|
PEPTAMEN AF CONTINUOUS FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
168955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.88
|
| Rate for Payer: UHC Core |
$32.77
|
| Rate for Payer: UHC Exchange |
$24.72
|
| Rate for Payer: UMR Bronson Commercial |
$23.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.17
|
|
|
PEPTAMEN AF CONTINUOUS FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
168955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.17
|
|
|
PEPTAMEN AF CONTINUOUS FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
168955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Advantage |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.62
|
| Rate for Payer: UHC Core |
$7.71
|
| Rate for Payer: UHC Exchange |
$5.82
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF CYCLIC FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.17
|
|
|
PEPTAMEN AF CYCLIC FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Advantage |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF CYCLIC FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.88
|
| Rate for Payer: UHC Core |
$32.77
|
| Rate for Payer: UHC Exchange |
$24.72
|
| Rate for Payer: UMR Bronson Commercial |
$23.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.17
|
|
|
PEPTAMEN AF CYCLIC FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Advantage |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.62
|
| Rate for Payer: UHC Core |
$7.71
|
| Rate for Payer: UHC Exchange |
$5.82
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.17
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.88
|
| Rate for Payer: UHC Core |
$32.77
|
| Rate for Payer: UHC Exchange |
$24.72
|
| Rate for Payer: UMR Bronson Commercial |
$23.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.17
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Advantage |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.62
|
| Rate for Payer: UHC Core |
$7.71
|
| Rate for Payer: UHC Exchange |
$5.82
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Advantage |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN INTENSE VHP BOLUS FEED
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Advantage |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.73
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.70
|
| Rate for Payer: UHC Core |
$36.63
|
| Rate for Payer: UHC Exchange |
$27.63
|
| Rate for Payer: UMR Bronson Commercial |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
PEPTAMEN INTENSE VHP BOLUS FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Advantage |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.73
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Advantage |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.73
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.70
|
| Rate for Payer: UHC Core |
$36.63
|
| Rate for Payer: UHC Exchange |
$27.63
|
| Rate for Payer: UMR Bronson Commercial |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Advantage |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.73
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Advantage |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.73
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Advantage |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.73
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.70
|
| Rate for Payer: UHC Core |
$36.63
|
| Rate for Payer: UHC Exchange |
$27.63
|
| Rate for Payer: UMR Bronson Commercial |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$15,240.27
|
|
|
Service Code
|
APR-DRG 2414
|
| Min. Negotiated Rate |
$14,514.54 |
| Max. Negotiated Rate |
$15,240.27 |
| Rate for Payer: BCBS Complete |
$15,240.27
|
| Rate for Payer: Mclaren Medicaid |
$14,514.54
|
| Rate for Payer: Meridian Medicaid |
$15,240.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,514.54
|
| Rate for Payer: UHC Medicaid |
$14,514.54
|
| Rate for Payer: UHCCP Medicaid |
$14,514.54
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$8,207.00
|
|
|
Service Code
|
APR-DRG 2413
|
| Min. Negotiated Rate |
$7,816.19 |
| Max. Negotiated Rate |
$8,207.00 |
| Rate for Payer: BCBS Complete |
$8,207.00
|
| Rate for Payer: Mclaren Medicaid |
$7,816.19
|
| Rate for Payer: Meridian Medicaid |
$8,207.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,816.19
|
| Rate for Payer: UHC Medicaid |
$7,816.19
|
| Rate for Payer: UHCCP Medicaid |
$7,816.19
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$5,647.08
|
|
|
Service Code
|
APR-DRG 2412
|
| Min. Negotiated Rate |
$5,378.17 |
| Max. Negotiated Rate |
$5,647.08 |
| Rate for Payer: BCBS Complete |
$5,647.08
|
| Rate for Payer: Mclaren Medicaid |
$5,378.17
|
| Rate for Payer: Meridian Medicaid |
$5,647.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,378.17
|
| Rate for Payer: UHC Medicaid |
$5,378.17
|
| Rate for Payer: UHCCP Medicaid |
$5,378.17
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$4,490.30
|
|
|
Service Code
|
APR-DRG 2411
|
| Min. Negotiated Rate |
$4,276.48 |
| Max. Negotiated Rate |
$4,490.30 |
| Rate for Payer: BCBS Complete |
$4,490.30
|
| Rate for Payer: Mclaren Medicaid |
$4,276.48
|
| Rate for Payer: Meridian Medicaid |
$4,490.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,276.48
|
| Rate for Payer: UHC Medicaid |
$4,276.48
|
| Rate for Payer: UHCCP Medicaid |
$4,276.48
|
|
|
PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,035.68
|
|
|
Service Code
|
HCPCS J2547
|
| Hospital Charge Code |
119324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$932.11 |
| Rate for Payer: Aetna American Axle |
$673.19
|
| Rate for Payer: Aetna Commercial |
$880.33
|
| Rate for Payer: Aetna Medicare |
$1.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.10
|
| Rate for Payer: BCBS Complete |
$0.92
|
| Rate for Payer: BCBS MAPPO |
$1.68
|
| Rate for Payer: BCBS Trust/PPO |
$5.06
|
| Rate for Payer: BCN Commercial |
$5.06
|
| Rate for Payer: BCN Medicare Advantage |
$1.68
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cofinity Advantage |
$724.98
|
| Rate for Payer: Cofinity Commercial |
$890.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.68
|
| Rate for Payer: Healthscope Commercial |
$932.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$724.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$776.76
|
| Rate for Payer: Mclaren Medicaid |
$1.68
|
| Rate for Payer: Mclaren Medicare |
$1.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.76
|
| Rate for Payer: Meridian Medicaid |
$1.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$880.33
|
| Rate for Payer: Nomi Health Commercial |
$5.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$776.76
|
| Rate for Payer: PACE Medicare |
$1.60
|
| Rate for Payer: PACE SWMI |
$1.68
|
| Rate for Payer: PHP Commercial |
$880.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.31
|
| Rate for Payer: Priority Health Medicare |
$1.68
|
| Rate for Payer: Priority Health SBD |
$652.48
|
| Rate for Payer: Priority Health Tiered Network |
$4.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.77
|
| Rate for Payer: UHC Core |
$2.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.68
|
| Rate for Payer: UHC Exchange |
$2.77
|
| Rate for Payer: UHC Medicaid |
$0.88
|
| Rate for Payer: UHCCP Medicaid |
$0.88
|
| Rate for Payer: UMR Bronson Commercial |
$383.20
|
| Rate for Payer: VA VA |
$1.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$776.76
|
|
|
PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,035.68
|
|
|
Service Code
|
HCPCS J2547
|
| Hospital Charge Code |
119324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.70 |
| Max. Negotiated Rate |
$932.11 |
| Rate for Payer: Aetna American Axle |
$673.19
|
| Rate for Payer: Aetna Commercial |
$880.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.19
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cofinity Advantage |
$724.98
|
| Rate for Payer: Cofinity Commercial |
$890.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.54
|
| Rate for Payer: Healthscope Commercial |
$932.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$724.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$776.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$880.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$776.76
|
| Rate for Payer: PHP Commercial |
$880.33
|
| Rate for Payer: Priority Health SBD |
$652.48
|
| Rate for Payer: UMR Bronson Commercial |
$455.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$776.76
|
|
|
PERAMPANEL 2 MG TABLET
|
Facility
|
OP
|
$2,136.87
|
|
|
Service Code
|
NDC 62856027230
|
| Hospital Charge Code |
169250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$790.64 |
| Max. Negotiated Rate |
$1,923.18 |
| Rate for Payer: Aetna American Axle |
$1,388.97
|
| Rate for Payer: Aetna Commercial |
$1,816.34
|
| Rate for Payer: Aetna Medicare |
$1,068.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,388.97
|
| Rate for Payer: BCBS Complete |
$854.75
|
| Rate for Payer: Cash Price |
$1,709.50
|
| Rate for Payer: Cofinity Advantage |
$1,495.81
|
| Rate for Payer: Cofinity Commercial |
$1,837.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,709.50
|
| Rate for Payer: Healthscope Commercial |
$1,923.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,495.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,602.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,709.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,816.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,602.65
|
| Rate for Payer: PHP Commercial |
$1,816.34
|
| Rate for Payer: Priority Health SBD |
$1,346.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,388.97
|
| Rate for Payer: UHC Core |
$1,113.31
|
| Rate for Payer: UHC Exchange |
$839.79
|
| Rate for Payer: UMR Bronson Commercial |
$790.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,602.65
|
|
|
PERAMPANEL 2 MG TABLET
|
Facility
|
IP
|
$2,136.87
|
|
|
Service Code
|
NDC 62856027230
|
| Hospital Charge Code |
169250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$940.22 |
| Max. Negotiated Rate |
$1,923.18 |
| Rate for Payer: Aetna American Axle |
$1,388.97
|
| Rate for Payer: Aetna Commercial |
$1,816.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,388.97
|
| Rate for Payer: Cash Price |
$1,709.50
|
| Rate for Payer: Cofinity Advantage |
$1,495.81
|
| Rate for Payer: Cofinity Commercial |
$1,837.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,709.50
|
| Rate for Payer: Healthscope Commercial |
$1,923.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,495.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,602.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,816.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,602.65
|
| Rate for Payer: PHP Commercial |
$1,816.34
|
| Rate for Payer: Priority Health SBD |
$1,346.23
|
| Rate for Payer: UMR Bronson Commercial |
$940.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,602.65
|
|
