|
OXYMORPHONE 10 MG TABLET
|
Facility
|
OP
|
$758.88
|
|
|
Service Code
|
NDC 31722093001
|
| Hospital Charge Code |
76676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.79 |
| Max. Negotiated Rate |
$682.99 |
| Rate for Payer: Aetna American Axle |
$493.27
|
| Rate for Payer: Aetna Commercial |
$645.05
|
| Rate for Payer: Aetna Medicare |
$379.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.27
|
| Rate for Payer: BCBS Complete |
$303.55
|
| Rate for Payer: Cash Price |
$607.10
|
| Rate for Payer: Cofinity Commercial |
$531.22
|
| Rate for Payer: Cofinity Commercial |
$652.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.10
|
| Rate for Payer: Healthscope Commercial |
$682.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.05
|
| Rate for Payer: PHP Commercial |
$645.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.27
|
| Rate for Payer: Priority Health SBD |
$478.09
|
| Rate for Payer: UMR Bronson Commercial |
$280.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.16
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$728.19
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$269.43 |
| Max. Negotiated Rate |
$655.37 |
| Rate for Payer: Aetna American Axle |
$473.32
|
| Rate for Payer: Aetna American Axle |
$95.71
|
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna Commercial |
$618.96
|
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: Aetna Commercial |
$125.16
|
| Rate for Payer: Aetna Medicare |
$364.10
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Aetna Medicare |
$73.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.71
|
| Rate for Payer: BCBS Complete |
$58.90
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS Complete |
$291.28
|
| Rate for Payer: Cash Price |
$582.55
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$117.80
|
| Rate for Payer: Cofinity Commercial |
$21.31
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Cofinity Commercial |
$126.64
|
| Rate for Payer: Cofinity Commercial |
$626.24
|
| Rate for Payer: Cofinity Commercial |
$509.73
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$509.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.55
|
| Rate for Payer: Healthscope Commercial |
$132.53
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Healthscope Commercial |
$655.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$509.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$618.96
|
| Rate for Payer: PHP Commercial |
$125.16
|
| Rate for Payer: PHP Commercial |
$21.06
|
| Rate for Payer: PHP Commercial |
$618.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.71
|
| Rate for Payer: Priority Health SBD |
$15.61
|
| Rate for Payer: Priority Health SBD |
$92.77
|
| Rate for Payer: Priority Health SBD |
$458.76
|
| Rate for Payer: UMR Bronson Commercial |
$269.43
|
| Rate for Payer: UMR Bronson Commercial |
$54.48
|
| Rate for Payer: UMR Bronson Commercial |
$9.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.14
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.78
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$22.30 |
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna American Axle |
$95.71
|
| Rate for Payer: Aetna American Axle |
$473.32
|
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: Aetna Commercial |
$125.16
|
| Rate for Payer: Aetna Commercial |
$618.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.71
|
| Rate for Payer: Cash Price |
$582.55
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$117.80
|
| Rate for Payer: Cofinity Commercial |
$126.64
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$21.31
|
| Rate for Payer: Cofinity Commercial |
$509.73
|
| Rate for Payer: Cofinity Commercial |
$626.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$509.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.80
|
| Rate for Payer: Healthscope Commercial |
$655.37
|
| Rate for Payer: Healthscope Commercial |
$132.53
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$509.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$618.96
|
| Rate for Payer: PHP Commercial |
$125.16
|
| Rate for Payer: PHP Commercial |
$618.96
|
| Rate for Payer: PHP Commercial |
$21.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.32
|
| Rate for Payer: Priority Health SBD |
$15.61
|
| Rate for Payer: Priority Health SBD |
$92.77
|
| Rate for Payer: Priority Health SBD |
$458.76
|
| Rate for Payer: UMR Bronson Commercial |
$320.40
|
| Rate for Payer: UMR Bronson Commercial |
$10.90
|
| Rate for Payer: UMR Bronson Commercial |
$64.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
|
|
OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
115673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
115673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
IP
|
$245.39
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
10843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.97 |
| Max. Negotiated Rate |
$220.85 |
| Rate for Payer: Aetna American Axle |
$159.50
|
| Rate for Payer: Aetna American Axle |
$307.54
|
| Rate for Payer: Aetna American Axle |
$282.49
|
| Rate for Payer: Aetna American Axle |
$262.84
|
| Rate for Payer: Aetna American Axle |
$267.59
|
| Rate for Payer: Aetna American Axle |
$328.28
|
| Rate for Payer: Aetna Commercial |
$208.58
|
| Rate for Payer: Aetna Commercial |
$343.71
|
| Rate for Payer: Aetna Commercial |
$369.41
|
| Rate for Payer: Aetna Commercial |
$429.29
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$347.68
|
| Rate for Payer: Cash Price |
$196.31
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cash Price |
$404.04
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$171.77
|
| Rate for Payer: Cofinity Commercial |
$373.76
|
| Rate for Payer: Cofinity Commercial |
$304.22
|
| Rate for Payer: Cofinity Commercial |
$288.18
|
| Rate for Payer: Cofinity Commercial |
$283.06
|
| Rate for Payer: Cofinity Commercial |
$347.76
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Cofinity Commercial |
$211.04
|
| Rate for Payer: Cofinity Commercial |
$434.34
|
| Rate for Payer: Cofinity Commercial |
$353.54
|
| Rate for Payer: Cofinity Commercial |
$331.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$283.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.04
|
| Rate for Payer: Healthscope Commercial |
$391.14
|
| Rate for Payer: Healthscope Commercial |
$454.55
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Healthscope Commercial |
$363.93
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Healthscope Commercial |
$220.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: PHP Commercial |
$208.58
|
| Rate for Payer: PHP Commercial |
$343.71
|
| Rate for Payer: PHP Commercial |
$369.41
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: PHP Commercial |
$429.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.28
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$273.80
|
| Rate for Payer: Priority Health SBD |
$154.60
|
| Rate for Payer: Priority Health SBD |
$254.75
|
| Rate for Payer: Priority Health SBD |
$259.36
|
| Rate for Payer: Priority Health SBD |
$318.18
|
| Rate for Payer: UMR Bronson Commercial |
$222.22
|
| Rate for Payer: UMR Bronson Commercial |
$177.92
|
| Rate for Payer: UMR Bronson Commercial |
$181.14
|
| Rate for Payer: UMR Bronson Commercial |
$208.18
|
| Rate for Payer: UMR Bronson Commercial |
$191.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
OP
|
$356.19
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
10843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.79 |
| Max. Negotiated Rate |
$320.57 |
| Rate for Payer: Aetna American Axle |
$231.52
|
| Rate for Payer: Aetna American Axle |
$267.59
|
| Rate for Payer: Aetna American Axle |
$159.50
|
| Rate for Payer: Aetna American Axle |
$262.84
|
| Rate for Payer: Aetna American Axle |
$204.21
|
| Rate for Payer: Aetna American Axle |
$723.01
|
| Rate for Payer: Aetna American Axle |
$328.28
|
| Rate for Payer: Aetna American Axle |
$173.13
|
| Rate for Payer: Aetna American Axle |
$307.54
|
| Rate for Payer: Aetna American Axle |
$301.08
|
| Rate for Payer: Aetna American Axle |
$282.49
|
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna Commercial |
$208.58
|
| Rate for Payer: Aetna Commercial |
$945.47
|
| Rate for Payer: Aetna Commercial |
$343.71
|
| Rate for Payer: Aetna Commercial |
$429.29
|
| Rate for Payer: Aetna Commercial |
$267.04
|
| Rate for Payer: Aetna Commercial |
$302.76
|
| Rate for Payer: Aetna Commercial |
$369.41
|
| Rate for Payer: Aetna Commercial |
$226.40
|
| Rate for Payer: Aetna Commercial |
$393.72
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna Medicare |
$157.09
|
| Rate for Payer: Aetna Medicare |
$133.18
|
| Rate for Payer: Aetna Medicare |
$217.30
|
| Rate for Payer: Aetna Medicare |
$252.53
|
| Rate for Payer: Aetna Medicare |
$202.19
|
| Rate for Payer: Aetna Medicare |
$556.16
|
| Rate for Payer: Aetna Medicare |
$205.84
|
| Rate for Payer: Aetna Medicare |
$236.57
|
| Rate for Payer: Aetna Medicare |
$178.09
|
| Rate for Payer: Aetna Medicare |
$231.60
|
| Rate for Payer: Aetna Medicare |
$122.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$723.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.59
|
| Rate for Payer: BCBS Complete |
$173.84
|
| Rate for Payer: BCBS Complete |
$185.28
|
| Rate for Payer: BCBS Complete |
$202.02
|
| Rate for Payer: BCBS Complete |
$125.67
|
| Rate for Payer: BCBS Complete |
$161.75
|
| Rate for Payer: BCBS Complete |
$164.67
|
| Rate for Payer: BCBS Complete |
$444.93
|
| Rate for Payer: BCBS Complete |
$189.26
|
| Rate for Payer: BCBS Complete |
$106.54
|
| Rate for Payer: BCBS Complete |
$142.48
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: Cash Price |
$213.08
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$370.56
|
| Rate for Payer: Cash Price |
$347.68
|
| Rate for Payer: Cash Price |
$251.34
|
| Rate for Payer: Cash Price |
$196.31
|
| Rate for Payer: Cash Price |
$889.86
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cash Price |
$284.95
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cash Price |
$404.04
|
| Rate for Payer: Cofinity Commercial |
$270.19
|
| Rate for Payer: Cofinity Commercial |
$249.33
|
| Rate for Payer: Cofinity Commercial |
$306.32
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Cofinity Commercial |
$288.18
|
| Rate for Payer: Cofinity Commercial |
$398.35
|
| Rate for Payer: Cofinity Commercial |
$324.24
|
| Rate for Payer: Cofinity Commercial |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$347.76
|
| Rate for Payer: Cofinity Commercial |
$186.44
|
| Rate for Payer: Cofinity Commercial |
$229.06
|
| Rate for Payer: Cofinity Commercial |
$778.62
|
| Rate for Payer: Cofinity Commercial |
$373.76
|
| Rate for Payer: Cofinity Commercial |
$304.22
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$219.92
|
| Rate for Payer: Cofinity Commercial |
$283.06
|
| Rate for Payer: Cofinity Commercial |
$211.04
|
| Rate for Payer: Cofinity Commercial |
$434.34
|
| Rate for Payer: Cofinity Commercial |
$956.60
|
| Rate for Payer: Cofinity Commercial |
$353.54
|
| Rate for Payer: Cofinity Commercial |
$171.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$283.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$778.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.04
|
| Rate for Payer: Healthscope Commercial |
$239.72
|
| Rate for Payer: Healthscope Commercial |
$320.57
|
| Rate for Payer: Healthscope Commercial |
$391.14
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Healthscope Commercial |
$363.93
|
| Rate for Payer: Healthscope Commercial |
$416.88
|
| Rate for Payer: Healthscope Commercial |
$1,001.09
|
| Rate for Payer: Healthscope Commercial |
$282.75
|
| Rate for Payer: Healthscope Commercial |
$220.85
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Healthscope Commercial |
$454.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$834.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: PHP Commercial |
$393.72
|
| Rate for Payer: PHP Commercial |
$226.40
|
| Rate for Payer: PHP Commercial |
$369.41
|
| Rate for Payer: PHP Commercial |
$302.76
|
| Rate for Payer: PHP Commercial |
$343.71
|
| Rate for Payer: PHP Commercial |
$945.47
|
| Rate for Payer: PHP Commercial |
$429.29
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: PHP Commercial |
$208.58
|
| Rate for Payer: PHP Commercial |
$267.04
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.54
|
| Rate for Payer: Priority Health SBD |
$154.60
|
| Rate for Payer: Priority Health SBD |
$259.36
|
| Rate for Payer: Priority Health SBD |
$224.40
|
| Rate for Payer: Priority Health SBD |
$254.75
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$291.82
|
| Rate for Payer: Priority Health SBD |
$318.18
|
| Rate for Payer: Priority Health SBD |
$167.80
|
| Rate for Payer: Priority Health SBD |
$700.76
|
| Rate for Payer: Priority Health SBD |
$273.80
|
| Rate for Payer: Priority Health SBD |
$197.93
|
| Rate for Payer: UMR Bronson Commercial |
$160.80
|
| Rate for Payer: UMR Bronson Commercial |
$98.55
|
| Rate for Payer: UMR Bronson Commercial |
$411.56
|
| Rate for Payer: UMR Bronson Commercial |
$152.32
|
| Rate for Payer: UMR Bronson Commercial |
$175.06
|
| Rate for Payer: UMR Bronson Commercial |
$186.87
|
| Rate for Payer: UMR Bronson Commercial |
$131.79
|
| Rate for Payer: UMR Bronson Commercial |
$90.79
|
| Rate for Payer: UMR Bronson Commercial |
$116.24
|
| Rate for Payer: UMR Bronson Commercial |
$149.62
|
| Rate for Payer: UMR Bronson Commercial |
$171.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$834.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.28
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION
|
Facility
|
IP
|
$6,917.12
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
40475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,043.53 |
| Max. Negotiated Rate |
$6,225.41 |
| Rate for Payer: Aetna American Axle |
$4,496.13
|
| Rate for Payer: Aetna Commercial |
$5,879.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,496.13
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cofinity Commercial |
$4,841.98
|
| Rate for Payer: Cofinity Commercial |
$5,948.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,841.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,533.70
|
| Rate for Payer: Healthscope Commercial |
$6,225.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,841.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,187.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,879.55
|
| Rate for Payer: PHP Commercial |
$5,879.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,496.13
|
| Rate for Payer: Priority Health SBD |
$4,357.79
|
| Rate for Payer: UMR Bronson Commercial |
$3,043.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,187.84
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$6,917.12
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
40475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$6,225.41 |
| Rate for Payer: Aetna American Axle |
$4,496.13
|
| Rate for Payer: Aetna American Axle |
$2,836.93
|
| Rate for Payer: Aetna American Axle |
$3,911.20
|
| Rate for Payer: Aetna American Axle |
$3,924.01
|
| Rate for Payer: Aetna Commercial |
$5,114.65
|
| Rate for Payer: Aetna Commercial |
$5,131.40
|
| Rate for Payer: Aetna Commercial |
$5,879.55
|
| Rate for Payer: Aetna Commercial |
$3,709.83
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,924.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,836.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,911.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,496.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: Cash Price |
$4,829.55
|
| Rate for Payer: Cash Price |
$3,491.61
|
| Rate for Payer: Cash Price |
$4,813.78
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cash Price |
$4,829.55
|
| Rate for Payer: Cash Price |
$4,813.78
|
| Rate for Payer: Cash Price |
$3,491.61
|
| Rate for Payer: Cofinity Commercial |
$5,174.82
|
| Rate for Payer: Cofinity Commercial |
$3,753.48
|
| Rate for Payer: Cofinity Commercial |
$3,055.16
|
| Rate for Payer: Cofinity Commercial |
$4,212.06
|
| Rate for Payer: Cofinity Commercial |
$5,948.72
|
| Rate for Payer: Cofinity Commercial |
$4,841.98
|
| Rate for Payer: Cofinity Commercial |
$4,225.86
|
| Rate for Payer: Cofinity Commercial |
$5,191.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,212.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,055.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,841.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,225.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,533.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,829.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,491.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$3,928.06
|
| Rate for Payer: Healthscope Commercial |
$6,225.41
|
| Rate for Payer: Healthscope Commercial |
$5,433.25
|
| Rate for Payer: Healthscope Commercial |
$5,415.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,841.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,225.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,055.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,212.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,187.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,273.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,527.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,512.92
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,131.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,879.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,709.83
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PHP Commercial |
$3,709.83
|
| Rate for Payer: PHP Commercial |
$5,879.55
|
| Rate for Payer: PHP Commercial |
$5,114.65
|
| Rate for Payer: PHP Commercial |
$5,131.40
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,836.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,496.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,911.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,924.01
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health SBD |
$3,790.85
|
| Rate for Payer: Priority Health SBD |
$4,357.79
|
| Rate for Payer: Priority Health SBD |
$2,749.64
|
| Rate for Payer: Priority Health SBD |
$3,803.27
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Exchange |
$20.14
|
| Rate for Payer: UHC Exchange |
$20.14
|
| Rate for Payer: UHC Exchange |
$20.14
|
| Rate for Payer: UHC Exchange |
$20.14
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,233.67
|
| Rate for Payer: UMR Bronson Commercial |
$2,226.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,614.87
|
| Rate for Payer: UMR Bronson Commercial |
$2,559.33
|
| Rate for Payer: VA VA |
$10.54
|
| Rate for Payer: VA VA |
$10.54
|
| Rate for Payer: VA VA |
$10.54
|
| Rate for Payer: VA VA |
$10.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,273.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,512.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,527.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,187.84
|
|
|
PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY)
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 42145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
PALATOPLASTY FOR CLEFT PALATE; ATTACHMENT PHARYNGEAL FLAP
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 42225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
PALATOPLASTY FOR CLEFT PALATE, SOFT AND/OR HARD PALATE ONLY
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 42200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; SOFT TISSUE ONLY
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 42205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; WITH BONE GRAFT TO ALVEOLAR RIDGE (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 42210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2,523.92
|
|
|
Service Code
|
NDC 00378397893
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,110.52 |
| Max. Negotiated Rate |
$2,271.53 |
| Rate for Payer: Aetna American Axle |
$1,640.55
|
| Rate for Payer: Aetna Commercial |
$2,145.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,640.55
|
| Rate for Payer: Cash Price |
$2,019.14
|
| Rate for Payer: Cofinity Commercial |
$1,766.74
|
| Rate for Payer: Cofinity Commercial |
$2,170.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,766.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,019.14
|
| Rate for Payer: Healthscope Commercial |
$2,271.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,766.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,892.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,145.33
|
| Rate for Payer: PHP Commercial |
$2,145.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,640.55
|
| Rate for Payer: Priority Health SBD |
$1,590.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,110.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,892.94
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2,523.92
|
|
|
Service Code
|
NDC 00378397893
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$933.85 |
| Max. Negotiated Rate |
$2,271.53 |
| Rate for Payer: Aetna American Axle |
$1,640.55
|
| Rate for Payer: Aetna Commercial |
$2,145.33
|
| Rate for Payer: Aetna Medicare |
$1,261.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,640.55
|
| Rate for Payer: BCBS Complete |
$1,009.57
|
| Rate for Payer: Cash Price |
$2,019.14
|
| Rate for Payer: Cofinity Commercial |
$1,766.74
|
| Rate for Payer: Cofinity Commercial |
$2,170.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,766.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,019.14
|
| Rate for Payer: Healthscope Commercial |
$2,271.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,766.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,892.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,145.33
|
| Rate for Payer: PHP Commercial |
$2,145.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,640.55
|
| Rate for Payer: Priority Health SBD |
$1,590.07
|
| Rate for Payer: UMR Bronson Commercial |
$933.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,892.94
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458055401
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$468.12 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna American Axle |
$822.37
|
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna Medicare |
$632.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: BCBS Complete |
$506.07
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$885.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.14
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$885.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$948.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.37
|
| Rate for Payer: Priority Health SBD |
$797.06
|
| Rate for Payer: UMR Bronson Commercial |
$468.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$948.88
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458055401
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$556.68 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna American Axle |
$822.37
|
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$885.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.14
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$885.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$948.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.37
|
| Rate for Payer: Priority Health SBD |
$797.06
|
| Rate for Payer: UMR Bronson Commercial |
$556.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$948.88
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458055001
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$556.68 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna American Axle |
$822.37
|
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$885.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.14
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$885.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$948.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.37
|
| Rate for Payer: Priority Health SBD |
$797.06
|
| Rate for Payer: UMR Bronson Commercial |
$556.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$948.88
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$223.67
|
|
|
Service Code
|
NDC 43975035003
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.76 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna American Axle |
$145.39
|
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna Medicare |
$111.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: BCBS Complete |
$89.47
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.39
|
| Rate for Payer: Priority Health SBD |
$140.91
|
| Rate for Payer: UMR Bronson Commercial |
$82.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.75
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$344.10
|
|
|
Service Code
|
NDC 47335076583
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.32 |
| Max. Negotiated Rate |
$309.69 |
| Rate for Payer: Aetna American Axle |
$223.66
|
| Rate for Payer: Aetna Commercial |
$292.49
|
| Rate for Payer: Aetna Medicare |
$172.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.66
|
| Rate for Payer: BCBS Complete |
$137.64
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cofinity Commercial |
$240.87
|
| Rate for Payer: Cofinity Commercial |
$295.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$240.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.28
|
| Rate for Payer: Healthscope Commercial |
$309.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.49
|
| Rate for Payer: PHP Commercial |
$292.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.66
|
| Rate for Payer: Priority Health SBD |
$216.78
|
| Rate for Payer: UMR Bronson Commercial |
$127.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.07
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$223.67
|
|
|
Service Code
|
NDC 43975035003
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna American Axle |
$145.39
|
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.39
|
| Rate for Payer: Priority Health SBD |
$140.91
|
| Rate for Payer: UMR Bronson Commercial |
$98.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.75
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$223.67
|
|
|
Service Code
|
NDC 68180052406
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.76 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna American Axle |
$145.39
|
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna Medicare |
$111.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: BCBS Complete |
$89.47
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.39
|
| Rate for Payer: Priority Health SBD |
$140.91
|
| Rate for Payer: UMR Bronson Commercial |
$82.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.75
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$344.10
|
|
|
Service Code
|
NDC 47335076583
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$309.69 |
| Rate for Payer: Aetna American Axle |
$223.66
|
| Rate for Payer: Aetna Commercial |
$292.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.66
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cofinity Commercial |
$240.87
|
| Rate for Payer: Cofinity Commercial |
$295.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$240.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.28
|
| Rate for Payer: Healthscope Commercial |
$309.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.49
|
| Rate for Payer: PHP Commercial |
$292.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.66
|
| Rate for Payer: Priority Health SBD |
$216.78
|
| Rate for Payer: UMR Bronson Commercial |
$151.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.07
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$223.67
|
|
|
Service Code
|
NDC 68180052406
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna American Axle |
$145.39
|
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.39
|
| Rate for Payer: Priority Health SBD |
$140.91
|
| Rate for Payer: UMR Bronson Commercial |
$98.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.75
|
|
