,299.46
|
| Rate for Payer: PHP Commercial |
$33,299.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27,423.09
|
| Rate for Payer: Priority Health SBD |
$24,680.78
|
| Rate for Payer: UMR Bronson Commercial |
$17,237.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29,381.88
|
|
|
PERTUZUMAB 600 MG-TRASTUZUMAB 600 MG-HYALURONID-ZZXF/10 ML SUBCUT SOLN
|
Facility
|
OP
|
$39,175.84
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
194378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.68 |
| Max. Negotiated Rate |
$35,258.26 |
| Rate for Payer: Aetna American Axle |
$25,464.30
|
| Rate for Payer: Aetna Commercial |
$33,299.46
|
| Rate for Payer: Aetna Medicare |
$69.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,464.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.81
|
| Rate for Payer: BCBS Complete |
$38.51
|
| Rate for Payer: BCBS MAPPO |
$67.05
|
| Rate for Payer: BCBS Trust/PPO |
$216.66
|
| Rate for Payer: BCN Medicare Advantage |
$67.05
|
| Rate for Payer: Cash Price |
$31,340.67
|
| Rate for Payer: Cash Price |
$31,340.67
|
| Rate for Payer: Cofinity Commercial |
$27,423.09
|
| Rate for Payer: Cofinity Commercial |
$33,691.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31,340.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.05
|
| Rate for Payer: Healthscope Commercial |
$35,258.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27,423.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29,381.88
|
| Rate for Payer: Mclaren Medicaid |
$36.68
|
| Rate for Payer: Mclaren Medicare |
$67.05
|
| Rate for Payer: Meridian Medicaid |
$38.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33,299.46
|
| Rate for Payer: PACE Medicare |
$63.70
|
| Rate for Payer: PACE SWMI |
$67.05
|
| Rate for Payer: PHP Commercial |
$33,299.46
|
| Rate for Payer: PHP Medicare Advantage |
$67.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27,423.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.43
|
| Rate for Payer: Priority Health Medicare |
$67.05
|
| Rate for Payer: Priority Health Narrow Network |
$159.54
|
| Rate for Payer: Priority Health SBD |
$24,680.78
|
| Rate for Payer: Railroad Medicare Medicare |
$67.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.05
|
| Rate for Payer: UHC Medicare Advantage |
$69.06
|
| Rate for Payer: UMR Bronson Commercial |
$14,495.06
|
| Rate for Payer: VA VA |
$67.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29,381.88
|
|
|
PE/TROP/CYC/KETOR (PF) 10-1-0.5% OPH (EYE DROP #4)
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
NDC 9900-0008-95
|
| Hospital Charge Code |
180468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
IP
|
$379.68
|
|
|
Service Code
|
NDC 69367-162-04
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.06 |
| Max. Negotiated Rate |
$341.71 |
| Rate for Payer: Aetna American Axle |
$246.79
|
| Rate for Payer: Aetna Commercial |
$322.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.79
|
| Rate for Payer: Cash Price |
$303.74
|
| Rate for Payer: Cofinity Commercial |
$265.78
|
| Rate for Payer: Cofinity Commercial |
$326.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.74
|
| Rate for Payer: Healthscope Commercial |
$341.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$322.73
|
| Rate for Payer: PHP Commercial |
$322.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.78
|
| Rate for Payer: Priority Health SBD |
$239.20
|
| Rate for Payer: UMR Bronson Commercial |
$167.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.76
|
|
|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 42192-801-01
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.21 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna American Axle |
$137.70
|
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.70
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$148.30
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.07
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.30
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UMR Bronson Commercial |
$93.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
