|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458055001
|
| Hospital Charge Code |
78064
|
|
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 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$252.20
|
|
|
Service Code
|
NDC 65162028103
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.97 |
| Max. Negotiated Rate |
$226.98 |
| Rate for Payer: Aetna American Axle |
$163.93
|
| Rate for Payer: Aetna Commercial |
$214.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.93
|
| Rate for Payer: Cash Price |
$201.76
|
| Rate for Payer: Cofinity Commercial |
$176.54
|
| Rate for Payer: Cofinity Commercial |
$216.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.76
|
| Rate for Payer: Healthscope Commercial |
$226.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.37
|
| Rate for Payer: PHP Commercial |
$214.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.93
|
| Rate for Payer: Priority Health SBD |
$158.89
|
| Rate for Payer: UMR Bronson Commercial |
$110.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.15
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$252.20
|
|
|
Service Code
|
NDC 65162028103
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.31 |
| Max. Negotiated Rate |
$226.98 |
| Rate for Payer: Aetna American Axle |
$163.93
|
| Rate for Payer: Aetna Commercial |
$214.37
|
| Rate for Payer: Aetna Medicare |
$126.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.93
|
| Rate for Payer: BCBS Complete |
$100.88
|
| Rate for Payer: Cash Price |
$201.76
|
| Rate for Payer: Cofinity Commercial |
$176.54
|
| Rate for Payer: Cofinity Commercial |
$216.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.76
|
| Rate for Payer: Healthscope Commercial |
$226.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.37
|
| Rate for Payer: PHP Commercial |
$214.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.93
|
| Rate for Payer: Priority Health SBD |
$158.89
|
| Rate for Payer: UMR Bronson Commercial |
$93.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.15
|
|
|
PALIPERIDONE PALMITATE 117 MG/0.75 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$5,072.71
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
119133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,231.99 |
| Max. Negotiated Rate |
$4,565.44 |
| Rate for Payer: Aetna American Axle |
$3,297.26
|
| Rate for Payer: Aetna Commercial |
$4,311.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,297.26
|
| Rate for Payer: Cash Price |
$4,058.17
|
| Rate for Payer: Cofinity Commercial |
$3,550.90
|
| Rate for Payer: Cofinity Commercial |
$4,362.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,550.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,058.17
|
| Rate for Payer: Healthscope Commercial |
$4,565.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,550.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,804.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,311.80
|
| Rate for Payer: PHP Commercial |
$4,311.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,297.26
|
| Rate for Payer: Priority Health SBD |
$3,195.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,231.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,804.53
|
|
|
PALIPERIDONE PALMITATE 117 MG/0.75 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$5,072.71
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
119133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$4,565.44 |
| Rate for Payer: Aetna American Axle |
$3,297.26
|
| Rate for Payer: Aetna Commercial |
$4,311.80
|
| Rate for Payer: Aetna Medicare |
$15.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,297.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.89
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: BCBS MAPPO |
$15.11
|
| Rate for Payer: BCN Medicare Advantage |
$15.11
|
| Rate for Payer: Cash Price |
$4,058.17
|
| Rate for Payer: Cash Price |
$4,058.17
|
| Rate for Payer: Cofinity Commercial |
$4,362.53
|
| Rate for Payer: Cofinity Commercial |
$3,550.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,550.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,058.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.11
|
| Rate for Payer: Healthscope Commercial |
$4,565.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,550.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,804.53
|
| Rate for Payer: Mclaren Medicaid |
$8.10
|
| Rate for Payer: Mclaren Medicare |
$15.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.87
|
| Rate for Payer: Meridian Medicaid |
$8.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,311.80
|
| Rate for Payer: PACE Medicare |
$14.35
|
| Rate for Payer: PACE SWMI |
$15.11
|
| Rate for Payer: PHP Commercial |
$4,311.80
|
| Rate for Payer: PHP Medicare Advantage |
$15.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,297.26
|
| Rate for Payer: Priority Health Medicare |
$15.11
|
| Rate for Payer: Priority Health SBD |
$3,195.81
|
| Rate for Payer: Railroad Medicare Medicare |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.11
|
| Rate for Payer: UHC Exchange |
$28.88
|
| Rate for Payer: UHC Medicare Advantage |
$15.11
|
| Rate for Payer: UHCCP Medicaid |
$8.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,876.90
|
| Rate for Payer: VA VA |
$15.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,804.53
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$5,495.65
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
119134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,418.09 |
| Max. Negotiated Rate |
$4,946.09 |
| Rate for Payer: Aetna American Axle |
$3,572.17
|
| Rate for Payer: Aetna Commercial |
$4,671.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,572.17
|
| Rate for Payer: Cash Price |
$4,396.52
|
| Rate for Payer: Cofinity Commercial |
$3,846.95
|
| Rate for Payer: Cofinity Commercial |
$4,726.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,846.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,396.52
|
| Rate for Payer: Healthscope Commercial |
$4,946.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,846.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,121.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,671.30
|
| Rate for Payer: PHP Commercial |
$4,671.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,572.17
|
| Rate for Payer: Priority Health SBD |
$3,462.26
|
| Rate for Payer: UMR Bronson Commercial |
$2,418.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,121.74
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$5,495.65
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
119134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$4,946.09 |
| Rate for Payer: Aetna American Axle |
$3,572.17
|
| Rate for Payer: Aetna Commercial |
$4,671.30
|
| Rate for Payer: Aetna Medicare |
$15.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,572.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.89
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: BCBS MAPPO |
$15.11
|
| Rate for Payer: BCN Medicare Advantage |
$15.11
|
| Rate for Payer: Cash Price |
$4,396.52
|
| Rate for Payer: Cash Price |
$4,396.52
|
| Rate for Payer: Cofinity Commercial |
$4,726.26
|
| Rate for Payer: Cofinity Commercial |
$3,846.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,846.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,396.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.11
|
| Rate for Payer: Healthscope Commercial |
$4,946.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,846.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,121.74
|
| Rate for Payer: Mclaren Medicaid |
$8.10
|
| Rate for Payer: Mclaren Medicare |
$15.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.87
|
| Rate for Payer: Meridian Medicaid |
$8.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,671.30
|
| Rate for Payer: PACE Medicare |
$14.35
|
| Rate for Payer: PACE SWMI |
$15.11
|
| Rate for Payer: PHP Commercial |
$4,671.30
|
| Rate for Payer: PHP Medicare Advantage |
$15.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,572.17
|
| Rate for Payer: Priority Health Medicare |
$15.11
|
| Rate for Payer: Priority Health SBD |
$3,462.26
|
| Rate for Payer: Railroad Medicare Medicare |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.11
|
| Rate for Payer: UHC Exchange |
$28.88
|
| Rate for Payer: UHC Medicare Advantage |
$15.11
|
| Rate for Payer: UHCCP Medicaid |
$8.10
|
| Rate for Payer: UMR Bronson Commercial |
$2,033.39
|
| Rate for Payer: VA VA |
$15.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,121.74
|
|
|
PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$8,553.69
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
41675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,763.62 |
| Max. Negotiated Rate |
$7,698.32 |
| Rate for Payer: Aetna American Axle |
$5,559.90
|
| Rate for Payer: Aetna Commercial |
$7,270.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,559.90
|
| Rate for Payer: Cash Price |
$6,842.95
|
| Rate for Payer: Cofinity Commercial |
$5,987.58
|
| Rate for Payer: Cofinity Commercial |
$7,356.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,987.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,842.95
|
| Rate for Payer: Healthscope Commercial |
$7,698.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,987.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,415.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,270.64
|
| Rate for Payer: PHP Commercial |
$7,270.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,559.90
|
| Rate for Payer: Priority Health SBD |
$5,388.82
|
| Rate for Payer: UMR Bronson Commercial |
$3,763.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,415.27
|
|
|
PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$8,553.69
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
41675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$385.85 |
| Max. Negotiated Rate |
$7,698.32 |
| Rate for Payer: Aetna American Axle |
$5,559.90
|
| Rate for Payer: Aetna Commercial |
$7,270.64
|
| Rate for Payer: Aetna Medicare |
$748.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,559.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$899.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$899.84
|
| Rate for Payer: BCBS Complete |
$405.14
|
| Rate for Payer: BCBS MAPPO |
$719.87
|
| Rate for Payer: BCN Medicare Advantage |
$719.87
|
| Rate for Payer: Cash Price |
$6,842.95
|
| Rate for Payer: Cash Price |
$6,842.95
|
| Rate for Payer: Cofinity Commercial |
$7,356.17
|
| Rate for Payer: Cofinity Commercial |
$5,987.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,987.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,842.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.87
|
| Rate for Payer: Healthscope Commercial |
$7,698.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,987.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,415.27
|
| Rate for Payer: Mclaren Medicaid |
$385.85
|
| Rate for Payer: Mclaren Medicare |
$719.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$755.86
|
| Rate for Payer: Meridian Medicaid |
$405.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$827.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,270.64
|
| Rate for Payer: PACE Medicare |
$683.88
|
| Rate for Payer: PACE SWMI |
$719.87
|
| Rate for Payer: PHP Commercial |
$7,270.64
|
| Rate for Payer: PHP Medicare Advantage |
$719.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,559.90
|
| Rate for Payer: Priority Health Medicare |
$719.87
|
| Rate for Payer: Priority Health SBD |
$5,388.82
|
| Rate for Payer: Railroad Medicare Medicare |
$719.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,026.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.87
|
| Rate for Payer: UHC Exchange |
$1,375.74
|
| Rate for Payer: UHC Medicare Advantage |
$719.87
|
| Rate for Payer: UHCCP Medicaid |
$385.85
|
| Rate for Payer: UMR Bronson Commercial |
$3,164.87
|
| Rate for Payer: VA VA |
$719.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,415.27
|
|
|
PALIVIZUMAB 50 MG/0.5 ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$5,826.12
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
115944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$385.85 |
| Max. Negotiated Rate |
$5,243.51 |
| Rate for Payer: Aetna American Axle |
$3,786.98
|
| Rate for Payer: Aetna Commercial |
$4,952.20
|
| Rate for Payer: Aetna Medicare |
$748.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,786.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$899.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$899.84
|
| Rate for Payer: BCBS Complete |
$405.14
|
| Rate for Payer: BCBS MAPPO |
$719.87
|
| Rate for Payer: BCN Medicare Advantage |
$719.87
|
| Rate for Payer: Cash Price |
$4,660.90
|
| Rate for Payer: Cash Price |
$4,660.90
|
| Rate for Payer: Cofinity Commercial |
$5,010.46
|
| Rate for Payer: Cofinity Commercial |
$4,078.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,078.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,660.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.87
|
| Rate for Payer: Healthscope Commercial |
$5,243.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,078.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,369.59
|
| Rate for Payer: Mclaren Medicaid |
$385.85
|
| Rate for Payer: Mclaren Medicare |
$719.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$755.86
|
| Rate for Payer: Meridian Medicaid |
$405.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$827.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,952.20
|
| Rate for Payer: PACE Medicare |
$683.88
|
| Rate for Payer: PACE SWMI |
$719.87
|
| Rate for Payer: PHP Commercial |
$4,952.20
|
| Rate for Payer: PHP Medicare Advantage |
$719.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,786.98
|
| Rate for Payer: Priority Health Medicare |
$719.87
|
| Rate for Payer: Priority Health SBD |
$3,670.46
|
| Rate for Payer: Railroad Medicare Medicare |
$719.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,026.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.87
|
| Rate for Payer: UHC Exchange |
$1,375.74
|
| Rate for Payer: UHC Medicare Advantage |
$719.87
|
| Rate for Payer: UHCCP Medicaid |
$385.85
|
| Rate for Payer: UMR Bronson Commercial |
$2,155.66
|
| Rate for Payer: VA VA |
$719.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,369.59
|
|
|
PALIVIZUMAB 50 MG/0.5 ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$5,826.12
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
115944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,563.49 |
| Max. Negotiated Rate |
$5,243.51 |
| Rate for Payer: Aetna American Axle |
$3,786.98
|
| Rate for Payer: Aetna Commercial |
$4,952.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,786.98
|
| Rate for Payer: Cash Price |
$4,660.90
|
| Rate for Payer: Cofinity Commercial |
$4,078.28
|
| Rate for Payer: Cofinity Commercial |
$5,010.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,078.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,660.90
|
| Rate for Payer: Healthscope Commercial |
$5,243.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,078.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,369.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,952.20
|
| Rate for Payer: PHP Commercial |
$4,952.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,786.98
|
| Rate for Payer: Priority Health SBD |
$3,670.46
|
| Rate for Payer: UMR Bronson Commercial |
$2,563.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,369.59
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$143.91
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
36591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.32 |
| Max. Negotiated Rate |
$129.52 |
| Rate for Payer: Aetna American Axle |
$93.54
|
| Rate for Payer: Aetna Commercial |
$122.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.54
|
| Rate for Payer: Cash Price |
$115.13
|
| Rate for Payer: Cofinity Commercial |
$100.74
|
| Rate for Payer: Cofinity Commercial |
$123.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.13
|
| Rate for Payer: Healthscope Commercial |
$129.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.32
|
| Rate for Payer: PHP Commercial |
$122.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.54
|
| Rate for Payer: Priority Health SBD |
$90.66
|
| Rate for Payer: UMR Bronson Commercial |
$63.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.93
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$276.55
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
36591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.32 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna American Axle |
$179.76
|
| Rate for Payer: Aetna American Axle |
$93.54
|
| Rate for Payer: Aetna American Axle |
$89.68
|
| Rate for Payer: Aetna American Axle |
$301.95
|
| Rate for Payer: Aetna American Axle |
$91.00
|
| Rate for Payer: Aetna American Axle |
$166.24
|
| Rate for Payer: Aetna American Axle |
$72.09
|
| Rate for Payer: Aetna American Axle |
$121.66
|
| Rate for Payer: Aetna American Axle |
$109.93
|
| Rate for Payer: Aetna Commercial |
$394.86
|
| Rate for Payer: Aetna Commercial |
$117.27
|
| Rate for Payer: Aetna Commercial |
$122.32
|
| Rate for Payer: Aetna Commercial |
$235.07
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna Commercial |
$143.76
|
| Rate for Payer: Aetna Commercial |
$159.09
|
| Rate for Payer: Aetna Commercial |
$94.27
|
| Rate for Payer: Aetna Medicare |
$71.95
|
| Rate for Payer: Aetna Medicare |
$70.00
|
| Rate for Payer: Aetna Medicare |
$232.27
|
| Rate for Payer: Aetna Medicare |
$55.45
|
| Rate for Payer: Aetna Medicare |
$93.58
|
| Rate for Payer: Aetna Medicare |
$68.98
|
| Rate for Payer: Aetna Medicare |
$127.88
|
| Rate for Payer: Aetna Medicare |
$138.28
|
| Rate for Payer: Aetna Medicare |
$84.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.95
|
| Rate for Payer: BCBS Complete |
$185.82
|
| Rate for Payer: BCBS Complete |
$57.56
|
| Rate for Payer: BCBS Complete |
$74.87
|
| Rate for Payer: BCBS Complete |
$67.65
|
| Rate for Payer: BCBS Complete |
$55.19
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS Complete |
$44.36
|
| Rate for Payer: BCBS Complete |
$110.62
|
| Rate for Payer: BCBS Complete |
$102.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$88.73
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$371.63
|
| Rate for Payer: Cash Price |
$221.24
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$115.13
|
| Rate for Payer: Cash Price |
$149.74
|
| Rate for Payer: Cofinity Commercial |
$98.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$96.58
|
| Rate for Payer: Cofinity Commercial |
$118.65
|
| Rate for Payer: Cofinity Commercial |
$77.64
|
| Rate for Payer: Cofinity Commercial |
$95.38
|
| Rate for Payer: Cofinity Commercial |
$145.45
|
| Rate for Payer: Cofinity Commercial |
$179.03
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$100.74
|
| Rate for Payer: Cofinity Commercial |
$123.76
|
| Rate for Payer: Cofinity Commercial |
$325.18
|
| Rate for Payer: Cofinity Commercial |
$399.50
|
| Rate for Payer: Cofinity Commercial |
$237.83
|
| Rate for Payer: Cofinity Commercial |
$160.97
|
| Rate for Payer: Cofinity Commercial |
$131.02
|
| Rate for Payer: Cofinity Commercial |
$118.39
|
| Rate for Payer: Cofinity Commercial |
$193.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.63
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$152.22
|
| Rate for Payer: Healthscope Commercial |
$248.90
|
| Rate for Payer: Healthscope Commercial |
$129.52
|
| Rate for Payer: Healthscope Commercial |
$99.82
|
| Rate for Payer: Healthscope Commercial |
$168.45
|
| Rate for Payer: Healthscope Commercial |
$124.17
|
| Rate for Payer: Healthscope Commercial |
$418.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.27
|
| Rate for Payer: PHP Commercial |
$143.76
|
| Rate for Payer: PHP Commercial |
$122.32
|
| Rate for Payer: PHP Commercial |
$159.09
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$117.27
|
| Rate for Payer: PHP Commercial |
$235.07
|
| Rate for Payer: PHP Commercial |
$94.27
|
| Rate for Payer: PHP Commercial |
$394.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.95
|
| Rate for Payer: Priority Health SBD |
$106.55
|
| Rate for Payer: Priority Health SBD |
$117.92
|
| Rate for Payer: Priority Health SBD |
$86.92
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: Priority Health SBD |
$292.66
|
| Rate for Payer: Priority Health SBD |
$69.87
|
| Rate for Payer: Priority Health SBD |
$174.23
|
| Rate for Payer: Priority Health SBD |
$90.66
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: UMR Bronson Commercial |
$41.04
|
| Rate for Payer: UMR Bronson Commercial |
$51.05
|
| Rate for Payer: UMR Bronson Commercial |
$171.88
|
| Rate for Payer: UMR Bronson Commercial |
$62.58
|
| Rate for Payer: UMR Bronson Commercial |
$102.32
|
| Rate for Payer: UMR Bronson Commercial |
$51.80
|
| Rate for Payer: UMR Bronson Commercial |
$69.25
|
| Rate for Payer: UMR Bronson Commercial |
$53.25
|
| Rate for Payer: UMR Bronson Commercial |
$94.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.40
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$129.64
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
188040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.04 |
| Max. Negotiated Rate |
$116.68 |
| Rate for Payer: Aetna American Axle |
$84.27
|
| Rate for Payer: Aetna American Axle |
$171.32
|
| Rate for Payer: Aetna Commercial |
$110.19
|
| Rate for Payer: Aetna Commercial |
$224.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.32
|
| Rate for Payer: Cash Price |
$103.71
|
| Rate for Payer: Cash Price |
$210.86
|
| Rate for Payer: Cofinity Commercial |
$226.67
|
| Rate for Payer: Cofinity Commercial |
$184.50
|
| Rate for Payer: Cofinity Commercial |
$111.49
|
| Rate for Payer: Cofinity Commercial |
$90.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.86
|
| Rate for Payer: Healthscope Commercial |
$116.68
|
| Rate for Payer: Healthscope Commercial |
$237.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.19
|
| Rate for Payer: PHP Commercial |
$224.03
|
| Rate for Payer: PHP Commercial |
$110.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.32
|
| Rate for Payer: Priority Health SBD |
$81.67
|
| Rate for Payer: Priority Health SBD |
$166.05
|
| Rate for Payer: UMR Bronson Commercial |
$57.04
|
| Rate for Payer: UMR Bronson Commercial |
$115.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.68
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$129.64
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
188040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$116.68 |
| Rate for Payer: Aetna American Axle |
$84.27
|
| Rate for Payer: Aetna American Axle |
$171.32
|
| Rate for Payer: Aetna Commercial |
$110.19
|
| Rate for Payer: Aetna Commercial |
$224.03
|
| Rate for Payer: Aetna Medicare |
$64.82
|
| Rate for Payer: Aetna Medicare |
$131.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.32
|
| Rate for Payer: BCBS Complete |
$105.43
|
| Rate for Payer: BCBS Complete |
$51.86
|
| Rate for Payer: Cash Price |
$103.71
|
| Rate for Payer: Cash Price |
$210.86
|
| Rate for Payer: Cofinity Commercial |
$90.75
|
| Rate for Payer: Cofinity Commercial |
$111.49
|
| Rate for Payer: Cofinity Commercial |
$184.50
|
| Rate for Payer: Cofinity Commercial |
$226.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.86
|
| Rate for Payer: Healthscope Commercial |
$237.21
|
| Rate for Payer: Healthscope Commercial |
$116.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.03
|
| Rate for Payer: PHP Commercial |
$224.03
|
| Rate for Payer: PHP Commercial |
$110.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.32
|
| Rate for Payer: Priority Health SBD |
$166.05
|
| Rate for Payer: Priority Health SBD |
$81.67
|
| Rate for Payer: UMR Bronson Commercial |
$47.97
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.23
|
|
|
PALONOSETRON 250 MCG + DEXAMETHASONE 10 MG IVPB (PREMIX)
|
Facility
|
IP
|
$298.74
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
301168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$268.87 |
| Rate for Payer: Aetna American Axle |
$194.18
|
| Rate for Payer: Aetna Commercial |
$253.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.18
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cofinity Commercial |
$209.12
|
| Rate for Payer: Cofinity Commercial |
$256.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.99
|
| Rate for Payer: Healthscope Commercial |
$268.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.93
|
| Rate for Payer: PHP Commercial |
$253.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.18
|
| Rate for Payer: Priority Health SBD |
$188.21
|
| Rate for Payer: UMR Bronson Commercial |
$131.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.06
|
|
|
PALONOSETRON 250 MCG + DEXAMETHASONE 10 MG IVPB (PREMIX)
|
Facility
|
OP
|
$298.74
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
301168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.53 |
| Max. Negotiated Rate |
$268.87 |
| Rate for Payer: Aetna American Axle |
$194.18
|
| Rate for Payer: Aetna Commercial |
$253.93
|
| Rate for Payer: Aetna Medicare |
$149.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.18
|
| Rate for Payer: BCBS Complete |
$119.50
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cofinity Commercial |
$209.12
|
| Rate for Payer: Cofinity Commercial |
$256.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.99
|
| Rate for Payer: Healthscope Commercial |
$268.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.93
|
| Rate for Payer: PHP Commercial |
$253.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.18
|
| Rate for Payer: Priority Health SBD |
$188.21
|
| Rate for Payer: UMR Bronson Commercial |
$110.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.06
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38.14
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
32589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna American Axle |
$24.79
|
| Rate for Payer: Aetna American Axle |
$38.71
|
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Commercial |
$50.62
|
| Rate for Payer: Aetna Medicare |
$19.07
|
| Rate for Payer: Aetna Medicare |
$29.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.71
|
| Rate for Payer: BCBS Complete |
$23.82
|
| Rate for Payer: BCBS Complete |
$15.26
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$47.64
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$41.69
|
| Rate for Payer: Cofinity Commercial |
$51.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.64
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.62
|
| Rate for Payer: PHP Commercial |
$50.62
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.71
|
| Rate for Payer: Priority Health SBD |
$37.52
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: UMR Bronson Commercial |
$14.11
|
| Rate for Payer: UMR Bronson Commercial |
$22.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.61
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$59.55
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
32589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$53.59 |
| Rate for Payer: Aetna American Axle |
$38.71
|
| Rate for Payer: Aetna American Axle |
$24.79
|
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Commercial |
$50.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.71
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$47.64
|
| Rate for Payer: Cofinity Commercial |
$51.21
|
| Rate for Payer: Cofinity Commercial |
$41.69
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.64
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.62
|
| Rate for Payer: PHP Commercial |
$50.62
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.71
|
| Rate for Payer: Priority Health SBD |
$37.52
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: UMR Bronson Commercial |
$16.78
|
| Rate for Payer: UMR Bronson Commercial |
$26.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.66
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$166.52
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
33886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.61 |
| Max. Negotiated Rate |
$149.87 |
| Rate for Payer: Aetna American Axle |
$108.24
|
| Rate for Payer: Aetna Commercial |
$141.54
|
| Rate for Payer: Aetna Medicare |
$83.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.24
|
| Rate for Payer: BCBS Complete |
$66.61
|
| Rate for Payer: Cash Price |
$133.22
|
| Rate for Payer: Cofinity Commercial |
$116.56
|
| Rate for Payer: Cofinity Commercial |
$143.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.22
|
| Rate for Payer: Healthscope Commercial |
$149.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.54
|
| Rate for Payer: PHP Commercial |
$141.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.24
|
| Rate for Payer: Priority Health SBD |
$104.91
|
| Rate for Payer: UMR Bronson Commercial |
$61.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.89
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$166.52
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
33886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$149.87 |
| Rate for Payer: Aetna American Axle |
$108.24
|
| Rate for Payer: Aetna Commercial |
$141.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.24
|
| Rate for Payer: Cash Price |
$133.22
|
| Rate for Payer: Cofinity Commercial |
$116.56
|
| Rate for Payer: Cofinity Commercial |
$143.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.22
|
| Rate for Payer: Healthscope Commercial |
$149.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.54
|
| Rate for Payer: PHP Commercial |
$141.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.24
|
| Rate for Payer: Priority Health SBD |
$104.91
|
| Rate for Payer: UMR Bronson Commercial |
$73.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.89
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,930.15
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
77484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.74 |
| Max. Negotiated Rate |
$7,137.14 |
| Rate for Payer: Aetna American Axle |
$5,154.60
|
| Rate for Payer: Aetna Commercial |
$6,740.63
|
| Rate for Payer: Aetna Medicare |
$179.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,154.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.29
|
| Rate for Payer: BCBS Complete |
$97.38
|
| Rate for Payer: BCBS MAPPO |
$173.03
|
| Rate for Payer: BCN Medicare Advantage |
$173.03
|
| Rate for Payer: Cash Price |
$6,344.12
|
| Rate for Payer: Cash Price |
$6,344.12
|
| Rate for Payer: Cofinity Commercial |
$6,819.93
|
| Rate for Payer: Cofinity Commercial |
$5,551.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,551.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,344.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.03
|
| Rate for Payer: Healthscope Commercial |
$7,137.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,551.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,947.61
|
| Rate for Payer: Mclaren Medicaid |
$92.74
|
| Rate for Payer: Mclaren Medicare |
$173.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.68
|
| Rate for Payer: Meridian Medicaid |
$97.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,740.63
|
| Rate for Payer: PACE Medicare |
$164.38
|
| Rate for Payer: PACE SWMI |
$173.03
|
| Rate for Payer: PHP Commercial |
$6,740.63
|
| Rate for Payer: PHP Medicare Advantage |
$173.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,154.60
|
| Rate for Payer: Priority Health Medicare |
$173.03
|
| Rate for Payer: Priority Health SBD |
$4,995.99
|
| Rate for Payer: Railroad Medicare Medicare |
$173.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$487.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.03
|
| Rate for Payer: UHC Exchange |
$330.68
|
| Rate for Payer: UHC Medicare Advantage |
$173.03
|
| Rate for Payer: UHCCP Medicaid |
$92.74
|
| Rate for Payer: UMR Bronson Commercial |
$2,934.16
|
| Rate for Payer: VA VA |
$173.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,947.61
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,930.15
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
77484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,489.27 |
| Max. Negotiated Rate |
$7,137.14 |
| Rate for Payer: Aetna American Axle |
$5,154.60
|
| Rate for Payer: Aetna Commercial |
$6,740.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,154.60
|
| Rate for Payer: Cash Price |
$6,344.12
|
| Rate for Payer: Cofinity Commercial |
$5,551.10
|
| Rate for Payer: Cofinity Commercial |
$6,819.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,551.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,344.12
|
| Rate for Payer: Healthscope Commercial |
$7,137.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,551.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,947.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,740.63
|
| Rate for Payer: PHP Commercial |
$6,740.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,154.60
|
| Rate for Payer: Priority Health SBD |
$4,995.99
|
| Rate for Payer: UMR Bronson Commercial |
$3,489.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,947.61
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18,368.33
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
118465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.74 |
| Max. Negotiated Rate |
$16,531.50 |
| Rate for Payer: Aetna American Axle |
$11,939.41
|
| Rate for Payer: Aetna Commercial |
$15,613.08
|
| Rate for Payer: Aetna Medicare |
$179.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,939.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.29
|
| Rate for Payer: BCBS Complete |
$97.38
|
| Rate for Payer: BCBS MAPPO |
$173.03
|
| Rate for Payer: BCN Medicare Advantage |
$173.03
|
| Rate for Payer: Cash Price |
$14,694.66
|
| Rate for Payer: Cash Price |
$14,694.66
|
| Rate for Payer: Cofinity Commercial |
$12,857.83
|
| Rate for Payer: Cofinity Commercial |
$15,796.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,857.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,694.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.03
|
| Rate for Payer: Healthscope Commercial |
$16,531.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,857.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,776.25
|
| Rate for Payer: Mclaren Medicaid |
$92.74
|
| Rate for Payer: Mclaren Medicare |
$173.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.68
|
| Rate for Payer: Meridian Medicaid |
$97.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,613.08
|
| Rate for Payer: PACE Medicare |
$164.38
|
| Rate for Payer: PACE SWMI |
$173.03
|
| Rate for Payer: PHP Commercial |
$15,613.08
|
| Rate for Payer: PHP Medicare Advantage |
$173.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,939.41
|
| Rate for Payer: Priority Health Medicare |
$173.03
|
| Rate for Payer: Priority Health SBD |
$11,572.05
|
| Rate for Payer: Railroad Medicare Medicare |
$173.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$487.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.03
|
| Rate for Payer: UHC Exchange |
$330.68
|
| Rate for Payer: UHC Medicare Advantage |
$173.03
|
| Rate for Payer: UHCCP Medicaid |
$92.74
|
| Rate for Payer: UMR Bronson Commercial |
$6,796.28
|
| Rate for Payer: VA VA |
$173.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,776.25
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$224.19
|
|
|
Service Code
|
NDC 65162063609
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$201.77 |
| Rate for Payer: Aetna American Axle |
$145.72
|
| Rate for Payer: Aetna Commercial |
$190.56
|
| Rate for Payer: Aetna Medicare |
$112.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.72
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: Cash Price |
$179.35
|
| Rate for Payer: Cofinity Commercial |
$156.93
|
| Rate for Payer: Cofinity Commercial |
$192.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.35
|
| Rate for Payer: Healthscope Commercial |
$201.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.56
|
| Rate for Payer: PHP Commercial |
$190.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.72
|
| Rate for Payer: Priority Health SBD |
$141.24
|
| Rate for Payer: UMR Bronson Commercial |
$82.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.14
|
|
