|
PALONOSETRON 250 MCG + DEXAMETHASONE 10 MG IVPB (PREMIX)
|
Facility
|
OP
|
$298.74
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
301168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$268.87 |
| Rate for Payer: Aetna American Axle |
$194.18
|
| Rate for Payer: Aetna Commercial |
$253.93
|
| Rate for Payer: Aetna Medicare |
$149.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.18
|
| Rate for Payer: BCBS Complete |
$119.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cofinity Advantage |
$209.12
|
| Rate for Payer: Cofinity Commercial |
$256.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.99
|
| Rate for Payer: Healthscope Commercial |
$268.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.06
|
| Rate for Payer: PHP Commercial |
$253.93
|
| Rate for Payer: Priority Health SBD |
$188.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UMR Bronson Commercial |
$110.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.06
|
|
|
PALONOSETRON 250 MCG + DEXAMETHASONE 10 MG IVPB (PREMIX)
|
Facility
|
IP
|
$298.74
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
301168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$268.87 |
| Rate for Payer: Aetna American Axle |
$194.18
|
| Rate for Payer: Aetna Commercial |
$253.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.18
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cofinity Advantage |
$209.12
|
| Rate for Payer: Cofinity Commercial |
$256.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.99
|
| Rate for Payer: Healthscope Commercial |
$268.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.06
|
| Rate for Payer: PHP Commercial |
$253.93
|
| Rate for Payer: Priority Health SBD |
$188.21
|
| Rate for Payer: UMR Bronson Commercial |
$131.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.06
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.14
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
32589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.78 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna American Axle |
$24.79
|
| Rate for Payer: Aetna American Axle |
$38.71
|
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Commercial |
$50.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.71
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$47.64
|
| Rate for Payer: Cofinity Advantage |
$41.69
|
| Rate for Payer: Cofinity Advantage |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$51.21
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.64
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.66
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$50.62
|
| Rate for Payer: Priority Health SBD |
$37.52
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: UMR Bronson Commercial |
$16.78
|
| Rate for Payer: UMR Bronson Commercial |
$26.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.66
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38.14
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
32589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$36.60 |
| Rate for Payer: Aetna American Axle |
$24.79
|
| Rate for Payer: Aetna American Axle |
$38.71
|
| Rate for Payer: Aetna Commercial |
$50.62
|
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Medicare |
$19.07
|
| Rate for Payer: Aetna Medicare |
$29.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.71
|
| Rate for Payer: BCBS Complete |
$23.82
|
| Rate for Payer: BCBS Complete |
$15.26
|
| Rate for Payer: BCBS Trust/PPO |
$36.60
|
| Rate for Payer: BCBS Trust/PPO |
$36.60
|
| Rate for Payer: BCN Commercial |
$36.60
|
| Rate for Payer: BCN Commercial |
$36.60
|
| Rate for Payer: Cash Price |
$47.64
|
| Rate for Payer: Cash Price |
$47.64
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cofinity Advantage |
$26.70
|
| Rate for Payer: Cofinity Advantage |
$41.69
|
| Rate for Payer: Cofinity Commercial |
$51.21
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.64
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.66
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$50.62
|
| Rate for Payer: Priority Health SBD |
$37.52
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.79
|
| Rate for Payer: UHC Core |
$19.87
|
| Rate for Payer: UHC Core |
$31.03
|
| Rate for Payer: UHC Exchange |
$14.99
|
| Rate for Payer: UHC Exchange |
$23.40
|
| Rate for Payer: UMR Bronson Commercial |
$14.11
|
| Rate for Payer: UMR Bronson Commercial |
$22.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.66
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$179.07
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
33886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.79 |
| Max. Negotiated Rate |
$161.16 |
| Rate for Payer: Aetna American Axle |
$116.40
|
| Rate for Payer: Aetna Commercial |
$152.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.40
|
| Rate for Payer: Cash Price |
$143.26
|
| Rate for Payer: Cofinity Advantage |
$125.35
|
| Rate for Payer: Cofinity Commercial |
$154.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.26
|
| Rate for Payer: Healthscope Commercial |
$161.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.30
|
| Rate for Payer: PHP Commercial |
$152.21
|
| Rate for Payer: Priority Health SBD |
$112.81
|
| Rate for Payer: UMR Bronson Commercial |
$78.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.30
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$179.07
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
33886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.63 |
| Max. Negotiated Rate |
$161.16 |
| Rate for Payer: Aetna American Axle |
$116.40
|
| Rate for Payer: Aetna Commercial |
$152.21
|
| Rate for Payer: Aetna Medicare |
$89.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.40
|
| Rate for Payer: BCBS Complete |
$71.63
|
| Rate for Payer: BCBS Trust/PPO |
$36.60
|
| Rate for Payer: BCN Commercial |
$36.60
|
| Rate for Payer: Cash Price |
$143.26
|
| Rate for Payer: Cash Price |
$143.26
|
| Rate for Payer: Cofinity Advantage |
$125.35
|
| Rate for Payer: Cofinity Commercial |
$154.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.26
|
| Rate for Payer: Healthscope Commercial |
$161.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.30
|
| Rate for Payer: PHP Commercial |
$152.21
|
| Rate for Payer: Priority Health SBD |
$112.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.63
|
| Rate for Payer: UHC Core |
$18.63
|
| Rate for Payer: UHC Exchange |
$18.63
|
| Rate for Payer: UMR Bronson Commercial |
$66.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.30
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$74,246.72
|
|
|
Service Code
|
MSDRG 406
|
| Min. Negotiated Rate |
$23,604.14 |
| Max. Negotiated Rate |
$74,246.72 |
| Rate for Payer: Aetna Medicare |
$25,840.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,058.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,058.08
|
| Rate for Payer: BCBS MAPPO |
$24,846.46
|
| Rate for Payer: BCBS Trust/PPO |
$74,246.72
|
| Rate for Payer: BCN Commercial |
$74,246.72
|
| Rate for Payer: BCN Medicare Advantage |
$24,846.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,846.46
|
| Rate for Payer: Mclaren Medicare |
$24,846.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,088.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,573.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,331.11
|
| Rate for Payer: Nomi Health Commercial |
$37,412.58
|
| Rate for Payer: PACE Medicare |
$23,604.14
|
| Rate for Payer: PACE SWMI |
$24,846.46
|
| Rate for Payer: PHP Medicare Advantage |
$24,846.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$46,757.43
|
| Rate for Payer: Priority Health Medicare |
$24,846.46
|
| Rate for Payer: Priority Health Tiered Network |
$37,405.94
|
| Rate for Payer: Railroad Medicare Medicare |
$24,846.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47,273.26
|
| Rate for Payer: UHC Core |
$39,550.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,846.46
|
| Rate for Payer: UHC Exchange |
$32,299.53
|
| Rate for Payer: VA VA |
$24,846.46
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$103,440.86
|
|
|
Service Code
|
MSDRG 405
|
| Min. Negotiated Rate |
$44,024.03 |
| Max. Negotiated Rate |
$103,440.86 |
| Rate for Payer: Aetna Medicare |
$48,194.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57,926.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57,926.35
|
| Rate for Payer: BCBS MAPPO |
$46,341.08
|
| Rate for Payer: BCBS Trust/PPO |
$103,440.86
|
| Rate for Payer: BCN Commercial |
$103,440.86
|
| Rate for Payer: BCN Medicare Advantage |
$46,341.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46,341.08
|
| Rate for Payer: Mclaren Medicare |
$46,341.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48,658.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53,292.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$50,975.19
|
| Rate for Payer: Nomi Health Commercial |
$70,569.45
|
| Rate for Payer: PACE Medicare |
$44,024.03
|
| Rate for Payer: PACE SWMI |
$46,341.08
|
| Rate for Payer: PHP Medicare Advantage |
$46,341.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88,196.17
|
| Rate for Payer: Priority Health Medicare |
$46,341.08
|
| Rate for Payer: Priority Health Tiered Network |
$70,556.92
|
| Rate for Payer: Railroad Medicare Medicare |
$46,341.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89,169.15
|
| Rate for Payer: UHC Core |
$74,601.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46,341.08
|
| Rate for Payer: UHC Exchange |
$60,924.96
|
| Rate for Payer: VA VA |
$46,341.08
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$49,307.49
|
|
|
Service Code
|
MSDRG 407
|
| Min. Negotiated Rate |
$18,197.07 |
| Max. Negotiated Rate |
$49,307.49 |
| Rate for Payer: Aetna Medicare |
$19,921.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,943.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,943.51
|
| Rate for Payer: BCBS MAPPO |
$19,154.81
|
| Rate for Payer: BCBS Trust/PPO |
$49,307.49
|
| Rate for Payer: BCN Commercial |
$49,307.49
|
| Rate for Payer: BCN Medicare Advantage |
$19,154.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,154.81
|
| Rate for Payer: Mclaren Medicare |
$19,154.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,112.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,028.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,070.29
|
| Rate for Payer: Nomi Health Commercial |
$28,632.84
|
| Rate for Payer: PACE Medicare |
$18,197.07
|
| Rate for Payer: PACE SWMI |
$19,154.81
|
| Rate for Payer: PHP Medicare Advantage |
$19,154.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35,784.70
|
| Rate for Payer: Priority Health Medicare |
$19,154.81
|
| Rate for Payer: Priority Health Tiered Network |
$28,627.76
|
| Rate for Payer: Railroad Medicare Medicare |
$19,154.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,179.48
|
| Rate for Payer: UHC Core |
$30,268.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,154.81
|
| Rate for Payer: UHC Exchange |
$24,719.69
|
| Rate for Payer: VA VA |
$19,154.81
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$115,687.64
|
|
|
Service Code
|
MSDRG 010
|
| Min. Negotiated Rate |
$39,601.71 |
| Max. Negotiated Rate |
$115,687.64 |
| Rate for Payer: Aetna Medicare |
$63,025.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75,751.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75,751.46
|
| Rate for Payer: BCBS MAPPO |
$60,601.17
|
| Rate for Payer: BCBS Trust/PPO |
$97,385.17
|
| Rate for Payer: BCN Commercial |
$97,385.17
|
| Rate for Payer: BCN Medicare Advantage |
$60,601.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60,601.17
|
| Rate for Payer: Mclaren Medicare |
$60,601.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63,631.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69,691.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$66,661.29
|
| Rate for Payer: Nomi Health Commercial |
$39,601.71
|
| Rate for Payer: PACE Medicare |
$57,571.11
|
| Rate for Payer: PACE SWMI |
$60,601.17
|
| Rate for Payer: PHP Medicare Advantage |
$60,601.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115,687.64
|
| Rate for Payer: Priority Health Medicare |
$60,601.17
|
| Rate for Payer: Priority Health Tiered Network |
$92,550.10
|
| Rate for Payer: Railroad Medicare Medicare |
$60,601.17
|
| Rate for Payer: VA VA |
$60,601.17
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$8,326.67
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
77484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.21 |
| Max. Negotiated Rate |
$7,494.00 |
| Rate for Payer: Aetna American Axle |
$5,412.34
|
| Rate for Payer: Aetna Commercial |
$7,077.67
|
| Rate for Payer: Aetna Medicare |
$181.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,412.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.99
|
| Rate for Payer: BCBS Complete |
$95.77
|
| Rate for Payer: BCBS MAPPO |
$174.39
|
| Rate for Payer: BCBS Trust/PPO |
$552.72
|
| Rate for Payer: BCN Commercial |
$552.72
|
| Rate for Payer: BCN Medicare Advantage |
$174.39
|
| Rate for Payer: Cash Price |
$6,661.34
|
| Rate for Payer: Cash Price |
$6,661.34
|
| Rate for Payer: Cofinity Advantage |
$5,828.67
|
| Rate for Payer: Cofinity Commercial |
$7,160.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,661.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.39
|
| Rate for Payer: Healthscope Commercial |
$7,494.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,828.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,245.00
|
| Rate for Payer: Mclaren Medicaid |
$174.39
|
| Rate for Payer: Mclaren Medicare |
$174.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.11
|
| Rate for Payer: Meridian Medicaid |
$183.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,077.67
|
| Rate for Payer: Nomi Health Commercial |
$523.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,245.00
|
| Rate for Payer: PACE Medicare |
$165.67
|
| Rate for Payer: PACE SWMI |
$174.39
|
| Rate for Payer: PHP Commercial |
$7,077.67
|
| Rate for Payer: PHP Medicare Advantage |
$174.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$545.73
|
| Rate for Payer: Priority Health Medicare |
$174.39
|
| Rate for Payer: Priority Health SBD |
$5,245.80
|
| Rate for Payer: Priority Health Tiered Network |
$436.58
|
| Rate for Payer: Railroad Medicare Medicare |
$174.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.56
|
| Rate for Payer: UHC Core |
$286.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.39
|
| Rate for Payer: UHC Exchange |
$286.56
|
| Rate for Payer: UHC Medicaid |
$91.21
|
| Rate for Payer: UHCCP Medicaid |
$91.21
|
| Rate for Payer: UMR Bronson Commercial |
$3,080.87
|
| Rate for Payer: VA VA |
$174.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,245.00
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$8,326.67
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
77484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,663.73 |
| Max. Negotiated Rate |
$7,494.00 |
| Rate for Payer: Aetna American Axle |
$5,412.34
|
| Rate for Payer: Aetna Commercial |
$7,077.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,412.34
|
| Rate for Payer: Cash Price |
$6,661.34
|
| Rate for Payer: Cofinity Advantage |
$5,828.67
|
| Rate for Payer: Cofinity Commercial |
$7,160.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,661.34
|
| Rate for Payer: Healthscope Commercial |
$7,494.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,828.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,245.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,077.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,245.00
|
| Rate for Payer: PHP Commercial |
$7,077.67
|
| Rate for Payer: Priority Health SBD |
$5,245.80
|
| Rate for Payer: UMR Bronson Commercial |
$3,663.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,245.00
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19,286.75
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
118465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.21 |
| Max. Negotiated Rate |
$17,358.08 |
| Rate for Payer: Aetna American Axle |
$12,536.39
|
| Rate for Payer: Aetna Commercial |
$16,393.74
|
| Rate for Payer: Aetna Medicare |
$181.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,536.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.99
|
| Rate for Payer: BCBS Complete |
$95.77
|
| Rate for Payer: BCBS MAPPO |
$174.39
|
| Rate for Payer: BCBS Trust/PPO |
$552.72
|
| Rate for Payer: BCN Commercial |
$552.72
|
| Rate for Payer: BCN Medicare Advantage |
$174.39
|
| Rate for Payer: Cash Price |
$15,429.40
|
| Rate for Payer: Cash Price |
$15,429.40
|
| Rate for Payer: Cofinity Advantage |
$13,500.73
|
| Rate for Payer: Cofinity Commercial |
$16,586.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,429.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.39
|
| Rate for Payer: Healthscope Commercial |
$17,358.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,500.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,465.06
|
| Rate for Payer: Mclaren Medicaid |
$174.39
|
| Rate for Payer: Mclaren Medicare |
$174.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.11
|
| Rate for Payer: Meridian Medicaid |
$183.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,393.74
|
| Rate for Payer: Nomi Health Commercial |
$523.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,465.06
|
| Rate for Payer: PACE Medicare |
$165.67
|
| Rate for Payer: PACE SWMI |
$174.39
|
| Rate for Payer: PHP Commercial |
$16,393.74
|
| Rate for Payer: PHP Medicare Advantage |
$174.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$545.73
|
| Rate for Payer: Priority Health Medicare |
$174.39
|
| Rate for Payer: Priority Health SBD |
$12,150.65
|
| Rate for Payer: Priority Health Tiered Network |
$436.58
|
| Rate for Payer: Railroad Medicare Medicare |
$174.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.56
|
| Rate for Payer: UHC Core |
$286.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.39
|
| Rate for Payer: UHC Exchange |
$286.56
|
| Rate for Payer: UHC Medicaid |
$91.21
|
| Rate for Payer: UHCCP Medicaid |
$91.21
|
| Rate for Payer: UMR Bronson Commercial |
$7,136.10
|
| Rate for Payer: VA VA |
$174.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,465.06
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 65862055990
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Advantage |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.99
|
| Rate for Payer: UHC Core |
$52.89
|
| Rate for Payer: UHC Exchange |
$39.90
|
| Rate for Payer: UMR Bronson Commercial |
$37.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$126.83
|
|
|
Service Code
|
NDC 50268058515
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$114.15 |
| Rate for Payer: Aetna American Axle |
$82.44
|
| Rate for Payer: Aetna Commercial |
$107.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.44
|
| Rate for Payer: Cash Price |
$101.46
|
| Rate for Payer: Cofinity Advantage |
$88.78
|
| Rate for Payer: Cofinity Commercial |
$109.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.46
|
| Rate for Payer: Healthscope Commercial |
$114.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.12
|
| Rate for Payer: PHP Commercial |
$107.81
|
| Rate for Payer: Priority Health SBD |
$79.90
|
| Rate for Payer: UMR Bronson Commercial |
$55.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.12
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$219.96
|
|
|
Service Code
|
NDC 65162063609
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.39 |
| Max. Negotiated Rate |
$197.96 |
| Rate for Payer: Aetna American Axle |
$142.97
|
| Rate for Payer: Aetna Commercial |
$186.97
|
| Rate for Payer: Aetna Medicare |
$109.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.97
|
| Rate for Payer: BCBS Complete |
$87.98
|
| Rate for Payer: Cash Price |
$175.97
|
| Rate for Payer: Cofinity Advantage |
$153.97
|
| Rate for Payer: Cofinity Commercial |
$189.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.97
|
| Rate for Payer: Healthscope Commercial |
$197.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.97
|
| Rate for Payer: PHP Commercial |
$186.97
|
| Rate for Payer: Priority Health SBD |
$138.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.97
|
| Rate for Payer: UHC Core |
$114.60
|
| Rate for Payer: UHC Exchange |
$86.44
|
| Rate for Payer: UMR Bronson Commercial |
$81.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.97
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
NDC 50268058511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna American Axle |
$1.65
|
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Medicare |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Advantage |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: Priority Health SBD |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.65
|
| Rate for Payer: UHC Core |
$1.32
|
| Rate for Payer: UHC Exchange |
$1.00
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$197.60
|
|
|
Service Code
|
NDC 60687058501
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$177.84 |
| Rate for Payer: Aetna American Axle |
$128.44
|
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna Medicare |
$98.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.44
|
| Rate for Payer: BCBS Complete |
$79.04
|
| Rate for Payer: Cash Price |
$158.08
|
| Rate for Payer: Cofinity Advantage |
$138.32
|
| Rate for Payer: Cofinity Commercial |
$169.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.08
|
| Rate for Payer: Healthscope Commercial |
$177.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.20
|
| Rate for Payer: PHP Commercial |
$167.96
|
| Rate for Payer: Priority Health SBD |
$124.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.44
|
| Rate for Payer: UHC Core |
$102.95
|
| Rate for Payer: UHC Exchange |
$77.66
|
| Rate for Payer: UMR Bronson Commercial |
$73.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.20
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$197.60
|
|
|
Service Code
|
NDC 60687058501
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$177.84 |
| Rate for Payer: Aetna American Axle |
$128.44
|
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.44
|
| Rate for Payer: Cash Price |
$158.08
|
| Rate for Payer: Cofinity Advantage |
$138.32
|
| Rate for Payer: Cofinity Commercial |
$169.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.08
|
| Rate for Payer: Healthscope Commercial |
$177.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.20
|
| Rate for Payer: PHP Commercial |
$167.96
|
| Rate for Payer: Priority Health SBD |
$124.49
|
| Rate for Payer: UMR Bronson Commercial |
$86.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.20
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$219.96
|
|
|
Service Code
|
NDC 00378668877
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.78 |
| Max. Negotiated Rate |
$197.96 |
| Rate for Payer: Aetna American Axle |
$142.97
|
| Rate for Payer: Aetna Commercial |
$186.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.97
|
| Rate for Payer: Cash Price |
$175.97
|
| Rate for Payer: Cofinity Advantage |
$153.97
|
| Rate for Payer: Cofinity Commercial |
$189.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.97
|
| Rate for Payer: Healthscope Commercial |
$197.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.97
|
| Rate for Payer: PHP Commercial |
$186.97
|
| Rate for Payer: Priority Health SBD |
$138.57
|
| Rate for Payer: UMR Bronson Commercial |
$96.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.97
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 60687058511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Advantage |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 60687058511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Advantage |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Core |
$1.03
|
| Rate for Payer: UHC Exchange |
$0.78
|
| Rate for Payer: UMR Bronson Commercial |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 65862055990
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Advantage |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UMR Bronson Commercial |
$44.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$219.96
|
|
|
Service Code
|
NDC 00378668877
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.39 |
| Max. Negotiated Rate |
$197.96 |
| Rate for Payer: Aetna American Axle |
$142.97
|
| Rate for Payer: Aetna Commercial |
$186.97
|
| Rate for Payer: Aetna Medicare |
$109.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.97
|
| Rate for Payer: BCBS Complete |
$87.98
|
| Rate for Payer: Cash Price |
$175.97
|
| Rate for Payer: Cofinity Advantage |
$153.97
|
| Rate for Payer: Cofinity Commercial |
$189.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.97
|
| Rate for Payer: Healthscope Commercial |
$197.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.97
|
| Rate for Payer: PHP Commercial |
$186.97
|
| Rate for Payer: Priority Health SBD |
$138.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.97
|
| Rate for Payer: UHC Core |
$114.60
|
| Rate for Payer: UHC Exchange |
$86.44
|
| Rate for Payer: UMR Bronson Commercial |
$81.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.97
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$219.96
|
|
|
Service Code
|
NDC 65162063609
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.78 |
| Max. Negotiated Rate |
$197.96 |
| Rate for Payer: Aetna American Axle |
$142.97
|
| Rate for Payer: Aetna Commercial |
$186.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.97
|
| Rate for Payer: Cash Price |
$175.97
|
| Rate for Payer: Cofinity Advantage |
$153.97
|
| Rate for Payer: Cofinity Commercial |
$189.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.97
|
| Rate for Payer: Healthscope Commercial |
$197.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.97
|
| Rate for Payer: PHP Commercial |
$186.97
|
| Rate for Payer: Priority Health SBD |
$138.57
|
| Rate for Payer: UMR Bronson Commercial |
$96.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.97
|
|
