|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
IP
|
$245.39
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
10843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.97 |
| Max. Negotiated Rate |
$220.85 |
| Rate for Payer: Aetna American Axle |
$159.50
|
| Rate for Payer: Aetna American Axle |
$307.54
|
| Rate for Payer: Aetna American Axle |
$282.49
|
| Rate for Payer: Aetna American Axle |
$262.84
|
| Rate for Payer: Aetna American Axle |
$267.59
|
| Rate for Payer: Aetna American Axle |
$328.28
|
| Rate for Payer: Aetna Commercial |
$208.58
|
| Rate for Payer: Aetna Commercial |
$343.71
|
| Rate for Payer: Aetna Commercial |
$369.41
|
| Rate for Payer: Aetna Commercial |
$429.29
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$347.68
|
| Rate for Payer: Cash Price |
$196.31
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cash Price |
$404.04
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$171.77
|
| Rate for Payer: Cofinity Commercial |
$373.76
|
| Rate for Payer: Cofinity Commercial |
$304.22
|
| Rate for Payer: Cofinity Commercial |
$288.18
|
| Rate for Payer: Cofinity Commercial |
$283.06
|
| Rate for Payer: Cofinity Commercial |
$347.76
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Cofinity Commercial |
$211.04
|
| Rate for Payer: Cofinity Commercial |
$434.34
|
| Rate for Payer: Cofinity Commercial |
$353.54
|
| Rate for Payer: Cofinity Commercial |
$331.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$283.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.04
|
| Rate for Payer: Healthscope Commercial |
$391.14
|
| Rate for Payer: Healthscope Commercial |
$454.54
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Healthscope Commercial |
$363.93
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Healthscope Commercial |
$220.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: PHP Commercial |
$208.58
|
| Rate for Payer: PHP Commercial |
$343.71
|
| Rate for Payer: PHP Commercial |
$369.41
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: PHP Commercial |
$429.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.28
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$273.80
|
| Rate for Payer: Priority Health SBD |
$154.60
|
| Rate for Payer: Priority Health SBD |
$254.75
|
| Rate for Payer: Priority Health SBD |
$259.36
|
| Rate for Payer: Priority Health SBD |
$318.18
|
| Rate for Payer: UMR Bronson Commercial |
$222.22
|
| Rate for Payer: UMR Bronson Commercial |
$177.92
|
| Rate for Payer: UMR Bronson Commercial |
$181.14
|
| Rate for Payer: UMR Bronson Commercial |
$208.18
|
| Rate for Payer: UMR Bronson Commercial |
$191.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
OP
|
$434.60
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
10843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$391.14 |
| Rate for Payer: Aetna American Axle |
$282.49
|
| Rate for Payer: Aetna American Axle |
$328.28
|
| Rate for Payer: Aetna American Axle |
$173.13
|
| Rate for Payer: Aetna American Axle |
$231.52
|
| Rate for Payer: Aetna American Axle |
$307.54
|
| Rate for Payer: Aetna American Axle |
$204.21
|
| Rate for Payer: Aetna American Axle |
$301.08
|
| Rate for Payer: Aetna American Axle |
$723.01
|
| Rate for Payer: Aetna American Axle |
$159.50
|
| Rate for Payer: Aetna American Axle |
$262.84
|
| Rate for Payer: Aetna American Axle |
$267.59
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna Commercial |
$343.71
|
| Rate for Payer: Aetna Commercial |
$267.04
|
| Rate for Payer: Aetna Commercial |
$393.72
|
| Rate for Payer: Aetna Commercial |
$945.47
|
| Rate for Payer: Aetna Commercial |
$369.41
|
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna Commercial |
$429.29
|
| Rate for Payer: Aetna Commercial |
$302.76
|
| Rate for Payer: Aetna Commercial |
$208.58
|
| Rate for Payer: Aetna Commercial |
$226.40
|
| Rate for Payer: Aetna Medicare |
$217.30
|
| Rate for Payer: Aetna Medicare |
$178.10
|
| Rate for Payer: Aetna Medicare |
$122.70
|
| Rate for Payer: Aetna Medicare |
$556.16
|
| Rate for Payer: Aetna Medicare |
$202.18
|
| Rate for Payer: Aetna Medicare |
$205.84
|
| Rate for Payer: Aetna Medicare |
$133.18
|
| Rate for Payer: Aetna Medicare |
$252.52
|
| Rate for Payer: Aetna Medicare |
$236.57
|
| Rate for Payer: Aetna Medicare |
$231.60
|
| Rate for Payer: Aetna Medicare |
$157.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$723.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.50
|
| Rate for Payer: BCBS Complete |
$106.54
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS Complete |
$202.02
|
| Rate for Payer: BCBS Complete |
$142.48
|
| Rate for Payer: BCBS Complete |
$444.93
|
| Rate for Payer: BCBS Complete |
$173.84
|
| Rate for Payer: BCBS Complete |
$185.28
|
| Rate for Payer: BCBS Complete |
$189.26
|
| Rate for Payer: BCBS Complete |
$125.67
|
| Rate for Payer: BCBS Complete |
$164.67
|
| Rate for Payer: BCBS Complete |
$161.75
|
| Rate for Payer: BCBS Trust/PPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$370.56
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cash Price |
$196.31
|
| Rate for Payer: Cash Price |
$213.08
|
| Rate for Payer: Cash Price |
$889.86
|
| Rate for Payer: Cash Price |
$196.31
|
| Rate for Payer: Cash Price |
$889.86
|
| Rate for Payer: Cash Price |
$213.08
|
| Rate for Payer: Cash Price |
$404.04
|
| Rate for Payer: Cash Price |
$404.04
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$251.34
|
| Rate for Payer: Cash Price |
$251.34
|
| Rate for Payer: Cash Price |
$370.56
|
| Rate for Payer: Cash Price |
$347.68
|
| Rate for Payer: Cash Price |
$284.95
|
| Rate for Payer: Cash Price |
$284.95
|
| Rate for Payer: Cash Price |
$347.68
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cofinity Commercial |
$270.19
|
| Rate for Payer: Cofinity Commercial |
$219.92
|
| Rate for Payer: Cofinity Commercial |
$211.04
|
| Rate for Payer: Cofinity Commercial |
$324.24
|
| Rate for Payer: Cofinity Commercial |
$398.35
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Cofinity Commercial |
$288.18
|
| Rate for Payer: Cofinity Commercial |
$347.76
|
| Rate for Payer: Cofinity Commercial |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$353.54
|
| Rate for Payer: Cofinity Commercial |
$434.34
|
| Rate for Payer: Cofinity Commercial |
$229.06
|
| Rate for Payer: Cofinity Commercial |
$283.06
|
| Rate for Payer: Cofinity Commercial |
$186.44
|
| Rate for Payer: Cofinity Commercial |
$171.77
|
| Rate for Payer: Cofinity Commercial |
$956.60
|
| Rate for Payer: Cofinity Commercial |
$304.22
|
| Rate for Payer: Cofinity Commercial |
$373.76
|
| Rate for Payer: Cofinity Commercial |
$778.62
|
| Rate for Payer: Cofinity Commercial |
$249.33
|
| Rate for Payer: Cofinity Commercial |
$306.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$283.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$778.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.51
|
| Rate for Payer: Healthscope Commercial |
$363.93
|
| Rate for Payer: Healthscope Commercial |
$282.75
|
| Rate for Payer: Healthscope Commercial |
$320.57
|
| Rate for Payer: Healthscope Commercial |
$454.54
|
| Rate for Payer: Healthscope Commercial |
$239.72
|
| Rate for Payer: Healthscope Commercial |
$220.85
|
| Rate for Payer: Healthscope Commercial |
$1,001.09
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Healthscope Commercial |
$391.14
|
| Rate for Payer: Healthscope Commercial |
$416.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$834.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.71
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: PHP Commercial |
$302.76
|
| Rate for Payer: PHP Commercial |
$429.29
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: PHP Commercial |
$267.04
|
| Rate for Payer: PHP Commercial |
$369.41
|
| Rate for Payer: PHP Commercial |
$393.72
|
| Rate for Payer: PHP Commercial |
$208.58
|
| Rate for Payer: PHP Commercial |
$945.47
|
| Rate for Payer: PHP Commercial |
$226.40
|
| Rate for Payer: PHP Commercial |
$343.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.13
|
| Rate for Payer: Priority Health SBD |
$224.40
|
| Rate for Payer: Priority Health SBD |
$273.80
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$254.75
|
| Rate for Payer: Priority Health SBD |
$291.82
|
| Rate for Payer: Priority Health SBD |
$197.93
|
| Rate for Payer: Priority Health SBD |
$318.18
|
| Rate for Payer: Priority Health SBD |
$259.36
|
| Rate for Payer: Priority Health SBD |
$167.80
|
| Rate for Payer: Priority Health SBD |
$700.76
|
| Rate for Payer: Priority Health SBD |
$154.60
|
| Rate for Payer: UMR Bronson Commercial |
$160.80
|
| Rate for Payer: UMR Bronson Commercial |
$149.62
|
| Rate for Payer: UMR Bronson Commercial |
$98.55
|
| Rate for Payer: UMR Bronson Commercial |
$186.87
|
| Rate for Payer: UMR Bronson Commercial |
$411.56
|
| Rate for Payer: UMR Bronson Commercial |
$90.79
|
| Rate for Payer: UMR Bronson Commercial |
$175.06
|
| Rate for Payer: UMR Bronson Commercial |
$116.24
|
| Rate for Payer: UMR Bronson Commercial |
$152.32
|
| Rate for Payer: UMR Bronson Commercial |
$131.79
|
| Rate for Payer: UMR Bronson Commercial |
$171.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$834.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.63
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION
|
Facility
|
IP
|
$6,917.12
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
40475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,043.53 |
| Max. Negotiated Rate |
$6,225.41 |
| Rate for Payer: Aetna American Axle |
$4,496.13
|
| Rate for Payer: Aetna Commercial |
$5,879.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,496.13
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cofinity Commercial |
$4,841.98
|
| Rate for Payer: Cofinity Commercial |
$5,948.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,841.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,533.70
|
| Rate for Payer: Healthscope Commercial |
$6,225.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,841.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,187.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,879.55
|
| Rate for Payer: PHP Commercial |
$5,879.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,496.13
|
| Rate for Payer: Priority Health SBD |
$4,357.79
|
| Rate for Payer: UMR Bronson Commercial |
$3,043.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,187.84
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$6,036.94
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
40475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$5,433.25 |
| Rate for Payer: Aetna American Axle |
$3,924.01
|
| Rate for Payer: Aetna American Axle |
$3,911.20
|
| Rate for Payer: Aetna American Axle |
$4,496.13
|
| Rate for Payer: Aetna American Axle |
$2,836.93
|
| Rate for Payer: Aetna Commercial |
$5,131.40
|
| Rate for Payer: Aetna Commercial |
$3,709.83
|
| Rate for Payer: Aetna Commercial |
$5,114.65
|
| Rate for Payer: Aetna Commercial |
$5,879.55
|
| Rate for Payer: Aetna Medicare |
$14.08
|
| Rate for Payer: Aetna Medicare |
$14.08
|
| Rate for Payer: Aetna Medicare |
$14.08
|
| Rate for Payer: Aetna Medicare |
$14.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,911.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,924.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,836.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,496.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.92
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: BCBS MAPPO |
$13.54
|
| Rate for Payer: BCBS MAPPO |
$13.54
|
| Rate for Payer: BCBS MAPPO |
$13.54
|
| Rate for Payer: BCBS MAPPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$35.30
|
| Rate for Payer: BCBS Trust/PPO |
$35.30
|
| Rate for Payer: BCBS Trust/PPO |
$35.30
|
| Rate for Payer: BCBS Trust/PPO |
$35.30
|
| Rate for Payer: BCN Commercial |
$35.30
|
| Rate for Payer: BCN Commercial |
$35.30
|
| Rate for Payer: BCN Commercial |
$35.30
|
| Rate for Payer: BCN Commercial |
$35.30
|
| Rate for Payer: BCN Medicare Advantage |
$13.54
|
| Rate for Payer: BCN Medicare Advantage |
$13.54
|
| Rate for Payer: BCN Medicare Advantage |
$13.54
|
| Rate for Payer: BCN Medicare Advantage |
$13.54
|
| Rate for Payer: Cash Price |
$4,813.78
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cash Price |
$3,491.61
|
| Rate for Payer: Cash Price |
$4,829.55
|
| Rate for Payer: Cash Price |
$4,813.78
|
| Rate for Payer: Cash Price |
$3,491.61
|
| Rate for Payer: Cash Price |
$5,533.70
|
| Rate for Payer: Cash Price |
$4,829.55
|
| Rate for Payer: Cofinity Commercial |
$4,841.98
|
| Rate for Payer: Cofinity Commercial |
$3,055.16
|
| Rate for Payer: Cofinity Commercial |
$3,753.48
|
| Rate for Payer: Cofinity Commercial |
$5,191.77
|
| Rate for Payer: Cofinity Commercial |
$4,225.86
|
| Rate for Payer: Cofinity Commercial |
$5,948.72
|
| Rate for Payer: Cofinity Commercial |
$4,212.06
|
| Rate for Payer: Cofinity Commercial |
$5,174.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,212.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,225.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,055.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,841.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,829.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,533.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,491.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$6,225.41
|
| Rate for Payer: Healthscope Commercial |
$5,433.25
|
| Rate for Payer: Healthscope Commercial |
$3,928.06
|
| Rate for Payer: Healthscope Commercial |
$5,415.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,841.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,225.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,055.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,212.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,187.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,512.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,527.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,273.38
|
| Rate for Payer: Mclaren Medicaid |
$7.26
|
| Rate for Payer: Mclaren Medicaid |
$7.26
|
| Rate for Payer: Mclaren Medicaid |
$7.26
|
| Rate for Payer: Mclaren Medicaid |
$7.26
|
| Rate for Payer: Mclaren Medicare |
$13.54
|
| Rate for Payer: Mclaren Medicare |
$13.54
|
| Rate for Payer: Mclaren Medicare |
$13.54
|
| Rate for Payer: Mclaren Medicare |
$13.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Medicaid |
$7.62
|
| Rate for Payer: Meridian Medicaid |
$7.62
|
| Rate for Payer: Meridian Medicaid |
$7.62
|
| Rate for Payer: Meridian Medicaid |
$7.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,879.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,131.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,709.83
|
| Rate for Payer: Nomi Health Commercial |
$40.62
|
| Rate for Payer: Nomi Health Commercial |
$40.62
|
| Rate for Payer: Nomi Health Commercial |
$40.62
|
| Rate for Payer: Nomi Health Commercial |
$40.62
|
| Rate for Payer: PACE Medicare |
$12.86
|
| Rate for Payer: PACE Medicare |
$12.86
|
| Rate for Payer: PACE Medicare |
$12.86
|
| Rate for Payer: PACE Medicare |
$12.86
|
| Rate for Payer: PACE SWMI |
$13.54
|
| Rate for Payer: PACE SWMI |
$13.54
|
| Rate for Payer: PACE SWMI |
$13.54
|
| Rate for Payer: PACE SWMI |
$13.54
|
| Rate for Payer: PHP Commercial |
$3,709.83
|
| Rate for Payer: PHP Commercial |
$5,131.40
|
| Rate for Payer: PHP Commercial |
$5,114.65
|
| Rate for Payer: PHP Commercial |
$5,879.55
|
| Rate for Payer: PHP Medicare Advantage |
$13.54
|
| Rate for Payer: PHP Medicare Advantage |
$13.54
|
| Rate for Payer: PHP Medicare Advantage |
$13.54
|
| Rate for Payer: PHP Medicare Advantage |
$13.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,496.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,836.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,911.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,924.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.39
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health Narrow Network |
$30.71
|
| Rate for Payer: Priority Health Narrow Network |
$30.71
|
| Rate for Payer: Priority Health Narrow Network |
$30.71
|
| Rate for Payer: Priority Health Narrow Network |
$30.71
|
| Rate for Payer: Priority Health SBD |
$3,790.85
|
| Rate for Payer: Priority Health SBD |
$4,357.79
|
| Rate for Payer: Priority Health SBD |
$3,803.27
|
| Rate for Payer: Priority Health SBD |
$2,749.64
|
| Rate for Payer: Railroad Medicare Medicare |
$13.54
|
| Rate for Payer: Railroad Medicare Medicare |
$13.54
|
| Rate for Payer: Railroad Medicare Medicare |
$13.54
|
| Rate for Payer: Railroad Medicare Medicare |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.54
|
| Rate for Payer: UHC Exchange |
$25.88
|
| Rate for Payer: UHC Exchange |
$25.88
|
| Rate for Payer: UHC Exchange |
$25.88
|
| Rate for Payer: UHC Exchange |
$25.88
|
| Rate for Payer: UHC Medicare Advantage |
$13.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.54
|
| Rate for Payer: UHCCP Medicaid |
$7.26
|
| Rate for Payer: UHCCP Medicaid |
$7.26
|
| Rate for Payer: UHCCP Medicaid |
$7.26
|
| Rate for Payer: UHCCP Medicaid |
$7.26
|
| Rate for Payer: UMR Bronson Commercial |
$2,233.67
|
| Rate for Payer: UMR Bronson Commercial |
$2,559.33
|
| Rate for Payer: UMR Bronson Commercial |
$2,226.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,614.87
|
| Rate for Payer: VA VA |
$13.54
|
| Rate for Payer: VA VA |
$13.54
|
| Rate for Payer: VA VA |
$13.54
|
| Rate for Payer: VA VA |
$13.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,187.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,512.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,273.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,527.70
|
|
|
PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY)
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 42145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$661.02 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$5,153.30
|
| Rate for Payer: BCN Commercial |
$5,153.30
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.12
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$661.02
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
PALATOPLASTY FOR CLEFT PALATE; ATTACHMENT PHARYNGEAL FLAP
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 42225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$923.22 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,174.78
|
| Rate for Payer: BCN Commercial |
$3,174.78
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,015.54
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$923.22
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
PALATOPLASTY FOR CLEFT PALATE, SOFT AND/OR HARD PALATE ONLY
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 42200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$886.80 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,703.90
|
| Rate for Payer: BCN Commercial |
$3,703.90
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$975.48
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Exchange |
$886.80
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; SOFT TISSUE ONLY
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 42205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$925.09 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,164.10
|
| Rate for Payer: BCN Commercial |
$3,164.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,017.60
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$925.09
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; WITH BONE GRAFT TO ALVEOLAR RIDGE (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 42210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,031.37 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,703.90
|
| Rate for Payer: BCN Commercial |
$3,703.90
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,134.51
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$1,031.37
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2,523.92
|
|
|
Service Code
|
NDC 00378397893
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$933.85 |
| Max. Negotiated Rate |
$2,271.53 |
| Rate for Payer: Aetna American Axle |
$1,640.55
|
| Rate for Payer: Aetna Commercial |
$2,145.33
|
| Rate for Payer: Aetna Medicare |
$1,261.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,640.55
|
| Rate for Payer: BCBS Complete |
$1,009.57
|
| Rate for Payer: Cash Price |
$2,019.14
|
| Rate for Payer: Cofinity Commercial |
$1,766.74
|
| Rate for Payer: Cofinity Commercial |
$2,170.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,766.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,019.14
|
| Rate for Payer: Healthscope Commercial |
$2,271.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,766.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,892.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,145.33
|
| Rate for Payer: PHP Commercial |
$2,145.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,640.55
|
| Rate for Payer: Priority Health SBD |
$1,590.07
|
| Rate for Payer: UMR Bronson Commercial |
$933.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,892.94
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458055401
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$468.12 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna American Axle |
$822.37
|
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna Medicare |
$632.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: BCBS Complete |
$506.07
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$885.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.14
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$885.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$948.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.37
|
| Rate for Payer: Priority Health SBD |
$797.06
|
| Rate for Payer: UMR Bronson Commercial |
$468.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$948.88
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2,523.92
|
|
|
Service Code
|
NDC 00378397893
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,110.52 |
| Max. Negotiated Rate |
$2,271.53 |
| Rate for Payer: Aetna American Axle |
$1,640.55
|
| Rate for Payer: Aetna Commercial |
$2,145.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,640.55
|
| Rate for Payer: Cash Price |
$2,019.14
|
| Rate for Payer: Cofinity Commercial |
$1,766.74
|
| Rate for Payer: Cofinity Commercial |
$2,170.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,766.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,019.14
|
| Rate for Payer: Healthscope Commercial |
$2,271.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,766.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,892.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,145.33
|
| Rate for Payer: PHP Commercial |
$2,145.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,640.55
|
| Rate for Payer: Priority Health SBD |
$1,590.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,110.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,892.94
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458055401
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$556.68 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna American Axle |
$822.37
|
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$885.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.14
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$885.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$948.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.37
|
| Rate for Payer: Priority Health SBD |
$797.06
|
| Rate for Payer: UMR Bronson Commercial |
$556.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$948.88
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$344.10
|
|
|
Service Code
|
NDC 47335076583
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.32 |
| Max. Negotiated Rate |
$309.69 |
| Rate for Payer: Aetna American Axle |
$223.66
|
| Rate for Payer: Aetna Commercial |
$292.48
|
| Rate for Payer: Aetna Medicare |
$172.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.66
|
| Rate for Payer: BCBS Complete |
$137.64
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cofinity Commercial |
$240.87
|
| Rate for Payer: Cofinity Commercial |
$295.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$240.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.28
|
| Rate for Payer: Healthscope Commercial |
$309.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.48
|
| Rate for Payer: PHP Commercial |
$292.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.66
|
| Rate for Payer: Priority Health SBD |
$216.78
|
| Rate for Payer: UMR Bronson Commercial |
$127.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.08
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,265.18
|
|
|
Service Code
|
NDC 50458055001
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$556.68 |
| Max. Negotiated Rate |
$1,138.66 |
| Rate for Payer: Aetna American Axle |
$822.37
|
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.37
|
| Rate for Payer: Cash Price |
$1,012.14
|
| Rate for Payer: Cofinity Commercial |
$1,088.05
|
| Rate for Payer: Cofinity Commercial |
$885.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$885.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.14
|
| Rate for Payer: Healthscope Commercial |
$1,138.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$885.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$948.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.40
|
| Rate for Payer: PHP Commercial |
$1,075.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.37
|
| Rate for Payer: Priority Health SBD |
$797.06
|
| Rate for Payer: UMR Bronson Commercial |
$556.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$948.88
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$223.67
|
|
|
Service Code
|
NDC 68180052406
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.76 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna American Axle |
$145.39
|
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna Medicare |
$111.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: BCBS Complete |
$89.47
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.39
|
| Rate for Payer: Priority Health SBD |
$140.91
|
| Rate for Payer: UMR Bronson Commercial |
$82.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.75
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$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
|
IP
|
$223.67
|
|
|
Service Code
|
NDC 43975035003
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna American Axle |
$145.39
|
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.39
|
| Rate for Payer: Priority Health SBD |
$140.91
|
| Rate for Payer: UMR Bronson Commercial |
$98.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.75
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$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
|
OP
|
$223.67
|
|
|
Service Code
|
NDC 43975035003
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.76 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna American Axle |
$145.39
|
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna Medicare |
$111.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: BCBS Complete |
$89.47
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.39
|
| Rate for Payer: Priority Health SBD |
$140.91
|
| Rate for Payer: UMR Bronson Commercial |
$82.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.75
|
|
|
PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$344.10
|
|
|
Service Code
|
NDC 47335076583
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$309.69 |
| Rate for Payer: Aetna American Axle |
$223.66
|
| Rate for Payer: Aetna Commercial |
$292.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.66
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cofinity Commercial |
$240.87
|
| Rate for Payer: Cofinity Commercial |
$295.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$240.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.28
|
| Rate for Payer: Healthscope Commercial |
$309.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.48
|
| Rate for Payer: PHP Commercial |
$292.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.66
|
| Rate for Payer: Priority Health SBD |
$216.78
|
| Rate for Payer: UMR Bronson Commercial |
$151.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.08
|
|
|
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 ER 3 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$223.67
|
|
|
Service Code
|
NDC 68180052406
|
| Hospital Charge Code |
78064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna American Axle |
$145.39
|
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Commercial |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.39
|
| Rate for Payer: Priority Health SBD |
$140.91
|
| Rate for Payer: UMR Bronson Commercial |
$98.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.75
|
|
|
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 |
$7.90 |
| 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 |
$15.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,297.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.41
|
| Rate for Payer: BCBS Complete |
$8.29
|
| Rate for Payer: BCBS MAPPO |
$14.73
|
| Rate for Payer: BCBS Trust/PPO |
$39.80
|
| Rate for Payer: BCN Commercial |
$39.80
|
| Rate for Payer: BCN Medicare Advantage |
$14.73
|
| 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 |
$14.73
|
| 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 |
$7.90
|
| Rate for Payer: Mclaren Medicare |
$14.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.47
|
| Rate for Payer: Meridian Medicaid |
$8.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,311.80
|
| Rate for Payer: Nomi Health Commercial |
$44.19
|
| Rate for Payer: PACE Medicare |
$13.99
|
| Rate for Payer: PACE SWMI |
$14.73
|
| Rate for Payer: PHP Commercial |
$4,311.80
|
| Rate for Payer: PHP Medicare Advantage |
$14.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,297.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.50
|
| Rate for Payer: Priority Health Medicare |
$14.73
|
| Rate for Payer: Priority Health Narrow Network |
$34.00
|
| Rate for Payer: Priority Health SBD |
$3,195.81
|
| Rate for Payer: Railroad Medicare Medicare |
$14.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.73
|
| Rate for Payer: UHC Exchange |
$28.15
|
| Rate for Payer: UHC Medicare Advantage |
$14.73
|
| Rate for Payer: UHCCP Medicaid |
$7.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,876.90
|
| Rate for Payer: VA VA |
$14.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,804.53
|
|
