|
PERMETHRIN 1 % TOPICAL LIQUID
|
Facility
|
IP
|
$39.65
|
|
|
Service Code
|
NDC 63736012002
|
| Hospital Charge Code |
10918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$35.69 |
| Rate for Payer: Aetna American Axle |
$25.77
|
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.77
|
| Rate for Payer: Cash Price |
$31.72
|
| Rate for Payer: Cofinity Advantage |
$27.75
|
| Rate for Payer: Cofinity Commercial |
$34.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.72
|
| Rate for Payer: Healthscope Commercial |
$35.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.74
|
| Rate for Payer: PHP Commercial |
$33.70
|
| Rate for Payer: Priority Health SBD |
$24.98
|
| Rate for Payer: UMR Bronson Commercial |
$17.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.74
|
|
|
PERMETHRIN 1 % TOPICAL LIQUID
|
Facility
|
OP
|
$39.65
|
|
|
Service Code
|
NDC 63736012002
|
| Hospital Charge Code |
10918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.67 |
| Max. Negotiated Rate |
$35.69 |
| Rate for Payer: Aetna American Axle |
$25.77
|
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Medicare |
$19.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.77
|
| Rate for Payer: BCBS Complete |
$15.86
|
| Rate for Payer: Cash Price |
$31.72
|
| Rate for Payer: Cofinity Advantage |
$27.75
|
| Rate for Payer: Cofinity Commercial |
$34.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.72
|
| Rate for Payer: Healthscope Commercial |
$35.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.74
|
| Rate for Payer: PHP Commercial |
$33.70
|
| Rate for Payer: Priority Health SBD |
$24.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.77
|
| Rate for Payer: UHC Core |
$20.66
|
| Rate for Payer: UHC Exchange |
$15.58
|
| Rate for Payer: UMR Bronson Commercial |
$14.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.74
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
NDC 45802026937
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Aetna American Axle |
$63.47
|
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna Medicare |
$48.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Advantage |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$87.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.24
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: Priority Health SBD |
$61.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.47
|
| Rate for Payer: UHC Core |
$50.88
|
| Rate for Payer: UHC Exchange |
$38.38
|
| Rate for Payer: UMR Bronson Commercial |
$36.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.24
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$97.65
|
|
|
Service Code
|
NDC 45802026937
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.97 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Aetna American Axle |
$63.47
|
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Advantage |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$87.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.24
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: Priority Health SBD |
$61.52
|
| Rate for Payer: UMR Bronson Commercial |
$42.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.24
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$322.35
|
|
|
Service Code
|
NDC 00472024260
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.83 |
| Max. Negotiated Rate |
$290.12 |
| Rate for Payer: Aetna American Axle |
$209.53
|
| Rate for Payer: Aetna Commercial |
$274.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.53
|
| Rate for Payer: Cash Price |
$257.88
|
| Rate for Payer: Cofinity Advantage |
$225.65
|
| Rate for Payer: Cofinity Commercial |
$277.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.88
|
| Rate for Payer: Healthscope Commercial |
$290.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.76
|
| Rate for Payer: PHP Commercial |
$274.00
|
| Rate for Payer: Priority Health SBD |
$203.08
|
| Rate for Payer: UMR Bronson Commercial |
$141.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.76
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
OP
|
$322.35
|
|
|
Service Code
|
NDC 00472024260
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.27 |
| Max. Negotiated Rate |
$290.12 |
| Rate for Payer: Aetna American Axle |
$209.53
|
| Rate for Payer: Aetna Commercial |
$274.00
|
| Rate for Payer: Aetna Medicare |
$161.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.53
|
| Rate for Payer: BCBS Complete |
$128.94
|
| Rate for Payer: Cash Price |
$257.88
|
| Rate for Payer: Cofinity Advantage |
$225.65
|
| Rate for Payer: Cofinity Commercial |
$277.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.88
|
| Rate for Payer: Healthscope Commercial |
$290.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.76
|
| Rate for Payer: PHP Commercial |
$274.00
|
| Rate for Payer: Priority Health SBD |
$203.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.53
|
| Rate for Payer: UHC Core |
$167.94
|
| Rate for Payer: UHC Exchange |
$126.68
|
| Rate for Payer: UMR Bronson Commercial |
$119.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.76
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
OP
|
$68.88
|
|
|
Service Code
|
NDC 21922002107
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$61.99 |
| Rate for Payer: Aetna American Axle |
$44.77
|
| Rate for Payer: Aetna Commercial |
$58.55
|
| Rate for Payer: Aetna Medicare |
$34.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.77
|
| Rate for Payer: BCBS Complete |
$27.55
|
| Rate for Payer: Cash Price |
$55.10
|
| Rate for Payer: Cofinity Advantage |
$48.22
|
| Rate for Payer: Cofinity Commercial |
$59.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.10
|
| Rate for Payer: Healthscope Commercial |
$61.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.66
|
| Rate for Payer: PHP Commercial |
$58.55
|
| Rate for Payer: Priority Health SBD |
$43.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.77
|
| Rate for Payer: UHC Core |
$35.89
|
| Rate for Payer: UHC Exchange |
$27.07
|
| Rate for Payer: UMR Bronson Commercial |
$25.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.66
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$68.88
|
|
|
Service Code
|
NDC 21922002107
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$61.99 |
| Rate for Payer: Aetna American Axle |
$44.77
|
| Rate for Payer: Aetna Commercial |
$58.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.77
|
| Rate for Payer: Cash Price |
$55.10
|
| Rate for Payer: Cofinity Advantage |
$48.22
|
| Rate for Payer: Cofinity Commercial |
$59.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.10
|
| Rate for Payer: Healthscope Commercial |
$61.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.66
|
| Rate for Payer: PHP Commercial |
$58.55
|
| Rate for Payer: Priority Health SBD |
$43.39
|
| Rate for Payer: UMR Bronson Commercial |
$30.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.66
|
|
|
PERPHENAZINE 2 MG TABLET
|
Facility
|
IP
|
$203.30
|
|
|
Service Code
|
NDC 00603506021
|
| Hospital Charge Code |
6157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.45 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna American Axle |
$132.15
|
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Advantage |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.47
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UMR Bronson Commercial |
$89.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.47
|
|
|
PERPHENAZINE 2 MG TABLET
|
Facility
|
OP
|
$301.15
|
|
|
Service Code
|
NDC 52536016201
|
| Hospital Charge Code |
6157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.43 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Aetna American Axle |
$195.75
|
| Rate for Payer: Aetna Commercial |
$255.98
|
| Rate for Payer: Aetna Medicare |
$150.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.75
|
| Rate for Payer: BCBS Complete |
$120.46
|
| Rate for Payer: Cash Price |
$240.92
|
| Rate for Payer: Cofinity Advantage |
$210.81
|
| Rate for Payer: Cofinity Commercial |
$258.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.92
|
| Rate for Payer: Healthscope Commercial |
$271.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.86
|
| Rate for Payer: PHP Commercial |
$255.98
|
| Rate for Payer: Priority Health SBD |
$189.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.75
|
| Rate for Payer: UHC Core |
$156.90
|
| Rate for Payer: UHC Exchange |
$118.35
|
| Rate for Payer: UMR Bronson Commercial |
$111.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.86
|
|
|
PERPHENAZINE 2 MG TABLET
|
Facility
|
OP
|
$203.30
|
|
|
Service Code
|
NDC 00603506021
|
| Hospital Charge Code |
6157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.22 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna American Axle |
$132.15
|
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna Medicare |
$101.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: BCBS Complete |
$81.32
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Advantage |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.47
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.15
|
| Rate for Payer: UHC Core |
$105.92
|
| Rate for Payer: UHC Exchange |
$79.90
|
| Rate for Payer: UMR Bronson Commercial |
$75.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.47
|
|
|
PERPHENAZINE 2 MG TABLET
|
Facility
|
IP
|
$301.15
|
|
|
Service Code
|
NDC 52536016201
|
| Hospital Charge Code |
6157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.51 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Aetna American Axle |
$195.75
|
| Rate for Payer: Aetna Commercial |
$255.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.75
|
| Rate for Payer: Cash Price |
$240.92
|
| Rate for Payer: Cofinity Advantage |
$210.81
|
| Rate for Payer: Cofinity Commercial |
$258.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.92
|
| Rate for Payer: Healthscope Commercial |
$271.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.86
|
| Rate for Payer: PHP Commercial |
$255.98
|
| Rate for Payer: Priority Health SBD |
$189.72
|
| Rate for Payer: UMR Bronson Commercial |
$132.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.86
|
|
|
PERPHENAZINE 4 MG TABLET
|
Facility
|
OP
|
$448.32
|
|
|
Service Code
|
HCPCS Q0175
|
| Hospital Charge Code |
6158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$403.49 |
| Rate for Payer: Aetna American Axle |
$291.41
|
| Rate for Payer: Aetna Commercial |
$381.07
|
| Rate for Payer: Aetna Medicare |
$224.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.41
|
| Rate for Payer: BCBS Complete |
$179.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.23
|
| Rate for Payer: BCN Commercial |
$2.23
|
| Rate for Payer: Cash Price |
$358.66
|
| Rate for Payer: Cash Price |
$358.66
|
| Rate for Payer: Cofinity Advantage |
$313.82
|
| Rate for Payer: Cofinity Commercial |
$385.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.66
|
| Rate for Payer: Healthscope Commercial |
$403.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$358.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.24
|
| Rate for Payer: PHP Commercial |
$381.07
|
| Rate for Payer: Priority Health SBD |
$282.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.41
|
| Rate for Payer: UHC Core |
$233.57
|
| Rate for Payer: UHC Exchange |
$176.19
|
| Rate for Payer: UMR Bronson Commercial |
$165.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.24
|
|
|
PERPHENAZINE 4 MG TABLET
|
Facility
|
IP
|
$448.32
|
|
|
Service Code
|
HCPCS Q0175
|
| Hospital Charge Code |
6158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.26 |
| Max. Negotiated Rate |
$403.49 |
| Rate for Payer: Aetna American Axle |
$291.41
|
| Rate for Payer: Aetna Commercial |
$381.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.41
|
| Rate for Payer: Cash Price |
$358.66
|
| Rate for Payer: Cofinity Advantage |
$313.82
|
| Rate for Payer: Cofinity Commercial |
$385.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.66
|
| Rate for Payer: Healthscope Commercial |
$403.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.24
|
| Rate for Payer: PHP Commercial |
$381.07
|
| Rate for Payer: Priority Health SBD |
$282.44
|
| Rate for Payer: UMR Bronson Commercial |
$197.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.24
|
|
|
PERPHENAZINE 8 MG TABLET
|
Facility
|
OP
|
$526.08
|
|
|
Service Code
|
NDC 00904660161
|
| Hospital Charge Code |
6159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.65 |
| Max. Negotiated Rate |
$473.47 |
| Rate for Payer: Aetna American Axle |
$341.95
|
| Rate for Payer: Aetna Commercial |
$447.17
|
| Rate for Payer: Aetna Medicare |
$263.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.95
|
| Rate for Payer: BCBS Complete |
$210.43
|
| Rate for Payer: Cash Price |
$420.86
|
| Rate for Payer: Cofinity Advantage |
$368.26
|
| Rate for Payer: Cofinity Commercial |
$452.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.86
|
| Rate for Payer: Healthscope Commercial |
$473.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$368.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$420.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$394.56
|
| Rate for Payer: PHP Commercial |
$447.17
|
| Rate for Payer: Priority Health SBD |
$331.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.95
|
| Rate for Payer: UHC Core |
$274.09
|
| Rate for Payer: UHC Exchange |
$206.75
|
| Rate for Payer: UMR Bronson Commercial |
$194.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.56
|
|
|
PERPHENAZINE 8 MG TABLET
|
Facility
|
IP
|
$526.08
|
|
|
Service Code
|
NDC 00904660161
|
| Hospital Charge Code |
6159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.48 |
| Max. Negotiated Rate |
$473.47 |
| Rate for Payer: Aetna American Axle |
$341.95
|
| Rate for Payer: Aetna Commercial |
$447.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.95
|
| Rate for Payer: Cash Price |
$420.86
|
| Rate for Payer: Cofinity Advantage |
$368.26
|
| Rate for Payer: Cofinity Commercial |
$452.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.86
|
| Rate for Payer: Healthscope Commercial |
$473.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$368.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$394.56
|
| Rate for Payer: PHP Commercial |
$447.17
|
| Rate for Payer: Priority Health SBD |
$331.43
|
| Rate for Payer: UMR Bronson Commercial |
$231.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.56
|
|
|
PERSONALITY DISORDERS
|
Facility
|
IP
|
$7,889.81
|
|
|
Service Code
|
APR-DRG 7523
|
| Min. Negotiated Rate |
$7,514.10 |
| Max. Negotiated Rate |
$7,889.81 |
| Rate for Payer: BCBS Complete |
$7,889.81
|
| Rate for Payer: Mclaren Medicaid |
$7,514.10
|
| Rate for Payer: Meridian Medicaid |
$7,889.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,514.10
|
| Rate for Payer: UHC Medicaid |
$7,514.10
|
| Rate for Payer: UHCCP Medicaid |
$7,514.10
|
|
|
PERSONALITY DISORDERS
|
Facility
|
IP
|
$3,399.51
|
|
|
Service Code
|
APR-DRG 7522
|
| Min. Negotiated Rate |
$3,237.62 |
| Max. Negotiated Rate |
$3,399.51 |
| Rate for Payer: BCBS Complete |
$3,399.51
|
| Rate for Payer: Mclaren Medicaid |
$3,237.62
|
| Rate for Payer: Meridian Medicaid |
$3,399.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,237.62
|
| Rate for Payer: UHC Medicaid |
$3,237.62
|
| Rate for Payer: UHCCP Medicaid |
$3,237.62
|
|
|
PERSONALITY DISORDERS
|
Facility
|
IP
|
$2,723.36
|
|
|
Service Code
|
APR-DRG 7521
|
| Min. Negotiated Rate |
$2,593.67 |
| Max. Negotiated Rate |
$2,723.36 |
| Rate for Payer: BCBS Complete |
$2,723.36
|
| Rate for Payer: Mclaren Medicaid |
$2,593.67
|
| Rate for Payer: Meridian Medicaid |
$2,723.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,593.67
|
| Rate for Payer: UHC Medicaid |
$2,593.67
|
| Rate for Payer: UHCCP Medicaid |
$2,593.67
|
|
|
PERSONALITY DISORDERS
|
Facility
|
IP
|
$17,407.94
|
|
|
Service Code
|
APR-DRG 7524
|
| Min. Negotiated Rate |
$16,578.99 |
| Max. Negotiated Rate |
$17,407.94 |
| Rate for Payer: BCBS Complete |
$17,407.94
|
| Rate for Payer: Mclaren Medicaid |
$16,578.99
|
| Rate for Payer: Meridian Medicaid |
$17,407.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,578.99
|
| Rate for Payer: UHC Medicaid |
$16,578.99
|
| Rate for Payer: UHCCP Medicaid |
$16,578.99
|
|
|
PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30,930.21
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
160029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$27,837.19 |
| Rate for Payer: Aetna American Axle |
$20,104.64
|
| Rate for Payer: Aetna Commercial |
$26,290.68
|
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,104.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.27
|
| Rate for Payer: BCBS Complete |
$9.35
|
| Rate for Payer: BCBS MAPPO |
$17.02
|
| Rate for Payer: BCBS Trust/PPO |
$54.14
|
| Rate for Payer: BCN Commercial |
$54.14
|
| Rate for Payer: BCN Medicare Advantage |
$17.02
|
| Rate for Payer: Cash Price |
$24,744.17
|
| Rate for Payer: Cash Price |
$24,744.17
|
| Rate for Payer: Cofinity Advantage |
$21,651.15
|
| Rate for Payer: Cofinity Commercial |
$26,599.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,744.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.02
|
| Rate for Payer: Healthscope Commercial |
$27,837.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,651.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,197.66
|
| Rate for Payer: Mclaren Medicaid |
$17.02
|
| Rate for Payer: Mclaren Medicare |
$17.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.87
|
| Rate for Payer: Meridian Medicaid |
$17.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,290.68
|
| Rate for Payer: Nomi Health Commercial |
$51.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,197.66
|
| Rate for Payer: PACE Medicare |
$16.17
|
| Rate for Payer: PACE SWMI |
$17.02
|
| Rate for Payer: PHP Commercial |
$26,290.68
|
| Rate for Payer: PHP Medicare Advantage |
$17.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$53.69
|
| Rate for Payer: Priority Health Medicare |
$17.02
|
| Rate for Payer: Priority Health SBD |
$19,486.03
|
| Rate for Payer: Priority Health Tiered Network |
$42.95
|
| Rate for Payer: Railroad Medicare Medicare |
$17.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.07
|
| Rate for Payer: UHC Core |
$28.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.02
|
| Rate for Payer: UHC Exchange |
$28.07
|
| Rate for Payer: UHC Medicaid |
$8.90
|
| Rate for Payer: UHCCP Medicaid |
$8.90
|
| Rate for Payer: UMR Bronson Commercial |
$11,444.18
|
| Rate for Payer: VA VA |
$17.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,197.66
|
|
|
PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30,930.21
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
160029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,609.29 |
| Max. Negotiated Rate |
$27,837.19 |
| Rate for Payer: Aetna American Axle |
$20,104.64
|
| Rate for Payer: Aetna Commercial |
$26,290.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,104.64
|
| Rate for Payer: Cash Price |
$24,744.17
|
| Rate for Payer: Cofinity Advantage |
$21,651.15
|
| Rate for Payer: Cofinity Commercial |
$26,599.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,744.17
|
| Rate for Payer: Healthscope Commercial |
$27,837.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,651.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,197.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,290.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,197.66
|
| Rate for Payer: PHP Commercial |
$26,290.68
|
| Rate for Payer: Priority Health SBD |
$19,486.03
|
| Rate for Payer: UMR Bronson Commercial |
$13,609.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,197.66
|
|
|
PERTUZUMAB 600 MG-TRASTUZUMAB 600 MG-HYALURONID-ZZXF/10 ML SUBCUT SOLN
|
Facility
|
OP
|
$43,529.66
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
194378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$39,176.69 |
| Rate for Payer: Aetna American Axle |
$28,294.28
|
| Rate for Payer: Aetna Commercial |
$37,000.21
|
| Rate for Payer: Aetna Medicare |
$62.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,294.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.29
|
| Rate for Payer: BCBS Complete |
$33.08
|
| Rate for Payer: BCBS MAPPO |
$60.23
|
| Rate for Payer: BCBS Trust/PPO |
$197.67
|
| Rate for Payer: BCN Commercial |
$197.67
|
| Rate for Payer: BCN Medicare Advantage |
$60.23
|
| Rate for Payer: Cash Price |
$34,823.73
|
| Rate for Payer: Cash Price |
$34,823.73
|
| Rate for Payer: Cofinity Advantage |
$30,470.76
|
| Rate for Payer: Cofinity Commercial |
$37,435.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,823.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.23
|
| Rate for Payer: Healthscope Commercial |
$39,176.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,470.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32,647.24
|
| Rate for Payer: Mclaren Medicaid |
$60.23
|
| Rate for Payer: Mclaren Medicare |
$60.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.24
|
| Rate for Payer: Meridian Medicaid |
$63.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,000.21
|
| Rate for Payer: Nomi Health Commercial |
$180.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32,647.24
|
| Rate for Payer: PACE Medicare |
$57.22
|
| Rate for Payer: PACE SWMI |
$60.23
|
| Rate for Payer: PHP Commercial |
$37,000.21
|
| Rate for Payer: PHP Medicare Advantage |
$60.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$195.86
|
| Rate for Payer: Priority Health Medicare |
$60.23
|
| Rate for Payer: Priority Health SBD |
$27,423.69
|
| Rate for Payer: Priority Health Tiered Network |
$156.69
|
| Rate for Payer: Railroad Medicare Medicare |
$60.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.58
|
| Rate for Payer: UHC Core |
$100.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$60.23
|
| Rate for Payer: UHC Exchange |
$100.58
|
| Rate for Payer: UHC Medicaid |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$16,105.97
|
| Rate for Payer: VA VA |
$60.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32,647.24
|
|
|
PERTUZUMAB 600 MG-TRASTUZUMAB 600 MG-HYALURONID-ZZXF/10 ML SUBCUT SOLN
|
Facility
|
IP
|
$43,529.66
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
194378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,153.05 |
| Max. Negotiated Rate |
$39,176.69 |
| Rate for Payer: Aetna American Axle |
$28,294.28
|
| Rate for Payer: Aetna Commercial |
$37,000.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,294.28
|
| Rate for Payer: Cash Price |
$34,823.73
|
| Rate for Payer: Cofinity Advantage |
$30,470.76
|
| Rate for Payer: Cofinity Commercial |
$37,435.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,823.73
|
| Rate for Payer: Healthscope Commercial |
$39,176.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,470.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32,647.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,000.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32,647.24
|
| Rate for Payer: PHP Commercial |
$37,000.21
|
| Rate for Payer: Priority Health SBD |
$27,423.69
|
| Rate for Payer: UMR Bronson Commercial |
$19,153.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32,647.24
|
|
|
PE/TROP/CYC/KETOR (PF) 10-1-0.5% OPH (EYE DROP #4)
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
NDC 09900000895
|
| Hospital Charge Code |
180468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna Medicare |
$25.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Advantage |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.50
|
| Rate for Payer: UHC Core |
$26.05
|
| Rate for Payer: UHC Exchange |
$19.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
