|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,524.00
|
|
|
Service Code
|
HCPCS Q5108
|
| Hospital Charge Code |
187520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$4,071.60 |
| Rate for Payer: Aetna American Axle |
$2,940.60
|
| Rate for Payer: Aetna American Axle |
$3,650.40
|
| Rate for Payer: Aetna Commercial |
$3,845.40
|
| Rate for Payer: Aetna Commercial |
$4,773.60
|
| Rate for Payer: Aetna Medicare |
$82.68
|
| Rate for Payer: Aetna Medicare |
$82.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,940.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,650.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.38
|
| Rate for Payer: BCBS Complete |
$43.66
|
| Rate for Payer: BCBS Complete |
$43.66
|
| Rate for Payer: BCBS MAPPO |
$79.50
|
| Rate for Payer: BCBS MAPPO |
$79.50
|
| Rate for Payer: BCBS Trust/PPO |
$314.66
|
| Rate for Payer: BCBS Trust/PPO |
$314.66
|
| Rate for Payer: BCN Commercial |
$314.66
|
| Rate for Payer: BCN Commercial |
$314.66
|
| Rate for Payer: BCN Medicare Advantage |
$79.50
|
| Rate for Payer: BCN Medicare Advantage |
$79.50
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cash Price |
$3,619.20
|
| Rate for Payer: Cash Price |
$3,619.20
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cofinity Advantage |
$3,931.20
|
| Rate for Payer: Cofinity Advantage |
$3,166.80
|
| Rate for Payer: Cofinity Commercial |
$3,890.64
|
| Rate for Payer: Cofinity Commercial |
$4,829.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,492.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,619.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.50
|
| Rate for Payer: Healthscope Commercial |
$4,071.60
|
| Rate for Payer: Healthscope Commercial |
$5,054.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,166.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,931.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,212.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,393.00
|
| Rate for Payer: Mclaren Medicaid |
$79.50
|
| Rate for Payer: Mclaren Medicaid |
$79.50
|
| Rate for Payer: Mclaren Medicare |
$79.50
|
| Rate for Payer: Mclaren Medicare |
$79.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.47
|
| Rate for Payer: Meridian Medicaid |
$83.47
|
| Rate for Payer: Meridian Medicaid |
$83.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,773.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,845.40
|
| Rate for Payer: Nomi Health Commercial |
$238.50
|
| Rate for Payer: Nomi Health Commercial |
$238.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,393.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,212.00
|
| Rate for Payer: PACE Medicare |
$75.53
|
| Rate for Payer: PACE Medicare |
$75.53
|
| Rate for Payer: PACE SWMI |
$79.50
|
| Rate for Payer: PACE SWMI |
$79.50
|
| Rate for Payer: PHP Commercial |
$3,845.40
|
| Rate for Payer: PHP Commercial |
$4,773.60
|
| Rate for Payer: PHP Medicare Advantage |
$79.50
|
| Rate for Payer: PHP Medicare Advantage |
$79.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$312.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$312.65
|
| Rate for Payer: Priority Health Medicare |
$79.50
|
| Rate for Payer: Priority Health Medicare |
$79.50
|
| Rate for Payer: Priority Health SBD |
$3,538.08
|
| Rate for Payer: Priority Health SBD |
$2,850.12
|
| Rate for Payer: Priority Health Tiered Network |
$250.12
|
| Rate for Payer: Priority Health Tiered Network |
$250.12
|
| Rate for Payer: Railroad Medicare Medicare |
$79.50
|
| Rate for Payer: Railroad Medicare Medicare |
$79.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.14
|
| Rate for Payer: UHC Core |
$163.14
|
| Rate for Payer: UHC Core |
$163.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$79.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$79.50
|
| Rate for Payer: UHC Exchange |
$163.14
|
| Rate for Payer: UHC Exchange |
$163.14
|
| Rate for Payer: UHC Medicaid |
$41.58
|
| Rate for Payer: UHC Medicaid |
$41.58
|
| Rate for Payer: UHCCP Medicaid |
$41.58
|
| Rate for Payer: UHCCP Medicaid |
$41.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,673.88
|
| Rate for Payer: UMR Bronson Commercial |
$2,077.92
|
| Rate for Payer: VA VA |
$79.50
|
| Rate for Payer: VA VA |
$79.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,393.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,212.00
|
|
|
PEGINTERFERON ALFA-2A 180 MCG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$3,187.04
|
|
|
Service Code
|
HCPCS S0145
|
| Hospital Charge Code |
34034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$944.18 |
| Max. Negotiated Rate |
$2,868.34 |
| Rate for Payer: Aetna American Axle |
$2,071.58
|
| Rate for Payer: Aetna Commercial |
$2,708.98
|
| Rate for Payer: Aetna Medicare |
$1,593.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,071.58
|
| Rate for Payer: BCBS Complete |
$1,274.82
|
| Rate for Payer: Cash Price |
$2,549.63
|
| Rate for Payer: Cash Price |
$2,549.63
|
| Rate for Payer: Cofinity Advantage |
$2,230.93
|
| Rate for Payer: Cofinity Commercial |
$2,740.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,549.63
|
| Rate for Payer: Healthscope Commercial |
$2,868.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,230.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,390.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,549.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,708.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,390.28
|
| Rate for Payer: PHP Commercial |
$2,708.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,180.23
|
| Rate for Payer: Priority Health SBD |
$2,007.84
|
| Rate for Payer: Priority Health Tiered Network |
$944.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,179.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,390.28
|
|
|
PEGINTERFERON ALFA-2A 180 MCG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$3,187.04
|
|
|
Service Code
|
HCPCS S0145
|
| Hospital Charge Code |
34034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,402.30 |
| Max. Negotiated Rate |
$2,868.34 |
| Rate for Payer: Aetna American Axle |
$2,071.58
|
| Rate for Payer: Aetna Commercial |
$2,708.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,071.58
|
| Rate for Payer: Cash Price |
$2,549.63
|
| Rate for Payer: Cofinity Advantage |
$2,230.93
|
| Rate for Payer: Cofinity Commercial |
$2,740.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,549.63
|
| Rate for Payer: Healthscope Commercial |
$2,868.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,230.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,390.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,708.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,390.28
|
| Rate for Payer: PHP Commercial |
$2,708.98
|
| Rate for Payer: Priority Health SBD |
$2,007.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,402.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,390.28
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$79,931.78
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35,169.98 |
| Max. Negotiated Rate |
$71,938.60 |
| Rate for Payer: Aetna American Axle |
$51,955.66
|
| Rate for Payer: Aetna Commercial |
$67,942.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51,955.66
|
| Rate for Payer: Cash Price |
$63,945.42
|
| Rate for Payer: Cofinity Advantage |
$55,952.25
|
| Rate for Payer: Cofinity Commercial |
$68,741.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63,945.42
|
| Rate for Payer: Healthscope Commercial |
$71,938.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55,952.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59,948.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67,942.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59,948.83
|
| Rate for Payer: PHP Commercial |
$67,942.01
|
| Rate for Payer: Priority Health SBD |
$50,357.02
|
| Rate for Payer: UMR Bronson Commercial |
$35,169.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59,948.83
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$79,931.78
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,000.22 |
| Max. Negotiated Rate |
$71,938.60 |
| Rate for Payer: Aetna American Axle |
$51,955.66
|
| Rate for Payer: Aetna Commercial |
$67,942.01
|
| Rate for Payer: Aetna Medicare |
$3,977.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51,955.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,780.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,780.65
|
| Rate for Payer: BCBS Complete |
$2,100.43
|
| Rate for Payer: BCBS MAPPO |
$3,824.52
|
| Rate for Payer: BCBS Trust/PPO |
$12,220.90
|
| Rate for Payer: BCN Commercial |
$12,220.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,824.52
|
| Rate for Payer: Cash Price |
$63,945.42
|
| Rate for Payer: Cash Price |
$63,945.42
|
| Rate for Payer: Cofinity Advantage |
$55,952.25
|
| Rate for Payer: Cofinity Commercial |
$68,741.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63,945.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,824.52
|
| Rate for Payer: Healthscope Commercial |
$71,938.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55,952.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59,948.83
|
| Rate for Payer: Mclaren Medicaid |
$3,824.52
|
| Rate for Payer: Mclaren Medicare |
$3,824.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,015.75
|
| Rate for Payer: Meridian Medicaid |
$4,015.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,398.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,206.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67,942.01
|
| Rate for Payer: Nomi Health Commercial |
$11,473.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59,948.83
|
| Rate for Payer: PACE Medicare |
$3,633.29
|
| Rate for Payer: PACE SWMI |
$3,824.52
|
| Rate for Payer: PHP Commercial |
$67,942.01
|
| Rate for Payer: PHP Medicare Advantage |
$3,824.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,000.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,546.15
|
| Rate for Payer: Priority Health Medicare |
$3,824.52
|
| Rate for Payer: Priority Health SBD |
$50,357.02
|
| Rate for Payer: Priority Health Tiered Network |
$9,236.92
|
| Rate for Payer: Railroad Medicare Medicare |
$3,824.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,218.54
|
| Rate for Payer: UHC Core |
$6,218.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,824.52
|
| Rate for Payer: UHC Exchange |
$6,218.54
|
| Rate for Payer: UHC Medicaid |
$2,000.22
|
| Rate for Payer: UHCCP Medicaid |
$2,000.22
|
| Rate for Payer: UMR Bronson Commercial |
$29,574.76
|
| Rate for Payer: VA VA |
$3,824.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59,948.83
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC
|
Facility
|
IP
|
$41,758.46
|
|
|
Service Code
|
MSDRG 734
|
| Min. Negotiated Rate |
$17,485.22 |
| Max. Negotiated Rate |
$41,758.46 |
| Rate for Payer: Aetna Medicare |
$19,141.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,006.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,006.88
|
| Rate for Payer: BCBS MAPPO |
$18,405.50
|
| Rate for Payer: BCBS Trust/PPO |
$41,758.46
|
| Rate for Payer: BCN Commercial |
$41,758.46
|
| Rate for Payer: BCN Medicare Advantage |
$18,405.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,405.50
|
| Rate for Payer: Mclaren Medicare |
$18,405.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,325.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,166.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,246.05
|
| Rate for Payer: Nomi Health Commercial |
$27,477.00
|
| Rate for Payer: PACE Medicare |
$17,485.22
|
| Rate for Payer: PACE SWMI |
$18,405.50
|
| Rate for Payer: PHP Medicare Advantage |
$18,405.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,340.16
|
| Rate for Payer: Priority Health Medicare |
$18,405.50
|
| Rate for Payer: Priority Health Tiered Network |
$27,472.12
|
| Rate for Payer: Railroad Medicare Medicare |
$18,405.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,719.00
|
| Rate for Payer: UHC Core |
$29,046.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,405.50
|
| Rate for Payer: UHC Exchange |
$23,721.81
|
| Rate for Payer: VA VA |
$18,405.50
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$33,333.75
|
|
|
Service Code
|
MSDRG 735
|
| Min. Negotiated Rate |
$11,252.72 |
| Max. Negotiated Rate |
$33,333.75 |
| Rate for Payer: Aetna Medicare |
$12,318.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,806.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,806.21
|
| Rate for Payer: BCBS MAPPO |
$11,844.97
|
| Rate for Payer: BCBS Trust/PPO |
$33,333.75
|
| Rate for Payer: BCN Commercial |
$33,333.75
|
| Rate for Payer: BCN Medicare Advantage |
$11,844.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,844.97
|
| Rate for Payer: Mclaren Medicare |
$11,844.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,437.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,621.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,029.47
|
| Rate for Payer: Nomi Health Commercial |
$17,356.95
|
| Rate for Payer: PACE Medicare |
$11,252.72
|
| Rate for Payer: PACE SWMI |
$11,844.97
|
| Rate for Payer: PHP Medicare Advantage |
$11,844.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,692.34
|
| Rate for Payer: Priority Health Medicare |
$11,844.97
|
| Rate for Payer: Priority Health Tiered Network |
$17,353.87
|
| Rate for Payer: Railroad Medicare Medicare |
$11,844.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,931.65
|
| Rate for Payer: UHC Core |
$18,348.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,844.97
|
| Rate for Payer: UHC Exchange |
$14,984.83
|
| Rate for Payer: VA VA |
$11,844.97
|
|
|
PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,412.16
|
| Rate for Payer: BCN Commercial |
$3,412.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
PELVIC FIXATION (ATTACHMENT OF CAUDAL END OF INSTRUMENTATION TO PELVIC BONY STRUCTURES) OTHER THAN SACRUM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,605.78
|
|
|
Service Code
|
CPT 22848
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,605.78 |
| Max. Negotiated Rate |
$1,605.78 |
| Rate for Payer: BCBS Trust/PPO |
$1,605.78
|
| Rate for Payer: BCN Commercial |
$1,605.78
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27,010.41
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,884.58 |
| Max. Negotiated Rate |
$24,309.37 |
| Rate for Payer: Aetna American Axle |
$17,556.77
|
| Rate for Payer: Aetna Commercial |
$22,958.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,556.77
|
| Rate for Payer: Cash Price |
$21,608.33
|
| Rate for Payer: Cofinity Advantage |
$18,907.29
|
| Rate for Payer: Cofinity Commercial |
$23,228.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,608.33
|
| Rate for Payer: Healthscope Commercial |
$24,309.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,907.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,257.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,958.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20,257.81
|
| Rate for Payer: PHP Commercial |
$22,958.85
|
| Rate for Payer: Priority Health SBD |
$17,016.56
|
| Rate for Payer: UMR Bronson Commercial |
$11,884.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,257.81
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27,010.41
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.03 |
| Max. Negotiated Rate |
$24,309.37 |
| Rate for Payer: Aetna American Axle |
$17,556.77
|
| Rate for Payer: Aetna Commercial |
$22,958.85
|
| Rate for Payer: Aetna Medicare |
$63.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,556.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.56
|
| Rate for Payer: BCBS Complete |
$33.64
|
| Rate for Payer: BCBS MAPPO |
$61.25
|
| Rate for Payer: BCBS Trust/PPO |
$193.66
|
| Rate for Payer: BCN Commercial |
$193.66
|
| Rate for Payer: BCN Medicare Advantage |
$61.25
|
| Rate for Payer: Cash Price |
$21,608.33
|
| Rate for Payer: Cash Price |
$21,608.33
|
| Rate for Payer: Cofinity Advantage |
$18,907.29
|
| Rate for Payer: Cofinity Commercial |
$23,228.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,608.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.25
|
| Rate for Payer: Healthscope Commercial |
$24,309.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,907.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,257.81
|
| Rate for Payer: Mclaren Medicaid |
$61.25
|
| Rate for Payer: Mclaren Medicare |
$61.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.31
|
| Rate for Payer: Meridian Medicaid |
$64.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,958.85
|
| Rate for Payer: Nomi Health Commercial |
$183.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20,257.81
|
| Rate for Payer: PACE Medicare |
$58.19
|
| Rate for Payer: PACE SWMI |
$61.25
|
| Rate for Payer: PHP Commercial |
$22,958.85
|
| Rate for Payer: PHP Medicare Advantage |
$61.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.15
|
| Rate for Payer: Priority Health Medicare |
$61.25
|
| Rate for Payer: Priority Health SBD |
$17,016.56
|
| Rate for Payer: Priority Health Tiered Network |
$152.12
|
| Rate for Payer: Railroad Medicare Medicare |
$61.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.55
|
| Rate for Payer: UHC Core |
$98.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$61.25
|
| Rate for Payer: UHC Exchange |
$98.55
|
| Rate for Payer: UHC Medicaid |
$32.03
|
| Rate for Payer: UHCCP Medicaid |
$32.03
|
| Rate for Payer: UMR Bronson Commercial |
$9,993.85
|
| Rate for Payer: VA VA |
$61.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,257.81
|
|
|
PEMETREXED DISODIUM 1,000 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$748.42
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
200483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$673.58 |
| Rate for Payer: Aetna American Axle |
$486.47
|
| Rate for Payer: Aetna Commercial |
$636.16
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: Cash Price |
$598.74
|
| Rate for Payer: Cash Price |
$598.74
|
| Rate for Payer: Cofinity Advantage |
$523.89
|
| Rate for Payer: Cofinity Commercial |
$643.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Healthscope Commercial |
$673.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$523.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.32
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.16
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$561.32
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PHP Commercial |
$636.16
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health SBD |
$471.50
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UMR Bronson Commercial |
$276.92
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.32
|
|
|
PEMETREXED DISODIUM 1,000 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$748.42
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
200483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$329.30 |
| Max. Negotiated Rate |
$673.58 |
| Rate for Payer: Aetna American Axle |
$486.47
|
| Rate for Payer: Aetna Commercial |
$636.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.47
|
| Rate for Payer: Cash Price |
$598.74
|
| Rate for Payer: Cofinity Advantage |
$523.89
|
| Rate for Payer: Cofinity Commercial |
$643.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.74
|
| Rate for Payer: Healthscope Commercial |
$673.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$523.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$561.32
|
| Rate for Payer: PHP Commercial |
$636.16
|
| Rate for Payer: Priority Health SBD |
$471.50
|
| Rate for Payer: UMR Bronson Commercial |
$329.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.32
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$105.69
|
|
|
Service Code
|
HCPCS J9296
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$95.12 |
| Rate for Payer: Aetna American Axle |
$68.70
|
| Rate for Payer: Aetna Commercial |
$89.84
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.07
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS MAPPO |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$31.54
|
| Rate for Payer: BCN Commercial |
$31.54
|
| Rate for Payer: BCN Medicare Advantage |
$9.66
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: Cofinity Advantage |
$73.98
|
| Rate for Payer: Cofinity Commercial |
$90.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.66
|
| Rate for Payer: Healthscope Commercial |
$95.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.27
|
| Rate for Payer: Mclaren Medicaid |
$9.66
|
| Rate for Payer: Mclaren Medicare |
$9.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.14
|
| Rate for Payer: Meridian Medicaid |
$10.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.84
|
| Rate for Payer: Nomi Health Commercial |
$28.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.27
|
| Rate for Payer: PACE Medicare |
$9.18
|
| Rate for Payer: PACE SWMI |
$9.66
|
| Rate for Payer: PHP Commercial |
$89.84
|
| Rate for Payer: PHP Medicare Advantage |
$9.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30.71
|
| Rate for Payer: Priority Health Medicare |
$9.66
|
| Rate for Payer: Priority Health SBD |
$66.58
|
| Rate for Payer: Priority Health Tiered Network |
$24.57
|
| Rate for Payer: Railroad Medicare Medicare |
$9.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.07
|
| Rate for Payer: UHC Core |
$16.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.66
|
| Rate for Payer: UHC Exchange |
$16.07
|
| Rate for Payer: UHC Medicaid |
$5.05
|
| Rate for Payer: UHCCP Medicaid |
$5.05
|
| Rate for Payer: UMR Bronson Commercial |
$39.11
|
| Rate for Payer: VA VA |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.27
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$40.72
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$36.65 |
| Rate for Payer: Aetna American Axle |
$26.47
|
| Rate for Payer: Aetna American Axle |
$30.61
|
| Rate for Payer: Aetna Commercial |
$34.61
|
| Rate for Payer: Aetna Commercial |
$40.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.61
|
| Rate for Payer: Cash Price |
$32.58
|
| Rate for Payer: Cash Price |
$37.67
|
| Rate for Payer: Cofinity Advantage |
$32.96
|
| Rate for Payer: Cofinity Advantage |
$28.50
|
| Rate for Payer: Cofinity Commercial |
$40.50
|
| Rate for Payer: Cofinity Commercial |
$35.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.67
|
| Rate for Payer: Healthscope Commercial |
$36.65
|
| Rate for Payer: Healthscope Commercial |
$42.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.32
|
| Rate for Payer: PHP Commercial |
$34.61
|
| Rate for Payer: PHP Commercial |
$40.03
|
| Rate for Payer: Priority Health SBD |
$29.67
|
| Rate for Payer: Priority Health SBD |
$25.65
|
| Rate for Payer: UMR Bronson Commercial |
$17.92
|
| Rate for Payer: UMR Bronson Commercial |
$20.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.32
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$88.11
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna American Axle |
$57.27
|
| Rate for Payer: Aetna American Axle |
$52.18
|
| Rate for Payer: Aetna American Axle |
$1,639.85
|
| Rate for Payer: Aetna American Axle |
$39.14
|
| Rate for Payer: Aetna American Axle |
$66.30
|
| Rate for Payer: Aetna American Axle |
$30.61
|
| Rate for Payer: Aetna American Axle |
$26.47
|
| Rate for Payer: Aetna Commercial |
$51.18
|
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Commercial |
$74.89
|
| Rate for Payer: Aetna Commercial |
$68.24
|
| Rate for Payer: Aetna Commercial |
$34.61
|
| Rate for Payer: Aetna Commercial |
$2,144.42
|
| Rate for Payer: Aetna Commercial |
$40.03
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,639.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: Cash Price |
$70.49
|
| Rate for Payer: Cash Price |
$37.67
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$48.17
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$48.17
|
| Rate for Payer: Cash Price |
$32.58
|
| Rate for Payer: Cash Price |
$2,018.28
|
| Rate for Payer: Cash Price |
$70.49
|
| Rate for Payer: Cash Price |
$64.22
|
| Rate for Payer: Cash Price |
$64.22
|
| Rate for Payer: Cash Price |
$2,018.28
|
| Rate for Payer: Cash Price |
$37.67
|
| Rate for Payer: Cash Price |
$32.58
|
| Rate for Payer: Cofinity Advantage |
$61.68
|
| Rate for Payer: Cofinity Advantage |
$42.15
|
| Rate for Payer: Cofinity Advantage |
$71.40
|
| Rate for Payer: Cofinity Advantage |
$56.20
|
| Rate for Payer: Cofinity Advantage |
$28.50
|
| Rate for Payer: Cofinity Advantage |
$32.96
|
| Rate for Payer: Cofinity Advantage |
$1,765.99
|
| Rate for Payer: Cofinity Commercial |
$2,169.65
|
| Rate for Payer: Cofinity Commercial |
$69.04
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$75.77
|
| Rate for Payer: Cofinity Commercial |
$40.50
|
| Rate for Payer: Cofinity Commercial |
$35.02
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,018.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Healthscope Commercial |
$54.19
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Commercial |
$79.30
|
| Rate for Payer: Healthscope Commercial |
$42.38
|
| Rate for Payer: Healthscope Commercial |
$72.25
|
| Rate for Payer: Healthscope Commercial |
$36.65
|
| Rate for Payer: Healthscope Commercial |
$2,270.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,765.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,892.14
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,144.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.18
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,892.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.21
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PHP Commercial |
$68.24
|
| Rate for Payer: PHP Commercial |
$51.18
|
| Rate for Payer: PHP Commercial |
$40.03
|
| Rate for Payer: PHP Commercial |
$34.61
|
| Rate for Payer: PHP Commercial |
$2,144.42
|
| Rate for Payer: PHP Commercial |
$74.89
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health SBD |
$25.65
|
| Rate for Payer: Priority Health SBD |
$55.51
|
| Rate for Payer: Priority Health SBD |
$29.67
|
| Rate for Payer: Priority Health SBD |
$1,589.40
|
| Rate for Payer: Priority Health SBD |
$37.93
|
| Rate for Payer: Priority Health SBD |
$50.58
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UMR Bronson Commercial |
$29.70
|
| Rate for Payer: UMR Bronson Commercial |
$933.45
|
| Rate for Payer: UMR Bronson Commercial |
$22.28
|
| Rate for Payer: UMR Bronson Commercial |
$17.42
|
| Rate for Payer: UMR Bronson Commercial |
$15.07
|
| Rate for Payer: UMR Bronson Commercial |
$32.60
|
| Rate for Payer: UMR Bronson Commercial |
$37.74
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,892.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.08
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$467.81
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
37894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$421.03 |
| Rate for Payer: Aetna American Axle |
$304.08
|
| Rate for Payer: Aetna American Axle |
$406.81
|
| Rate for Payer: Aetna American Axle |
$428.89
|
| Rate for Payer: Aetna American Axle |
$2,689.58
|
| Rate for Payer: Aetna American Axle |
$11,504.53
|
| Rate for Payer: Aetna American Axle |
$218.13
|
| Rate for Payer: Aetna American Axle |
$313.54
|
| Rate for Payer: Aetna Commercial |
$531.98
|
| Rate for Payer: Aetna Commercial |
$397.64
|
| Rate for Payer: Aetna Commercial |
$285.25
|
| Rate for Payer: Aetna Commercial |
$3,517.14
|
| Rate for Payer: Aetna Commercial |
$15,044.38
|
| Rate for Payer: Aetna Commercial |
$560.86
|
| Rate for Payer: Aetna Commercial |
$410.01
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,504.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,689.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: Cash Price |
$527.86
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cash Price |
$500.69
|
| Rate for Payer: Cash Price |
$385.90
|
| Rate for Payer: Cash Price |
$385.90
|
| Rate for Payer: Cash Price |
$268.47
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cash Price |
$3,310.25
|
| Rate for Payer: Cash Price |
$527.86
|
| Rate for Payer: Cash Price |
$500.69
|
| Rate for Payer: Cash Price |
$374.25
|
| Rate for Payer: Cash Price |
$268.47
|
| Rate for Payer: Cash Price |
$3,310.25
|
| Rate for Payer: Cash Price |
$374.25
|
| Rate for Payer: Cofinity Advantage |
$12,389.49
|
| Rate for Payer: Cofinity Advantage |
$2,896.47
|
| Rate for Payer: Cofinity Advantage |
$461.88
|
| Rate for Payer: Cofinity Advantage |
$438.10
|
| Rate for Payer: Cofinity Advantage |
$337.66
|
| Rate for Payer: Cofinity Advantage |
$327.47
|
| Rate for Payer: Cofinity Advantage |
$234.91
|
| Rate for Payer: Cofinity Commercial |
$288.61
|
| Rate for Payer: Cofinity Commercial |
$414.84
|
| Rate for Payer: Cofinity Commercial |
$538.24
|
| Rate for Payer: Cofinity Commercial |
$567.45
|
| Rate for Payer: Cofinity Commercial |
$402.32
|
| Rate for Payer: Cofinity Commercial |
$3,558.52
|
| Rate for Payer: Cofinity Commercial |
$15,221.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$500.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,159.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,310.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Healthscope Commercial |
$563.27
|
| Rate for Payer: Healthscope Commercial |
$434.13
|
| Rate for Payer: Healthscope Commercial |
$593.85
|
| Rate for Payer: Healthscope Commercial |
$421.03
|
| Rate for Payer: Healthscope Commercial |
$302.03
|
| Rate for Payer: Healthscope Commercial |
$15,929.34
|
| Rate for Payer: Healthscope Commercial |
$3,724.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,389.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$438.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$461.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,896.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$469.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,103.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,274.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.78
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,044.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,517.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$531.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.01
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$469.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,274.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,103.36
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PHP Commercial |
$15,044.38
|
| Rate for Payer: PHP Commercial |
$397.64
|
| Rate for Payer: PHP Commercial |
$531.98
|
| Rate for Payer: PHP Commercial |
$560.86
|
| Rate for Payer: PHP Commercial |
$285.25
|
| Rate for Payer: PHP Commercial |
$3,517.14
|
| Rate for Payer: PHP Commercial |
$410.01
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health SBD |
$211.42
|
| Rate for Payer: Priority Health SBD |
$2,606.82
|
| Rate for Payer: Priority Health SBD |
$11,150.54
|
| Rate for Payer: Priority Health SBD |
$415.69
|
| Rate for Payer: Priority Health SBD |
$394.29
|
| Rate for Payer: Priority Health SBD |
$303.89
|
| Rate for Payer: Priority Health SBD |
$294.72
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UMR Bronson Commercial |
$124.17
|
| Rate for Payer: UMR Bronson Commercial |
$178.48
|
| Rate for Payer: UMR Bronson Commercial |
$173.09
|
| Rate for Payer: UMR Bronson Commercial |
$231.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,530.99
|
| Rate for Payer: UMR Bronson Commercial |
$6,548.73
|
| Rate for Payer: UMR Bronson Commercial |
$244.14
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,274.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$469.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,103.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.78
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$17,699.27
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
37894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,787.68 |
| Max. Negotiated Rate |
$15,929.34 |
| Rate for Payer: Aetna American Axle |
$11,504.53
|
| Rate for Payer: Aetna Commercial |
$15,044.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,504.53
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cofinity Advantage |
$12,389.49
|
| Rate for Payer: Cofinity Commercial |
$15,221.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,159.42
|
| Rate for Payer: Healthscope Commercial |
$15,929.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,389.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,274.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,044.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,274.45
|
| Rate for Payer: PHP Commercial |
$15,044.38
|
| Rate for Payer: Priority Health SBD |
$11,150.54
|
| Rate for Payer: UMR Bronson Commercial |
$7,787.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,274.45
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,208.01
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$1,087.21 |
| Rate for Payer: Aetna American Axle |
$785.21
|
| Rate for Payer: Aetna Commercial |
$1,026.81
|
| Rate for Payer: Aetna Medicare |
$32.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.34
|
| Rate for Payer: BCBS Complete |
$17.28
|
| Rate for Payer: BCBS MAPPO |
$31.47
|
| Rate for Payer: BCBS Trust/PPO |
$107.73
|
| Rate for Payer: BCN Commercial |
$107.73
|
| Rate for Payer: BCN Medicare Advantage |
$31.47
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cofinity Advantage |
$845.61
|
| Rate for Payer: Cofinity Commercial |
$1,038.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$1,087.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$845.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.01
|
| Rate for Payer: Mclaren Medicaid |
$31.47
|
| Rate for Payer: Mclaren Medicare |
$31.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.04
|
| Rate for Payer: Meridian Medicaid |
$33.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.81
|
| Rate for Payer: Nomi Health Commercial |
$94.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.01
|
| Rate for Payer: PACE Medicare |
$29.90
|
| Rate for Payer: PACE SWMI |
$31.47
|
| Rate for Payer: PHP Commercial |
$1,026.81
|
| Rate for Payer: PHP Medicare Advantage |
$31.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$94.66
|
| Rate for Payer: Priority Health Medicare |
$31.47
|
| Rate for Payer: Priority Health SBD |
$761.05
|
| Rate for Payer: Priority Health Tiered Network |
$75.73
|
| Rate for Payer: Railroad Medicare Medicare |
$31.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.75
|
| Rate for Payer: UHC Core |
$52.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.47
|
| Rate for Payer: UHC Exchange |
$52.75
|
| Rate for Payer: UHC Medicaid |
$16.46
|
| Rate for Payer: UHCCP Medicaid |
$16.46
|
| Rate for Payer: UMR Bronson Commercial |
$446.96
|
| Rate for Payer: VA VA |
$31.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.01
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,208.01
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$531.52 |
| Max. Negotiated Rate |
$1,087.21 |
| Rate for Payer: Aetna American Axle |
$785.21
|
| Rate for Payer: Aetna Commercial |
$1,026.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.21
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cofinity Advantage |
$845.61
|
| Rate for Payer: Cofinity Commercial |
$1,038.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.41
|
| Rate for Payer: Healthscope Commercial |
$1,087.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$845.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.01
|
| Rate for Payer: PHP Commercial |
$1,026.81
|
| Rate for Payer: Priority Health SBD |
$761.05
|
| Rate for Payer: UMR Bronson Commercial |
$531.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.01
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE CUSTOM
|
Facility
|
IP
|
$1,208.01
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
301789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$531.52 |
| Max. Negotiated Rate |
$1,087.21 |
| Rate for Payer: Aetna American Axle |
$785.21
|
| Rate for Payer: Aetna Commercial |
$1,026.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.21
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cofinity Advantage |
$845.61
|
| Rate for Payer: Cofinity Commercial |
$1,038.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.41
|
| Rate for Payer: Healthscope Commercial |
$1,087.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$845.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.01
|
| Rate for Payer: PHP Commercial |
$1,026.81
|
| Rate for Payer: Priority Health SBD |
$761.05
|
| Rate for Payer: UMR Bronson Commercial |
$531.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.01
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE CUSTOM
|
Facility
|
OP
|
$1,208.01
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
301789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$1,087.21 |
| Rate for Payer: Aetna American Axle |
$785.21
|
| Rate for Payer: Aetna Commercial |
$1,026.81
|
| Rate for Payer: Aetna Medicare |
$32.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.34
|
| Rate for Payer: BCBS Complete |
$17.28
|
| Rate for Payer: BCBS MAPPO |
$31.47
|
| Rate for Payer: BCBS Trust/PPO |
$107.73
|
| Rate for Payer: BCN Commercial |
$107.73
|
| Rate for Payer: BCN Medicare Advantage |
$31.47
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cofinity Advantage |
$845.61
|
| Rate for Payer: Cofinity Commercial |
$1,038.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$1,087.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$845.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.01
|
| Rate for Payer: Mclaren Medicaid |
$31.47
|
| Rate for Payer: Mclaren Medicare |
$31.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.04
|
| Rate for Payer: Meridian Medicaid |
$33.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.81
|
| Rate for Payer: Nomi Health Commercial |
$94.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.01
|
| Rate for Payer: PACE Medicare |
$29.90
|
| Rate for Payer: PACE SWMI |
$31.47
|
| Rate for Payer: PHP Commercial |
$1,026.81
|
| Rate for Payer: PHP Medicare Advantage |
$31.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$94.66
|
| Rate for Payer: Priority Health Medicare |
$31.47
|
| Rate for Payer: Priority Health SBD |
$761.05
|
| Rate for Payer: Priority Health Tiered Network |
$75.73
|
| Rate for Payer: Railroad Medicare Medicare |
$31.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.75
|
| Rate for Payer: UHC Core |
$52.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.47
|
| Rate for Payer: UHC Exchange |
$52.75
|
| Rate for Payer: UHC Medicaid |
$16.46
|
| Rate for Payer: UHCCP Medicaid |
$16.46
|
| Rate for Payer: UMR Bronson Commercial |
$446.96
|
| Rate for Payer: VA VA |
$31.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.01
|
|
|
PENICILLIN G IV 16,000 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
OP
|
$162.50
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna American Axle |
$105.62
|
| Rate for Payer: Aetna Commercial |
$138.12
|
| Rate for Payer: Aetna Medicare |
$81.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.62
|
| Rate for Payer: BCBS Complete |
$65.00
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cofinity Advantage |
$113.75
|
| Rate for Payer: Cofinity Commercial |
$139.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.00
|
| Rate for Payer: Healthscope Commercial |
$146.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.88
|
| Rate for Payer: PHP Commercial |
$138.12
|
| Rate for Payer: Priority Health SBD |
$102.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$60.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.88
|
|
|
PENICILLIN G IV 16,000 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$162.50
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna American Axle |
$105.62
|
| Rate for Payer: Aetna Commercial |
$138.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.62
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cofinity Advantage |
$113.75
|
| Rate for Payer: Cofinity Commercial |
$139.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.00
|
| Rate for Payer: Healthscope Commercial |
$146.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.88
|
| Rate for Payer: PHP Commercial |
$138.12
|
| Rate for Payer: Priority Health SBD |
$102.38
|
| Rate for Payer: UMR Bronson Commercial |
$71.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.88
|
|
|
PENICILLIN G IV 1,600 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
OP
|
$18.75
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna American Axle |
$12.19
|
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna Medicare |
$9.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.19
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cofinity Advantage |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.06
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
|
