|
PENICILLIN G IV 1,600 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$18.75
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna American Axle |
$12.19
|
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.19
|
| 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: 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: UMR Bronson Commercial |
$8.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
|
|
PENICILLIN G IV 160 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$6.25
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna American Axle |
$4.06
|
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cofinity Advantage |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$5.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.69
|
| Rate for Payer: PHP Commercial |
$5.31
|
| Rate for Payer: Priority Health SBD |
$3.94
|
| Rate for Payer: UMR Bronson Commercial |
$2.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.69
|
|
|
PENICILLIN G IV 160 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
OP
|
$6.25
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna American Axle |
$4.06
|
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cofinity Advantage |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$5.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.69
|
| Rate for Payer: PHP Commercial |
$5.31
|
| Rate for Payer: Priority Health SBD |
$3.94
|
| 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 |
$2.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.69
|
|
|
PENICILLIN G IV 3 MILLION UNITS IVPB 100 ML (IV PREMIX)
|
Facility
|
IP
|
$82.80
|
|
|
Service Code
|
NDC 09900000160
|
| Hospital Charge Code |
500537
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna American Axle |
$53.82
|
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.82
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Advantage |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.10
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health SBD |
$52.16
|
| Rate for Payer: UMR Bronson Commercial |
$36.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.10
|
|
|
PENICILLIN G IV 3 MILLION UNITS IVPB 100 ML (IV PREMIX)
|
Facility
|
OP
|
$82.80
|
|
|
Service Code
|
NDC 09900000160
|
| Hospital Charge Code |
500537
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna American Axle |
$53.82
|
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna Medicare |
$41.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.82
|
| Rate for Payer: BCBS Complete |
$33.12
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Advantage |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.10
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health SBD |
$52.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.82
|
| Rate for Payer: UHC Core |
$43.14
|
| Rate for Payer: UHC Exchange |
$32.54
|
| Rate for Payer: UMR Bronson Commercial |
$30.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.10
|
|
|
PENICILLIN G IV 5 MILLION UNITS IVPB 250 ML (IV PREMIX)
|
Facility
|
OP
|
$116.96
|
|
|
Service Code
|
NDC 09900000161
|
| Hospital Charge Code |
500538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.28 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna American Axle |
$76.02
|
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna Medicare |
$58.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.02
|
| Rate for Payer: BCBS Complete |
$46.78
|
| Rate for Payer: Cash Price |
$93.57
|
| Rate for Payer: Cofinity Advantage |
$81.87
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.57
|
| Rate for Payer: Healthscope Commercial |
$105.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.72
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: Priority Health SBD |
$73.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.02
|
| Rate for Payer: UHC Core |
$60.94
|
| Rate for Payer: UHC Exchange |
$45.97
|
| Rate for Payer: UMR Bronson Commercial |
$43.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.72
|
|
|
PENICILLIN G IV 5 MILLION UNITS IVPB 250 ML (IV PREMIX)
|
Facility
|
IP
|
$116.96
|
|
|
Service Code
|
NDC 09900000161
|
| Hospital Charge Code |
500538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.46 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna American Axle |
$76.02
|
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.02
|
| Rate for Payer: Cash Price |
$93.57
|
| Rate for Payer: Cofinity Advantage |
$81.87
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.57
|
| Rate for Payer: Healthscope Commercial |
$105.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.72
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: Priority Health SBD |
$73.68
|
| Rate for Payer: UMR Bronson Commercial |
$51.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.72
|
|
|
PENICILLIN G POT 3 MILLION UNIT/50 ML-DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$96.96
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
15960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.66 |
| Max. Negotiated Rate |
$87.26 |
| Rate for Payer: Aetna American Axle |
$63.02
|
| Rate for Payer: Aetna Commercial |
$82.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.02
|
| Rate for Payer: Cash Price |
$77.57
|
| Rate for Payer: Cofinity Advantage |
$67.87
|
| Rate for Payer: Cofinity Commercial |
$83.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.57
|
| Rate for Payer: Healthscope Commercial |
$87.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.72
|
| Rate for Payer: PHP Commercial |
$82.42
|
| Rate for Payer: Priority Health SBD |
$61.08
|
| Rate for Payer: UMR Bronson Commercial |
$42.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.72
|
|
|
PENICILLIN G POT 3 MILLION UNIT/50 ML-DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$96.96
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
15960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$87.26 |
| Rate for Payer: Aetna American Axle |
$63.02
|
| Rate for Payer: Aetna Commercial |
$82.42
|
| Rate for Payer: Aetna Medicare |
$48.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.02
|
| Rate for Payer: BCBS Complete |
$38.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$77.57
|
| Rate for Payer: Cash Price |
$77.57
|
| Rate for Payer: Cofinity Advantage |
$67.87
|
| Rate for Payer: Cofinity Commercial |
$83.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.57
|
| Rate for Payer: Healthscope Commercial |
$87.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.72
|
| Rate for Payer: PHP Commercial |
$82.42
|
| Rate for Payer: Priority Health SBD |
$61.08
|
| 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 |
$35.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.72
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$134.53
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$121.08 |
| Rate for Payer: Aetna American Axle |
$87.44
|
| Rate for Payer: Aetna American Axle |
$38.76
|
| Rate for Payer: Aetna American Axle |
$60.66
|
| Rate for Payer: Aetna American Axle |
$71.31
|
| Rate for Payer: Aetna American Axle |
$63.49
|
| Rate for Payer: Aetna American Axle |
$136.73
|
| Rate for Payer: Aetna Commercial |
$83.03
|
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Aetna Commercial |
$178.81
|
| Rate for Payer: Aetna Commercial |
$93.25
|
| Rate for Payer: Aetna Commercial |
$50.69
|
| Rate for Payer: Aetna Commercial |
$114.35
|
| Rate for Payer: Aetna Medicare |
$54.85
|
| Rate for Payer: Aetna Medicare |
$67.27
|
| Rate for Payer: Aetna Medicare |
$105.18
|
| Rate for Payer: Aetna Medicare |
$48.84
|
| Rate for Payer: Aetna Medicare |
$46.66
|
| Rate for Payer: Aetna Medicare |
$29.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.76
|
| Rate for Payer: BCBS Complete |
$84.14
|
| Rate for Payer: BCBS Complete |
$53.81
|
| Rate for Payer: BCBS Complete |
$43.88
|
| Rate for Payer: BCBS Complete |
$23.85
|
| Rate for Payer: BCBS Complete |
$37.33
|
| Rate for Payer: BCBS Complete |
$39.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$87.76
|
| Rate for Payer: Cash Price |
$87.76
|
| Rate for Payer: Cash Price |
$168.29
|
| Rate for Payer: Cash Price |
$168.29
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$74.66
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$74.66
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cofinity Advantage |
$41.74
|
| Rate for Payer: Cofinity Advantage |
$147.25
|
| Rate for Payer: Cofinity Advantage |
$68.38
|
| Rate for Payer: Cofinity Advantage |
$76.79
|
| Rate for Payer: Cofinity Advantage |
$94.17
|
| Rate for Payer: Cofinity Advantage |
$65.32
|
| Rate for Payer: Cofinity Commercial |
$80.26
|
| Rate for Payer: Cofinity Commercial |
$94.34
|
| Rate for Payer: Cofinity Commercial |
$115.70
|
| Rate for Payer: Cofinity Commercial |
$180.91
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.66
|
| Rate for Payer: Healthscope Commercial |
$98.73
|
| Rate for Payer: Healthscope Commercial |
$83.99
|
| Rate for Payer: Healthscope Commercial |
$189.32
|
| Rate for Payer: Healthscope Commercial |
$53.67
|
| Rate for Payer: Healthscope Commercial |
$87.91
|
| Rate for Payer: Healthscope Commercial |
$121.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.77
|
| Rate for Payer: PHP Commercial |
$114.35
|
| Rate for Payer: PHP Commercial |
$178.81
|
| Rate for Payer: PHP Commercial |
$50.69
|
| Rate for Payer: PHP Commercial |
$93.25
|
| Rate for Payer: PHP Commercial |
$79.32
|
| Rate for Payer: PHP Commercial |
$83.03
|
| Rate for Payer: Priority Health SBD |
$37.57
|
| Rate for Payer: Priority Health SBD |
$69.11
|
| Rate for Payer: Priority Health SBD |
$84.75
|
| Rate for Payer: Priority Health SBD |
$61.54
|
| Rate for Payer: Priority Health SBD |
$132.53
|
| Rate for Payer: Priority Health SBD |
$58.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$22.06
|
| Rate for Payer: UMR Bronson Commercial |
$34.53
|
| Rate for Payer: UMR Bronson Commercial |
$49.78
|
| Rate for Payer: UMR Bronson Commercial |
$40.59
|
| Rate for Payer: UMR Bronson Commercial |
$36.14
|
| Rate for Payer: UMR Bronson Commercial |
$77.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.90
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$97.68
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$87.91 |
| Rate for Payer: Aetna American Axle |
$63.49
|
| Rate for Payer: Aetna American Axle |
$60.66
|
| Rate for Payer: Aetna American Axle |
$38.76
|
| Rate for Payer: Aetna American Axle |
$71.31
|
| Rate for Payer: Aetna American Axle |
$136.73
|
| Rate for Payer: Aetna American Axle |
$87.44
|
| Rate for Payer: Aetna Commercial |
$83.03
|
| Rate for Payer: Aetna Commercial |
$178.81
|
| Rate for Payer: Aetna Commercial |
$50.69
|
| Rate for Payer: Aetna Commercial |
$114.35
|
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Aetna Commercial |
$93.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.31
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$74.66
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$87.76
|
| Rate for Payer: Cash Price |
$168.29
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cofinity Advantage |
$41.74
|
| Rate for Payer: Cofinity Advantage |
$94.17
|
| Rate for Payer: Cofinity Advantage |
$76.79
|
| Rate for Payer: Cofinity Advantage |
$65.32
|
| Rate for Payer: Cofinity Advantage |
$147.25
|
| Rate for Payer: Cofinity Advantage |
$68.38
|
| Rate for Payer: Cofinity Commercial |
$115.70
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Cofinity Commercial |
$80.26
|
| Rate for Payer: Cofinity Commercial |
$94.34
|
| Rate for Payer: Cofinity Commercial |
$180.91
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Healthscope Commercial |
$83.99
|
| Rate for Payer: Healthscope Commercial |
$98.73
|
| Rate for Payer: Healthscope Commercial |
$53.67
|
| Rate for Payer: Healthscope Commercial |
$121.08
|
| Rate for Payer: Healthscope Commercial |
$189.32
|
| Rate for Payer: Healthscope Commercial |
$87.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.77
|
| Rate for Payer: PHP Commercial |
$178.81
|
| Rate for Payer: PHP Commercial |
$83.03
|
| Rate for Payer: PHP Commercial |
$79.32
|
| Rate for Payer: PHP Commercial |
$50.69
|
| Rate for Payer: PHP Commercial |
$93.25
|
| Rate for Payer: PHP Commercial |
$114.35
|
| Rate for Payer: Priority Health SBD |
$58.79
|
| Rate for Payer: Priority Health SBD |
$84.75
|
| Rate for Payer: Priority Health SBD |
$69.11
|
| Rate for Payer: Priority Health SBD |
$132.53
|
| Rate for Payer: Priority Health SBD |
$37.57
|
| Rate for Payer: Priority Health SBD |
$61.54
|
| Rate for Payer: UMR Bronson Commercial |
$41.06
|
| Rate for Payer: UMR Bronson Commercial |
$92.56
|
| Rate for Payer: UMR Bronson Commercial |
$26.24
|
| Rate for Payer: UMR Bronson Commercial |
$59.19
|
| Rate for Payer: UMR Bronson Commercial |
$42.98
|
| Rate for Payer: UMR Bronson Commercial |
$48.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.77
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna American Axle |
$12.87
|
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna Commercial |
$16.83
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Medicare |
$9.90
|
| Rate for Payer: Aetna Medicare |
$14.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS Complete |
$7.92
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Advantage |
$13.86
|
| Rate for Payer: Cofinity Advantage |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.85
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: Priority Health SBD |
$12.47
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$7.33
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna American Axle |
$12.87
|
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna Commercial |
$16.83
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Advantage |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$13.86
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.20
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: Priority Health SBD |
$12.47
|
| Rate for Payer: UMR Bronson Commercial |
$8.71
|
| Rate for Payer: UMR Bronson Commercial |
$13.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$145.70
|
|
|
Service Code
|
NDC 00093412773
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna American Axle |
$94.70
|
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Advantage |
$101.99
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.28
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health SBD |
$91.79
|
| Rate for Payer: UMR Bronson Commercial |
$64.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.28
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$145.70
|
|
|
Service Code
|
NDC 00093412773
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.91 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna American Axle |
$94.70
|
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna Medicare |
$72.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: BCBS Complete |
$58.28
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Advantage |
$101.99
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.28
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health SBD |
$91.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.70
|
| Rate for Payer: UHC Core |
$75.91
|
| Rate for Payer: UHC Exchange |
$57.26
|
| Rate for Payer: UMR Bronson Commercial |
$53.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.28
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
OP
|
$176.25
|
|
|
Service Code
|
NDC 57237004001
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.21 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna American Axle |
$114.56
|
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna Medicare |
$88.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: BCBS Complete |
$70.50
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Advantage |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health SBD |
$111.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.56
|
| Rate for Payer: UHC Core |
$91.83
|
| Rate for Payer: UHC Exchange |
$69.27
|
| Rate for Payer: UMR Bronson Commercial |
$65.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
OP
|
$211.50
|
|
|
Service Code
|
NDC 65862017501
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.25 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.47
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna Medicare |
$105.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.47
|
| Rate for Payer: BCBS Complete |
$84.60
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Advantage |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.62
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health SBD |
$133.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.47
|
| Rate for Payer: UHC Core |
$110.19
|
| Rate for Payer: UHC Exchange |
$83.12
|
| Rate for Payer: UMR Bronson Commercial |
$78.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
IP
|
$211.50
|
|
|
Service Code
|
NDC 65862017501
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.47
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.47
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Advantage |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.62
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health SBD |
$133.25
|
| Rate for Payer: UMR Bronson Commercial |
$93.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 57237004001
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna American Axle |
$114.56
|
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Advantage |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health SBD |
$111.04
|
| Rate for Payer: UMR Bronson Commercial |
$77.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
|
PENIS PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$42,697.29
|
|
|
Service Code
|
MSDRG 709
|
| Min. Negotiated Rate |
$19,051.11 |
| Max. Negotiated Rate |
$42,697.29 |
| Rate for Payer: Aetna Medicare |
$20,855.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,067.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,067.25
|
| Rate for Payer: BCBS MAPPO |
$20,053.80
|
| Rate for Payer: BCBS Trust/PPO |
$42,697.29
|
| Rate for Payer: BCN Commercial |
$42,697.29
|
| Rate for Payer: BCN Medicare Advantage |
$20,053.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,053.80
|
| Rate for Payer: Mclaren Medicare |
$20,053.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,056.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,061.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,059.18
|
| Rate for Payer: Nomi Health Commercial |
$30,019.59
|
| Rate for Payer: PACE Medicare |
$19,051.11
|
| Rate for Payer: PACE SWMI |
$20,053.80
|
| Rate for Payer: PHP Medicare Advantage |
$20,053.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,517.83
|
| Rate for Payer: Priority Health Medicare |
$20,053.80
|
| Rate for Payer: Priority Health Tiered Network |
$30,014.26
|
| Rate for Payer: Railroad Medicare Medicare |
$20,053.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,931.73
|
| Rate for Payer: UHC Core |
$31,734.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,053.80
|
| Rate for Payer: UHC Exchange |
$25,916.91
|
| Rate for Payer: VA VA |
$20,053.80
|
|
|
PENIS PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,839.56
|
|
|
Service Code
|
MSDRG 710
|
| Min. Negotiated Rate |
$11,695.25 |
| Max. Negotiated Rate |
$22,839.56 |
| Rate for Payer: Aetna Medicare |
$12,803.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,388.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,388.49
|
| Rate for Payer: BCBS MAPPO |
$12,310.79
|
| Rate for Payer: BCBS Trust/PPO |
$14,093.34
|
| Rate for Payer: BCN Commercial |
$14,093.34
|
| Rate for Payer: BCN Medicare Advantage |
$12,310.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,310.79
|
| Rate for Payer: Mclaren Medicare |
$12,310.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,926.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,157.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,541.87
|
| Rate for Payer: Nomi Health Commercial |
$18,075.48
|
| Rate for Payer: PACE Medicare |
$11,695.25
|
| Rate for Payer: PACE SWMI |
$12,310.79
|
| Rate for Payer: PHP Medicare Advantage |
$12,310.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,590.34
|
| Rate for Payer: Priority Health Medicare |
$12,310.79
|
| Rate for Payer: Priority Health Tiered Network |
$18,072.27
|
| Rate for Payer: Railroad Medicare Medicare |
$12,310.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,839.56
|
| Rate for Payer: UHC Core |
$19,108.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,310.79
|
| Rate for Payer: UHC Exchange |
$15,605.16
|
| Rate for Payer: VA VA |
$12,310.79
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$25,819.53
|
|
|
Service Code
|
APR-DRG 4834
|
| Min. Negotiated Rate |
$24,590.03 |
| Max. Negotiated Rate |
$25,819.53 |
| Rate for Payer: BCBS Complete |
$25,819.53
|
| Rate for Payer: Mclaren Medicaid |
$24,590.03
|
| Rate for Payer: Meridian Medicaid |
$25,819.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,590.03
|
| Rate for Payer: UHC Medicaid |
$24,590.03
|
| Rate for Payer: UHCCP Medicaid |
$24,590.03
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$9,636.17
|
|
|
Service Code
|
APR-DRG 4832
|
| Min. Negotiated Rate |
$9,177.30 |
| Max. Negotiated Rate |
$9,636.17 |
| Rate for Payer: BCBS Complete |
$9,636.17
|
| Rate for Payer: Mclaren Medicaid |
$9,177.30
|
| Rate for Payer: Meridian Medicaid |
$9,636.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,177.30
|
| Rate for Payer: UHC Medicaid |
$9,177.30
|
| Rate for Payer: UHCCP Medicaid |
$9,177.30
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$13,961.82
|
|
|
Service Code
|
APR-DRG 4833
|
| Min. Negotiated Rate |
$13,296.97 |
| Max. Negotiated Rate |
$13,961.82 |
| Rate for Payer: BCBS Complete |
$13,961.82
|
| Rate for Payer: Mclaren Medicaid |
$13,296.97
|
| Rate for Payer: Meridian Medicaid |
$13,961.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,296.97
|
| Rate for Payer: UHC Medicaid |
$13,296.97
|
| Rate for Payer: UHCCP Medicaid |
$13,296.97
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$6,713.66
|
|
|
Service Code
|
APR-DRG 4831
|
| Min. Negotiated Rate |
$6,393.96 |
| Max. Negotiated Rate |
$6,713.66 |
| Rate for Payer: BCBS Complete |
$6,713.66
|
| Rate for Payer: Mclaren Medicaid |
$6,393.96
|
| Rate for Payer: Meridian Medicaid |
$6,713.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,393.96
|
| Rate for Payer: UHC Medicaid |
$6,393.96
|
| Rate for Payer: UHCCP Medicaid |
$6,393.96
|
|
