|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 60687-391-11
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna American Axle |
$2.99
|
| Rate for Payer: Aetna Commercial |
$3.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.99
|
| Rate for Payer: Cash Price |
$3.68
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.68
|
| Rate for Payer: Healthscope Commercial |
$4.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.91
|
| Rate for Payer: PHP Commercial |
$3.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.45
|
|
|
PIOGLITAZONE 30 MG TABLET
|
Facility
|
IP
|
$357.44
|
|
|
Service Code
|
NDC 16729-021-15
|
| Hospital Charge Code |
25529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.27 |
| Max. Negotiated Rate |
$321.70 |
| Rate for Payer: Aetna American Axle |
$232.34
|
| Rate for Payer: Aetna Commercial |
$303.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.34
|
| Rate for Payer: Cash Price |
$285.95
|
| Rate for Payer: Cofinity Commercial |
$250.21
|
| Rate for Payer: Cofinity Commercial |
$307.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.95
|
| Rate for Payer: Healthscope Commercial |
$321.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$303.82
|
| Rate for Payer: PHP Commercial |
$303.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.21
|
| Rate for Payer: Priority Health SBD |
$225.19
|
| Rate for Payer: UMR Bronson Commercial |
$157.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.08
|
|
|
PIOGLITAZONE 30 MG TABLET
|
Facility
|
IP
|
$304.56
|
|
|
Service Code
|
NDC 57237-220-90
|
| Hospital Charge Code |
25529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.01 |
| Max. Negotiated Rate |
$274.10 |
| Rate for Payer: Aetna American Axle |
$197.96
|
| Rate for Payer: Aetna Commercial |
$258.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.96
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Commercial |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$261.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.65
|
| Rate for Payer: Healthscope Commercial |
$274.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.88
|
| Rate for Payer: PHP Commercial |
$258.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.19
|
| Rate for Payer: Priority Health SBD |
$191.87
|
| Rate for Payer: UMR Bronson Commercial |
$134.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.42
|
|
|
PIOGLITAZONE 30 MG TABLET
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
NDC 0093-7272-98
|
| Hospital Charge Code |
25529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna American Axle |
$222.30
|
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.30
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$290.70
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.40
|
| Rate for Payer: Priority Health SBD |
$215.46
|
| Rate for Payer: UMR Bronson Commercial |
$150.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
PIOGLITAZONE 30 MG TABLET
|
Facility
|
IP
|
$361.67
|
|
|
Service Code
|
NDC 33342-055-10
|
| Hospital Charge Code |
25529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.13 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna American Axle |
$235.09
|
| Rate for Payer: Aetna Commercial |
$307.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.09
|
| Rate for Payer: Cash Price |
$289.34
|
| Rate for Payer: Cofinity Commercial |
$253.17
|
| Rate for Payer: Cofinity Commercial |
$311.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.34
|
| Rate for Payer: Healthscope Commercial |
$325.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.42
|
| Rate for Payer: PHP Commercial |
$307.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.17
|
| Rate for Payer: Priority Health SBD |
$227.85
|
| Rate for Payer: UMR Bronson Commercial |
$159.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.25
|
|
|
PIOGLITAZONE 45 MG TABLET
|
Facility
|
IP
|
$374.36
|
|
|
Service Code
|
NDC 16729-022-15
|
| Hospital Charge Code |
25530
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.72 |
| Max. Negotiated Rate |
$336.92 |
| Rate for Payer: Aetna American Axle |
$243.33
|
| Rate for Payer: Aetna Commercial |
$318.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.33
|
| Rate for Payer: Cash Price |
$299.49
|
| Rate for Payer: Cofinity Commercial |
$262.05
|
| Rate for Payer: Cofinity Commercial |
$321.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.49
|
| Rate for Payer: Healthscope Commercial |
$336.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.21
|
| Rate for Payer: PHP Commercial |
$318.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.05
|
| Rate for Payer: Priority Health SBD |
$235.85
|
| Rate for Payer: UMR Bronson Commercial |
$164.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.77
|
|
|
PIOGLITAZONE 45 MG TABLET
|
Facility
|
IP
|
$302.45
|
|
|
Service Code
|
NDC 57237-221-90
|
| Hospital Charge Code |
25530
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.08 |
| Max. Negotiated Rate |
$272.20 |
| Rate for Payer: Aetna American Axle |
$196.59
|
| Rate for Payer: Aetna Commercial |
$257.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.59
|
| Rate for Payer: Cash Price |
$241.96
|
| Rate for Payer: Cofinity Commercial |
$211.72
|
| Rate for Payer: Cofinity Commercial |
$260.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.96
|
| Rate for Payer: Healthscope Commercial |
$272.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.08
|
| Rate for Payer: PHP Commercial |
$257.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.72
|
| Rate for Payer: Priority Health SBD |
$190.54
|
| Rate for Payer: UMR Bronson Commercial |
$133.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.84
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.21
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna American Axle |
$11.79
|
| Rate for Payer: Aetna American Axle |
$18.70
|
| Rate for Payer: Aetna American Axle |
$11.35
|
| Rate for Payer: Aetna American Axle |
$16.16
|
| Rate for Payer: Aetna American Axle |
$18.94
|
| Rate for Payer: Aetna American Axle |
$12.12
|
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna Commercial |
$15.42
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$24.77
|
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: Aetna Commercial |
$14.84
|
| Rate for Payer: Aetna Commercial |
$21.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.94
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$23.31
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$14.51
|
| Rate for Payer: Cash Price |
$14.91
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cofinity Commercial |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$25.06
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.22
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$12.70
|
| Rate for Payer: Cofinity Commercial |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$13.05
|
| Rate for Payer: Cofinity Commercial |
$16.03
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.91
|
| Rate for Payer: Healthscope Commercial |
$26.23
|
| Rate for Payer: Healthscope Commercial |
$22.37
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Healthscope Commercial |
$16.78
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$16.33
|
| Rate for Payer: Healthscope Commercial |
$15.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.45
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: PHP Commercial |
$24.77
|
| Rate for Payer: PHP Commercial |
$14.84
|
| Rate for Payer: PHP Commercial |
$21.13
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: PHP Commercial |
$15.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.14
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$18.36
|
| Rate for Payer: Priority Health SBD |
$15.66
|
| Rate for Payer: Priority Health SBD |
$11.00
|
| Rate for Payer: Priority Health SBD |
$11.43
|
| Rate for Payer: Priority Health SBD |
$18.13
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: UMR Bronson Commercial |
$7.98
|
| Rate for Payer: UMR Bronson Commercial |
$7.57
|
| Rate for Payer: UMR Bronson Commercial |
$7.68
|
| Rate for Payer: UMR Bronson Commercial |
$8.20
|
| Rate for Payer: UMR Bronson Commercial |
$10.94
|
| Rate for Payer: UMR Bronson Commercial |
$12.66
|
| Rate for Payer: UMR Bronson Commercial |
$12.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.58
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.64
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$16.78 |
| Rate for Payer: Aetna American Axle |
$12.12
|
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.12
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: Cash Price |
$14.91
|
| Rate for Payer: Cash Price |
$14.91
|
| Rate for Payer: Cofinity Commercial |
$13.05
|
| Rate for Payer: Cofinity Commercial |
$16.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.91
|
| Rate for Payer: Healthscope Commercial |
$16.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.84
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.05
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.98
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.19
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$19.07 |
| Rate for Payer: Aetna American Axle |
$13.77
|
| Rate for Payer: Aetna American Axle |
$10.64
|
| Rate for Payer: Aetna American Axle |
$11.90
|
| Rate for Payer: Aetna American Axle |
$10.87
|
| Rate for Payer: Aetna American Axle |
$12.68
|
| Rate for Payer: Aetna Commercial |
$15.56
|
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Commercial |
$14.22
|
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Cofinity Commercial |
$14.08
|
| Rate for Payer: Cofinity Commercial |
$11.71
|
| Rate for Payer: Cofinity Commercial |
$14.39
|
| Rate for Payer: Cofinity Commercial |
$12.81
|
| Rate for Payer: Cofinity Commercial |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$13.65
|
| Rate for Payer: Cofinity Commercial |
$16.77
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.95
|
| Rate for Payer: Healthscope Commercial |
$16.47
|
| Rate for Payer: Healthscope Commercial |
$17.55
|
| Rate for Payer: Healthscope Commercial |
$19.07
|
| Rate for Payer: Healthscope Commercial |
$14.73
|
| Rate for Payer: Healthscope Commercial |
$15.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.56
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: PHP Commercial |
$14.22
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: PHP Commercial |
$15.56
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.83
|
| Rate for Payer: Priority Health SBD |
$10.54
|
| Rate for Payer: Priority Health SBD |
$11.53
|
| Rate for Payer: Priority Health SBD |
$10.31
|
| Rate for Payer: Priority Health SBD |
$12.28
|
| Rate for Payer: Priority Health SBD |
$13.35
|
| Rate for Payer: UMR Bronson Commercial |
$8.58
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$7.20
|
| Rate for Payer: UMR Bronson Commercial |
$9.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.55
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.30
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna American Axle |
$11.90
|
| Rate for Payer: Aetna Commercial |
$15.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.90
|
| Rate for Payer: BCBS Complete |
$7.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$12.81
|
| Rate for Payer: Cofinity Commercial |
$15.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.64
|
| Rate for Payer: Healthscope Commercial |
$16.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.56
|
| Rate for Payer: PHP Commercial |
$15.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health SBD |
$11.53
|
| Rate for Payer: UMR Bronson Commercial |
$6.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.72
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$186.24
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
12587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.95 |
| Max. Negotiated Rate |
$167.62 |
| Rate for Payer: Aetna American Axle |
$121.06
|
| Rate for Payer: Aetna American Axle |
$103.73
|
| Rate for Payer: Aetna American Axle |
$128.32
|
| Rate for Payer: Aetna American Axle |
$135.04
|
| Rate for Payer: Aetna American Axle |
$133.35
|
| Rate for Payer: Aetna American Axle |
$119.12
|
| Rate for Payer: Aetna Commercial |
$155.77
|
| Rate for Payer: Aetna Commercial |
$135.64
|
| Rate for Payer: Aetna Commercial |
$158.30
|
| Rate for Payer: Aetna Commercial |
$174.39
|
| Rate for Payer: Aetna Commercial |
$167.81
|
| Rate for Payer: Aetna Commercial |
$176.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.73
|
| Rate for Payer: Cash Price |
$164.13
|
| Rate for Payer: Cash Price |
$127.66
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$146.61
|
| Rate for Payer: Cash Price |
$157.94
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cofinity Commercial |
$130.37
|
| Rate for Payer: Cofinity Commercial |
$160.17
|
| Rate for Payer: Cofinity Commercial |
$128.28
|
| Rate for Payer: Cofinity Commercial |
$111.71
|
| Rate for Payer: Cofinity Commercial |
$145.42
|
| Rate for Payer: Cofinity Commercial |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$178.66
|
| Rate for Payer: Cofinity Commercial |
$176.44
|
| Rate for Payer: Cofinity Commercial |
$143.61
|
| Rate for Payer: Cofinity Commercial |
$169.78
|
| Rate for Payer: Cofinity Commercial |
$137.24
|
| Rate for Payer: Cofinity Commercial |
$138.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.61
|
| Rate for Payer: Healthscope Commercial |
$177.68
|
| Rate for Payer: Healthscope Commercial |
$143.62
|
| Rate for Payer: Healthscope Commercial |
$164.93
|
| Rate for Payer: Healthscope Commercial |
$167.62
|
| Rate for Payer: Healthscope Commercial |
$184.64
|
| Rate for Payer: Healthscope Commercial |
$186.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.64
|
| Rate for Payer: PHP Commercial |
$176.59
|
| Rate for Payer: PHP Commercial |
$135.64
|
| Rate for Payer: PHP Commercial |
$167.81
|
| Rate for Payer: PHP Commercial |
$158.30
|
| Rate for Payer: PHP Commercial |
$174.39
|
| Rate for Payer: PHP Commercial |
$155.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.71
|
| Rate for Payer: Priority Health SBD |
$115.45
|
| Rate for Payer: Priority Health SBD |
$130.88
|
| Rate for Payer: Priority Health SBD |
$124.37
|
| Rate for Payer: Priority Health SBD |
$129.25
|
| Rate for Payer: Priority Health SBD |
$117.33
|
| Rate for Payer: Priority Health SBD |
$100.54
|
| Rate for Payer: UMR Bronson Commercial |
$70.22
|
| Rate for Payer: UMR Bronson Commercial |
$90.27
|
| Rate for Payer: UMR Bronson Commercial |
$86.86
|
| Rate for Payer: UMR Bronson Commercial |
$91.41
|
| Rate for Payer: UMR Bronson Commercial |
$80.63
|
| Rate for Payer: UMR Bronson Commercial |
$81.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.68
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$390.04
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
12587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$351.04 |
| Rate for Payer: Aetna American Axle |
$253.53
|
| Rate for Payer: Aetna American Axle |
$133.35
|
| Rate for Payer: Aetna Commercial |
$331.53
|
| Rate for Payer: Aetna Commercial |
$174.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.35
|
| Rate for Payer: BCBS Complete |
$82.06
|
| Rate for Payer: BCBS Complete |
$156.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: Cash Price |
$312.03
|
| Rate for Payer: Cash Price |
$164.13
|
| Rate for Payer: Cash Price |
$312.03
|
| Rate for Payer: Cash Price |
$164.13
|
| Rate for Payer: Cofinity Commercial |
$335.43
|
| Rate for Payer: Cofinity Commercial |
$143.61
|
| Rate for Payer: Cofinity Commercial |
$273.03
|
| Rate for Payer: Cofinity Commercial |
$176.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.13
|
| Rate for Payer: Healthscope Commercial |
$351.04
|
| Rate for Payer: Healthscope Commercial |
$184.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.39
|
| Rate for Payer: PHP Commercial |
$174.39
|
| Rate for Payer: PHP Commercial |
$331.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.61
|
| Rate for Payer: Priority Health SBD |
$129.25
|
| Rate for Payer: Priority Health SBD |
$245.73
|
| Rate for Payer: UMR Bronson Commercial |
$75.91
|
| Rate for Payer: UMR Bronson Commercial |
$144.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.53
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.58
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$19.42 |
| Rate for Payer: Aetna American Axle |
$14.03
|
| Rate for Payer: Aetna Commercial |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: BCBS Complete |
$8.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: Cash Price |
$17.26
|
| Rate for Payer: Cash Price |
$17.26
|
| Rate for Payer: Cofinity Commercial |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$19.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.34
|
| Rate for Payer: PHP Commercial |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.11
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UMR Bronson Commercial |
$7.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.18
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.58
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$19.42 |
| Rate for Payer: Aetna American Axle |
$14.03
|
| Rate for Payer: Aetna American Axle |
$12.28
|
| Rate for Payer: Aetna American Axle |
$13.43
|
| Rate for Payer: Aetna Commercial |
$17.56
|
| Rate for Payer: Aetna Commercial |
$18.34
|
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: Cash Price |
$17.26
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$16.25
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.12
|
| Rate for Payer: Healthscope Commercial |
$19.42
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Healthscope Commercial |
$17.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.56
|
| Rate for Payer: PHP Commercial |
$17.56
|
| Rate for Payer: PHP Commercial |
$18.34
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health SBD |
$11.91
|
| Rate for Payer: Priority Health SBD |
$13.02
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.32
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: UMR Bronson Commercial |
$9.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.18
|
|
|
PIPERACILLIN-TAZOBACTAM (ZOSYN) 13.5 GRAM /560 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
IP
|
$99.68
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.86 |
| Max. Negotiated Rate |
$89.71 |
| Rate for Payer: Aetna American Axle |
$64.79
|
| Rate for Payer: Aetna Commercial |
$84.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.79
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cofinity Commercial |
$69.78
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.74
|
| Rate for Payer: Healthscope Commercial |
$89.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.73
|
| Rate for Payer: PHP Commercial |
$84.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.78
|
| Rate for Payer: Priority Health SBD |
$62.80
|
| Rate for Payer: UMR Bronson Commercial |
$43.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.76
|
|
|
PLACEMENT OF AMNIOTIC MEMBRANE ON THE OCULAR SURFACE; SINGLE LAYER, SUTURED
|
Facility
|
OP
|
$10,819.03
|
|
|
Service Code
|
CPT 65779
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.28 |
| Max. Negotiated Rate |
$10,819.03 |
| Rate for Payer: Aetna Medicare |
$3,574.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,295.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,295.94
|
| Rate for Payer: BCBS Complete |
$1,974.07
|
| Rate for Payer: BCBS MAPPO |
$3,436.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,471.05
|
| Rate for Payer: BCN Medicare Advantage |
$3,436.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,436.75
|
| Rate for Payer: Mclaren Medicaid |
$1,879.90
|
| Rate for Payer: Mclaren Medicare |
$3,436.75
|
| Rate for Payer: Meridian Medicaid |
$1,974.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,608.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,952.26
|
| Rate for Payer: PACE Medicare |
$3,264.91
|
| Rate for Payer: PACE SWMI |
$3,436.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,436.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,879.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,819.03
|
| Rate for Payer: Priority Health Medicare |
$3,436.75
|
| Rate for Payer: Priority Health Narrow Network |
$8,655.22
|
| Rate for Payer: Railroad Medicare Medicare |
$3,436.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.71
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,436.75
|
| Rate for Payer: UHC Exchange |
$114.28
|
| Rate for Payer: UHC Medicare Advantage |
$3,539.85
|
| Rate for Payer: VA VA |
$3,436.75
|
|
|
PLACEMENT OF NEPHROURETERAL CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, NEW ACCESS
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 50433
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$242.31 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,594.23
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.54
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$242.31
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$7,856.86
|
|
|
Service Code
|
CPT 46020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.60 |
| Max. Negotiated Rate |
$7,856.86 |
| Rate for Payer: Aetna Medicare |
$2,595.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,119.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,119.72
|
| Rate for Payer: BCBS Complete |
$1,433.58
|
| Rate for Payer: BCBS MAPPO |
$2,495.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,604.14
|
| Rate for Payer: BCN Medicare Advantage |
$2,495.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,495.78
|
| Rate for Payer: Mclaren Medicaid |
$1,365.19
|
| Rate for Payer: Mclaren Medicare |
$2,495.78
|
| Rate for Payer: Meridian Medicaid |
$1,433.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,620.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,870.15
|
| Rate for Payer: PACE Medicare |
$2,370.99
|
| Rate for Payer: PACE SWMI |
$2,495.78
|
| Rate for Payer: PHP Medicare Advantage |
$2,495.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,365.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,856.86
|
| Rate for Payer: Priority Health Medicare |
$2,495.78
|
| Rate for Payer: Priority Health Narrow Network |
$6,285.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2,495.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.06
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,495.78
|
| Rate for Payer: UHC Exchange |
$114.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,570.65
|
| Rate for Payer: VA VA |
$2,495.78
|
|
|
PLASMALYTE A 1 L/HEPARIN 30000UNIT IRRIGATION
|
Facility
|
IP
|
$35.43
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
500532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$31.89 |
| Rate for Payer: Aetna American Axle |
$23.03
|
| Rate for Payer: Aetna Commercial |
$30.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.03
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$30.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.34
|
| Rate for Payer: Healthscope Commercial |
$31.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.12
|
| Rate for Payer: PHP Commercial |
$30.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.80
|
| Rate for Payer: Priority Health SBD |
$22.32
|
| Rate for Payer: UMR Bronson Commercial |
$15.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.57
|
|
|
PLASTIC OPERATION OF PENIS FOR STRAIGHTENING OF CHORDEE (EG, HYPOSPADIAS), WITH OR WITHOUT MOBILIZATION OF URETHRA
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 54300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$632.62 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,548.65
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.88
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$632.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY, PARTIAL OR COMPLETE, UNILATERAL
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 40700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.82 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,531.52
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,091.00
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$991.82
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
PLASTIC REPAIR OF INTROITUS
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 56800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$250.82 |
| 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 |
$1,583.45
|
| 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) |
$275.90
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$250.82
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; PRIMARY OR SIMPLE
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 42500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$342.83 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,565.60
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.11
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$342.83
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
PLEURAL EFFUSION WITH CC
|
Facility
|
IP
|
$17,839.08
|
|
|
Service Code
|
MS-DRG 187
|
| Min. Negotiated Rate |
$7,780.39 |
| Max. Negotiated Rate |
$17,839.08 |
| Rate for Payer: Aetna Medicare |
$8,517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,237.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,237.35
|
| Rate for Payer: BCBS MAPPO |
$8,189.88
|
| Rate for Payer: BCBS Trust/PPO |
$17,839.08
|
| Rate for Payer: BCN Medicare Advantage |
$8,189.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,189.88
|
| Rate for Payer: Mclaren Medicare |
$8,189.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,599.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,418.36
|
| Rate for Payer: PACE Medicare |
$7,780.39
|
| Rate for Payer: PACE SWMI |
$8,189.88
|
| Rate for Payer: PHP Medicare Advantage |
$8,189.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,296.83
|
| Rate for Payer: Priority Health Medicare |
$8,189.88
|
| Rate for Payer: Priority Health Narrow Network |
$11,437.46
|
| Rate for Payer: Railroad Medicare Medicare |
$8,189.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,197.56
|
| Rate for Payer: UHC Core |
$12,461.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,189.88
|
| Rate for Payer: UHC Exchange |
$9,907.21
|
| Rate for Payer: UHC Medicare Advantage |
$8,435.58
|
| Rate for Payer: VA VA |
$8,189.88
|
|
