|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 00904647461
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna American Axle |
$130.29
|
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$140.31
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health SBD |
$126.28
|
| Rate for Payer: UMR Bronson Commercial |
$88.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$234.77
|
|
|
Service Code
|
NDC 13668042990
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$211.29 |
| Rate for Payer: Aetna American Axle |
$152.60
|
| Rate for Payer: Aetna Commercial |
$199.55
|
| Rate for Payer: Aetna Medicare |
$117.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.60
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: Cash Price |
$187.82
|
| Rate for Payer: Cofinity Commercial |
$164.34
|
| Rate for Payer: Cofinity Commercial |
$201.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.82
|
| Rate for Payer: Healthscope Commercial |
$211.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.55
|
| Rate for Payer: PHP Commercial |
$199.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.60
|
| Rate for Payer: Priority Health SBD |
$147.91
|
| Rate for Payer: UMR Bronson Commercial |
$86.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.08
|
|
|
PAPAVERINE 30MG/ML 2 ML IN 30ML NS IRRIGATION
|
Facility
|
IP
|
$73.16
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
500528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$65.84 |
| Rate for Payer: Aetna American Axle |
$47.55
|
| Rate for Payer: Aetna Commercial |
$62.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.55
|
| Rate for Payer: Cash Price |
$58.53
|
| Rate for Payer: Cofinity Commercial |
$51.21
|
| Rate for Payer: Cofinity Commercial |
$62.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$65.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.19
|
| Rate for Payer: PHP Commercial |
$62.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.55
|
| Rate for Payer: Priority Health SBD |
$46.09
|
| Rate for Payer: UMR Bronson Commercial |
$32.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.87
|
|
|
PAPAVERINE 30MG/ML 2 ML IN 30ML NS IRRIGATION
|
Facility
|
OP
|
$73.16
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
500528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$65.84 |
| Rate for Payer: Aetna American Axle |
$47.55
|
| Rate for Payer: Aetna Commercial |
$62.19
|
| Rate for Payer: Aetna Medicare |
$36.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.55
|
| Rate for Payer: BCBS Complete |
$29.26
|
| Rate for Payer: Cash Price |
$58.53
|
| Rate for Payer: Cofinity Commercial |
$51.21
|
| Rate for Payer: Cofinity Commercial |
$62.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$65.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.19
|
| Rate for Payer: PHP Commercial |
$62.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.55
|
| Rate for Payer: Priority Health SBD |
$46.09
|
| Rate for Payer: UMR Bronson Commercial |
$27.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.87
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$68.81
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
6030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Aetna American Axle |
$44.73
|
| Rate for Payer: Aetna Commercial |
$58.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.73
|
| Rate for Payer: Cash Price |
$55.05
|
| Rate for Payer: Cofinity Commercial |
$48.17
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.05
|
| Rate for Payer: Healthscope Commercial |
$61.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.49
|
| Rate for Payer: PHP Commercial |
$58.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.73
|
| Rate for Payer: Priority Health SBD |
$43.35
|
| Rate for Payer: UMR Bronson Commercial |
$30.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.61
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$68.81
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
6030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.46 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Aetna American Axle |
$44.73
|
| Rate for Payer: Aetna Commercial |
$58.49
|
| Rate for Payer: Aetna Medicare |
$34.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.73
|
| Rate for Payer: BCBS Complete |
$27.52
|
| Rate for Payer: Cash Price |
$55.05
|
| Rate for Payer: Cofinity Commercial |
$48.17
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.05
|
| Rate for Payer: Healthscope Commercial |
$61.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.49
|
| Rate for Payer: PHP Commercial |
$58.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.73
|
| Rate for Payer: Priority Health SBD |
$43.35
|
| Rate for Payer: UMR Bronson Commercial |
$25.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.61
|
|
|
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S);
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 60500
|
|
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
|
|
|
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S); RE-EXPLORATION
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 60502
|
|
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
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.6 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$40.60
|
|
|
Service Code
|
NDC 00338064406
|
| Hospital Charge Code |
117996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$36.54 |
| Rate for Payer: Aetna American Axle |
$26.39
|
| Rate for Payer: Aetna Commercial |
$34.51
|
| Rate for Payer: Aetna Medicare |
$20.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.39
|
| Rate for Payer: BCBS Complete |
$16.24
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cofinity Commercial |
$28.42
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.48
|
| Rate for Payer: Healthscope Commercial |
$36.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.51
|
| Rate for Payer: PHP Commercial |
$34.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.39
|
| Rate for Payer: Priority Health SBD |
$25.58
|
| Rate for Payer: UMR Bronson Commercial |
$15.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.45
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.6 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.60
|
|
|
Service Code
|
NDC 00338064406
|
| Hospital Charge Code |
117996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.86 |
| Max. Negotiated Rate |
$36.54 |
| Rate for Payer: Aetna American Axle |
$26.39
|
| Rate for Payer: Aetna Commercial |
$34.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.39
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cofinity Commercial |
$28.42
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.48
|
| Rate for Payer: Healthscope Commercial |
$36.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.51
|
| Rate for Payer: PHP Commercial |
$34.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.39
|
| Rate for Payer: Priority Health SBD |
$25.58
|
| Rate for Payer: UMR Bronson Commercial |
$17.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.45
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.7 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
NDC 00338113006
|
| Hospital Charge Code |
118122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna American Axle |
$975.00
|
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: Aetna Medicare |
$750.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.00
|
| Rate for Payer: BCBS Complete |
$600.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,050.00
|
| Rate for Payer: Cofinity Commercial |
$1,290.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,050.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,050.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,275.00
|
| Rate for Payer: PHP Commercial |
$1,275.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$975.00
|
| Rate for Payer: Priority Health SBD |
$945.00
|
| Rate for Payer: UMR Bronson Commercial |
$555.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,125.00
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.7 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
NDC 00338113004
|
| Hospital Charge Code |
118122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Aetna American Axle |
$568.75
|
| Rate for Payer: Aetna Commercial |
$743.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.75
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$612.50
|
| Rate for Payer: Cofinity Commercial |
$752.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$612.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.00
|
| Rate for Payer: Healthscope Commercial |
$787.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$656.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.75
|
| Rate for Payer: PHP Commercial |
$743.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.75
|
| Rate for Payer: Priority Health SBD |
$551.25
|
| Rate for Payer: UMR Bronson Commercial |
$385.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$656.25
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.7 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
NDC 00338113004
|
| Hospital Charge Code |
118122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$323.75 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Aetna American Axle |
$568.75
|
| Rate for Payer: Aetna Commercial |
$743.75
|
| Rate for Payer: Aetna Medicare |
$437.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.75
|
| Rate for Payer: BCBS Complete |
$350.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$612.50
|
| Rate for Payer: Cofinity Commercial |
$752.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$612.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.00
|
| Rate for Payer: Healthscope Commercial |
$787.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$656.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.75
|
| Rate for Payer: PHP Commercial |
$743.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.75
|
| Rate for Payer: Priority Health SBD |
$551.25
|
| Rate for Payer: UMR Bronson Commercial |
$323.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$656.25
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.7 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
NDC 00338113006
|
| Hospital Charge Code |
118122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna American Axle |
$975.00
|
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,050.00
|
| Rate for Payer: Cofinity Commercial |
$1,290.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,050.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,050.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,275.00
|
| Rate for Payer: PHP Commercial |
$1,275.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$975.00
|
| Rate for Payer: Priority Health SBD |
$945.00
|
| Rate for Payer: UMR Bronson Commercial |
$660.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,125.00
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$86.28
|
|
|
Service Code
|
NDC 00338050203
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$77.65 |
| Rate for Payer: Aetna American Axle |
$56.08
|
| Rate for Payer: Aetna Commercial |
$73.34
|
| Rate for Payer: Aetna Medicare |
$43.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.08
|
| Rate for Payer: BCBS Complete |
$34.51
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$74.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.02
|
| Rate for Payer: Healthscope Commercial |
$77.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.34
|
| Rate for Payer: PHP Commercial |
$73.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.08
|
| Rate for Payer: Priority Health SBD |
$54.36
|
| Rate for Payer: UMR Bronson Commercial |
$31.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.71
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$86.28
|
|
|
Service Code
|
NDC 00338050203
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$77.65 |
| Rate for Payer: Aetna American Axle |
$56.08
|
| Rate for Payer: Aetna Commercial |
$73.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.08
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$74.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.02
|
| Rate for Payer: Healthscope Commercial |
$77.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.34
|
| Rate for Payer: PHP Commercial |
$73.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.08
|
| Rate for Payer: Priority Health SBD |
$54.36
|
| Rate for Payer: UMR Bronson Commercial |
$37.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.71
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$72.50
|
|
|
Service Code
|
NDC 00338050206
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Aetna American Axle |
$47.12
|
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Aetna Medicare |
$36.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.12
|
| Rate for Payer: BCBS Complete |
$29.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cofinity Commercial |
$50.75
|
| Rate for Payer: Cofinity Commercial |
$62.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.00
|
| Rate for Payer: Healthscope Commercial |
$65.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.62
|
| Rate for Payer: PHP Commercial |
$61.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.12
|
| Rate for Payer: Priority Health SBD |
$45.67
|
| Rate for Payer: UMR Bronson Commercial |
$26.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.38
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.50
|
|
|
Service Code
|
NDC 00338050206
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Aetna American Axle |
$47.12
|
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.12
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cofinity Commercial |
$50.75
|
| Rate for Payer: Cofinity Commercial |
$62.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.00
|
| Rate for Payer: Healthscope Commercial |
$65.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.62
|
| Rate for Payer: PHP Commercial |
$61.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.12
|
| Rate for Payer: Priority Health SBD |
$45.67
|
| Rate for Payer: UMR Bronson Commercial |
$31.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.38
|
|
|
PARENTERAL AMINO ACID 8.5 % COMBINATION NO.3 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11.60
|
|
|
Service Code
|
NDC 00409416203
|
| Hospital Charge Code |
172719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna American Axle |
$7.54
|
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.54
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.28
|
| Rate for Payer: Healthscope Commercial |
$10.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.86
|
| Rate for Payer: PHP Commercial |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.54
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.70
|
|
|
PARENTERAL AMINO ACID 8.5 % COMBINATION NO.3 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11.60
|
|
|
Service Code
|
NDC 00409416203
|
| Hospital Charge Code |
172719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna American Axle |
$7.54
|
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna Medicare |
$5.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.54
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.28
|
| Rate for Payer: Healthscope Commercial |
$10.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.86
|
| Rate for Payer: PHP Commercial |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.54
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$4.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.70
|
|
|
PARICALCITOL 1 MCG CAPSULE
|
Facility
|
OP
|
$439.34
|
|
|
Service Code
|
NDC 69452014513
|
| Hospital Charge Code |
41497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.56 |
| Max. Negotiated Rate |
$395.41 |
| Rate for Payer: Aetna American Axle |
$285.57
|
| Rate for Payer: Aetna Commercial |
$373.44
|
| Rate for Payer: Aetna Medicare |
$219.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.57
|
| Rate for Payer: BCBS Complete |
$175.74
|
| Rate for Payer: Cash Price |
$351.47
|
| Rate for Payer: Cofinity Commercial |
$307.54
|
| Rate for Payer: Cofinity Commercial |
$377.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.47
|
| Rate for Payer: Healthscope Commercial |
$395.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.44
|
| Rate for Payer: PHP Commercial |
$373.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.57
|
| Rate for Payer: Priority Health SBD |
$276.78
|
| Rate for Payer: UMR Bronson Commercial |
$162.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.50
|
|
|
PARICALCITOL 1 MCG CAPSULE
|
Facility
|
OP
|
$133.92
|
|
|
Service Code
|
NDC 49483068703
|
| Hospital Charge Code |
41497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.55 |
| Max. Negotiated Rate |
$120.53 |
| Rate for Payer: Aetna American Axle |
$87.05
|
| Rate for Payer: Aetna Commercial |
$113.83
|
| Rate for Payer: Aetna Medicare |
$66.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.05
|
| Rate for Payer: BCBS Complete |
$53.57
|
| Rate for Payer: Cash Price |
$107.14
|
| Rate for Payer: Cofinity Commercial |
$115.17
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.14
|
| Rate for Payer: Healthscope Commercial |
$120.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.83
|
| Rate for Payer: PHP Commercial |
$113.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.05
|
| Rate for Payer: Priority Health SBD |
$84.37
|
| Rate for Payer: UMR Bronson Commercial |
$49.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.44
|
|
|
PARICALCITOL 1 MCG CAPSULE
|
Facility
|
IP
|
$439.34
|
|
|
Service Code
|
NDC 69452014513
|
| Hospital Charge Code |
41497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.31 |
| Max. Negotiated Rate |
$395.41 |
| Rate for Payer: Aetna American Axle |
$285.57
|
| Rate for Payer: Aetna Commercial |
$373.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.57
|
| Rate for Payer: Cash Price |
$351.47
|
| Rate for Payer: Cofinity Commercial |
$307.54
|
| Rate for Payer: Cofinity Commercial |
$377.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.47
|
| Rate for Payer: Healthscope Commercial |
$395.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.44
|
| Rate for Payer: PHP Commercial |
$373.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.57
|
| Rate for Payer: Priority Health SBD |
$276.78
|
| Rate for Payer: UMR Bronson Commercial |
$193.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.50
|
|
|
PARICALCITOL 1 MCG CAPSULE
|
Facility
|
IP
|
$133.92
|
|
|
Service Code
|
NDC 49483068703
|
| Hospital Charge Code |
41497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.92 |
| Max. Negotiated Rate |
$120.53 |
| Rate for Payer: Aetna American Axle |
$87.05
|
| Rate for Payer: Aetna Commercial |
$113.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.05
|
| Rate for Payer: Cash Price |
$107.14
|
| Rate for Payer: Cofinity Commercial |
$115.17
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.14
|
| Rate for Payer: Healthscope Commercial |
$120.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.83
|
| Rate for Payer: PHP Commercial |
$113.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.05
|
| Rate for Payer: Priority Health SBD |
$84.37
|
| Rate for Payer: UMR Bronson Commercial |
$58.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.44
|
|
|
PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.53
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
31688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna American Axle |
$18.01
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.01
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.17
|
| Rate for Payer: Cofinity Commercial |
$23.83
|
| Rate for Payer: Cofinity Commercial |
$19.40
|
| Rate for Payer: Cofinity Commercial |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$24.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.01
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$17.46
|
| Rate for Payer: UMR Bronson Commercial |
$12.11
|
| Rate for Payer: UMR Bronson Commercial |
$12.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
|
