|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$224.41
|
|
|
Service Code
|
HCPCS J2545
|
| Hospital Charge Code |
28235
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.74 |
| Max. Negotiated Rate |
$201.97 |
| Rate for Payer: Aetna American Axle |
$145.87
|
| Rate for Payer: Aetna American Axle |
$169.99
|
| Rate for Payer: Aetna American Axle |
$216.67
|
| Rate for Payer: Aetna Commercial |
$222.29
|
| Rate for Payer: Aetna Commercial |
$190.75
|
| Rate for Payer: Aetna Commercial |
$283.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.99
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Cash Price |
$209.22
|
| Rate for Payer: Cash Price |
$179.53
|
| Rate for Payer: Cofinity Commercial |
$192.99
|
| Rate for Payer: Cofinity Commercial |
$224.91
|
| Rate for Payer: Cofinity Commercial |
$183.06
|
| Rate for Payer: Cofinity Commercial |
$286.67
|
| Rate for Payer: Cofinity Commercial |
$233.34
|
| Rate for Payer: Cofinity Commercial |
$157.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.22
|
| Rate for Payer: Healthscope Commercial |
$235.37
|
| Rate for Payer: Healthscope Commercial |
$201.97
|
| Rate for Payer: Healthscope Commercial |
$300.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.29
|
| Rate for Payer: PHP Commercial |
$283.34
|
| Rate for Payer: PHP Commercial |
$222.29
|
| Rate for Payer: PHP Commercial |
$190.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.87
|
| Rate for Payer: Priority Health SBD |
$210.00
|
| Rate for Payer: Priority Health SBD |
$164.76
|
| Rate for Payer: Priority Health SBD |
$141.38
|
| Rate for Payer: UMR Bronson Commercial |
$98.74
|
| Rate for Payer: UMR Bronson Commercial |
$146.67
|
| Rate for Payer: UMR Bronson Commercial |
$115.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.14
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$168.58
|
|
|
Service Code
|
NDC 63323011301
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.18 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna American Axle |
$109.58
|
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.58
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$74.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.44
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$168.58
|
|
|
Service Code
|
NDC 63323011301
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna American Axle |
$109.58
|
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna Medicare |
$84.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: BCBS Complete |
$67.43
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.58
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$62.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.44
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$168.58
|
|
|
Service Code
|
NDC 63323011310
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.18 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna American Axle |
$109.58
|
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.58
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$74.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.44
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$350.71
|
|
|
Service Code
|
NDC 13925051510
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$129.76 |
| Max. Negotiated Rate |
$315.64 |
| Rate for Payer: Aetna American Axle |
$227.96
|
| Rate for Payer: Aetna Commercial |
$298.10
|
| Rate for Payer: Aetna Medicare |
$175.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.96
|
| Rate for Payer: BCBS Complete |
$140.28
|
| Rate for Payer: Cash Price |
$280.57
|
| Rate for Payer: Cofinity Commercial |
$245.50
|
| Rate for Payer: Cofinity Commercial |
$301.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.57
|
| Rate for Payer: Healthscope Commercial |
$315.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.10
|
| Rate for Payer: PHP Commercial |
$298.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.96
|
| Rate for Payer: Priority Health SBD |
$220.95
|
| Rate for Payer: UMR Bronson Commercial |
$129.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.03
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$350.71
|
|
|
Service Code
|
NDC 13925051510
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$315.64 |
| Rate for Payer: Aetna American Axle |
$227.96
|
| Rate for Payer: Aetna Commercial |
$298.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.96
|
| Rate for Payer: Cash Price |
$280.57
|
| Rate for Payer: Cofinity Commercial |
$245.50
|
| Rate for Payer: Cofinity Commercial |
$301.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.57
|
| Rate for Payer: Healthscope Commercial |
$315.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.10
|
| Rate for Payer: PHP Commercial |
$298.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.96
|
| Rate for Payer: Priority Health SBD |
$220.95
|
| Rate for Payer: UMR Bronson Commercial |
$154.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.03
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$350.71
|
|
|
Service Code
|
NDC 13925051501
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$129.76 |
| Max. Negotiated Rate |
$315.64 |
| Rate for Payer: Aetna American Axle |
$227.96
|
| Rate for Payer: Aetna Commercial |
$298.10
|
| Rate for Payer: Aetna Medicare |
$175.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.96
|
| Rate for Payer: BCBS Complete |
$140.28
|
| Rate for Payer: Cash Price |
$280.57
|
| Rate for Payer: Cofinity Commercial |
$245.50
|
| Rate for Payer: Cofinity Commercial |
$301.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.57
|
| Rate for Payer: Healthscope Commercial |
$315.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.10
|
| Rate for Payer: PHP Commercial |
$298.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.96
|
| Rate for Payer: Priority Health SBD |
$220.95
|
| Rate for Payer: UMR Bronson Commercial |
$129.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.03
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$350.71
|
|
|
Service Code
|
NDC 13925051501
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$315.64 |
| Rate for Payer: Aetna American Axle |
$227.96
|
| Rate for Payer: Aetna Commercial |
$298.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.96
|
| Rate for Payer: Cash Price |
$280.57
|
| Rate for Payer: Cofinity Commercial |
$245.50
|
| Rate for Payer: Cofinity Commercial |
$301.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.57
|
| Rate for Payer: Healthscope Commercial |
$315.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.10
|
| Rate for Payer: PHP Commercial |
$298.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.96
|
| Rate for Payer: Priority Health SBD |
$220.95
|
| Rate for Payer: UMR Bronson Commercial |
$154.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.03
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$168.58
|
|
|
Service Code
|
NDC 63323011310
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna American Axle |
$109.58
|
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna Medicare |
$84.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: BCBS Complete |
$67.43
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.58
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$62.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.44
|
|
|
PENTAZOCINE 50 MG-NALOXONE 0.5 MG TABLET
|
Facility
|
OP
|
$1,342.60
|
|
|
Service Code
|
NDC 00591039501
|
| Hospital Charge Code |
10908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$496.76 |
| Max. Negotiated Rate |
$1,208.34 |
| Rate for Payer: Aetna American Axle |
$872.69
|
| Rate for Payer: Aetna Commercial |
$1,141.21
|
| Rate for Payer: Aetna Medicare |
$671.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.69
|
| Rate for Payer: BCBS Complete |
$537.04
|
| Rate for Payer: Cash Price |
$1,074.08
|
| Rate for Payer: Cofinity Commercial |
$1,154.64
|
| Rate for Payer: Cofinity Commercial |
$939.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$939.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.08
|
| Rate for Payer: Healthscope Commercial |
$1,208.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$939.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,141.21
|
| Rate for Payer: PHP Commercial |
$1,141.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.69
|
| Rate for Payer: Priority Health SBD |
$845.84
|
| Rate for Payer: UMR Bronson Commercial |
$496.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.95
|
|
|
PENTAZOCINE 50 MG-NALOXONE 0.5 MG TABLET
|
Facility
|
IP
|
$1,342.60
|
|
|
Service Code
|
NDC 00591039501
|
| Hospital Charge Code |
10908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$590.74 |
| Max. Negotiated Rate |
$1,208.34 |
| Rate for Payer: Aetna American Axle |
$872.69
|
| Rate for Payer: Aetna Commercial |
$1,141.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.69
|
| Rate for Payer: Cash Price |
$1,074.08
|
| Rate for Payer: Cofinity Commercial |
$1,154.64
|
| Rate for Payer: Cofinity Commercial |
$939.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$939.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.08
|
| Rate for Payer: Healthscope Commercial |
$1,208.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$939.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,141.21
|
| Rate for Payer: PHP Commercial |
$1,141.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.69
|
| Rate for Payer: Priority Health SBD |
$845.84
|
| Rate for Payer: UMR Bronson Commercial |
$590.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.95
|
|
|
PENTOBARBITAL SODIUM 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$184.85
|
|
|
Service Code
|
HCPCS J2515
|
| Hospital Charge Code |
6097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.33 |
| Max. Negotiated Rate |
$166.37 |
| Rate for Payer: Aetna American Axle |
$120.15
|
| Rate for Payer: Aetna American Axle |
$3,095.46
|
| Rate for Payer: Aetna American Axle |
$3,035.99
|
| Rate for Payer: Aetna American Axle |
$2,173.21
|
| Rate for Payer: Aetna American Axle |
$2,002.45
|
| Rate for Payer: Aetna American Axle |
$2,176.20
|
| Rate for Payer: Aetna American Axle |
$3,173.62
|
| Rate for Payer: Aetna Commercial |
$4,047.91
|
| Rate for Payer: Aetna Commercial |
$2,618.59
|
| Rate for Payer: Aetna Commercial |
$2,845.80
|
| Rate for Payer: Aetna Commercial |
$3,970.14
|
| Rate for Payer: Aetna Commercial |
$4,150.12
|
| Rate for Payer: Aetna Commercial |
$2,841.89
|
| Rate for Payer: Aetna Commercial |
$157.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,035.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,002.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,176.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,173.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,173.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,095.46
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$3,809.80
|
| Rate for Payer: Cash Price |
$2,464.56
|
| Rate for Payer: Cash Price |
$147.88
|
| Rate for Payer: Cash Price |
$2,674.72
|
| Rate for Payer: Cash Price |
$3,736.60
|
| Rate for Payer: Cash Price |
$3,906.00
|
| Rate for Payer: Cofinity Commercial |
$4,095.53
|
| Rate for Payer: Cofinity Commercial |
$129.40
|
| Rate for Payer: Cofinity Commercial |
$2,879.28
|
| Rate for Payer: Cofinity Commercial |
$2,343.60
|
| Rate for Payer: Cofinity Commercial |
$2,340.38
|
| Rate for Payer: Cofinity Commercial |
$2,156.49
|
| Rate for Payer: Cofinity Commercial |
$2,649.40
|
| Rate for Payer: Cofinity Commercial |
$2,875.32
|
| Rate for Payer: Cofinity Commercial |
$158.97
|
| Rate for Payer: Cofinity Commercial |
$3,269.53
|
| Rate for Payer: Cofinity Commercial |
$4,016.84
|
| Rate for Payer: Cofinity Commercial |
$3,333.57
|
| Rate for Payer: Cofinity Commercial |
$3,417.75
|
| Rate for Payer: Cofinity Commercial |
$4,198.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,417.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,340.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,343.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,333.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,269.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,156.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,809.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,736.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,906.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,464.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.88
|
| Rate for Payer: Healthscope Commercial |
$4,394.25
|
| Rate for Payer: Healthscope Commercial |
$4,203.68
|
| Rate for Payer: Healthscope Commercial |
$3,009.06
|
| Rate for Payer: Healthscope Commercial |
$3,013.20
|
| Rate for Payer: Healthscope Commercial |
$2,772.63
|
| Rate for Payer: Healthscope Commercial |
$166.37
|
| Rate for Payer: Healthscope Commercial |
$4,286.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,340.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,343.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,156.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,417.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,269.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,333.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,503.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,310.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,507.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,511.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,571.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,661.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,845.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,618.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,150.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,970.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,047.91
|
| Rate for Payer: PHP Commercial |
$3,970.14
|
| Rate for Payer: PHP Commercial |
$2,841.89
|
| Rate for Payer: PHP Commercial |
$2,845.80
|
| Rate for Payer: PHP Commercial |
$157.12
|
| Rate for Payer: PHP Commercial |
$2,618.59
|
| Rate for Payer: PHP Commercial |
$4,150.12
|
| Rate for Payer: PHP Commercial |
$4,047.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,095.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,002.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,173.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,173.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,035.99
|
| Rate for Payer: Priority Health SBD |
$2,106.34
|
| Rate for Payer: Priority Health SBD |
$1,940.84
|
| Rate for Payer: Priority Health SBD |
$116.46
|
| Rate for Payer: Priority Health SBD |
$3,075.97
|
| Rate for Payer: Priority Health SBD |
$3,000.22
|
| Rate for Payer: Priority Health SBD |
$2,942.57
|
| Rate for Payer: Priority Health SBD |
$2,109.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,473.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,148.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,055.13
|
| Rate for Payer: UMR Bronson Commercial |
$2,095.39
|
| Rate for Payer: UMR Bronson Commercial |
$81.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,471.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,355.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,310.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,511.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,571.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,507.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,503.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,661.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.64
|
|
|
PENTOBARBITAL SODIUM 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$4,882.50
|
|
|
Service Code
|
HCPCS J2515
|
| Hospital Charge Code |
6097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,806.53 |
| Max. Negotiated Rate |
$4,394.25 |
| Rate for Payer: Aetna American Axle |
$3,173.62
|
| Rate for Payer: Aetna American Axle |
$2,002.45
|
| Rate for Payer: Aetna American Axle |
$2,173.21
|
| Rate for Payer: Aetna American Axle |
$3,035.99
|
| Rate for Payer: Aetna American Axle |
$2,176.20
|
| Rate for Payer: Aetna American Axle |
$120.15
|
| Rate for Payer: Aetna American Axle |
$3,095.46
|
| Rate for Payer: Aetna Commercial |
$4,150.12
|
| Rate for Payer: Aetna Commercial |
$2,618.59
|
| Rate for Payer: Aetna Commercial |
$4,047.91
|
| Rate for Payer: Aetna Commercial |
$157.12
|
| Rate for Payer: Aetna Commercial |
$3,970.14
|
| Rate for Payer: Aetna Commercial |
$2,841.89
|
| Rate for Payer: Aetna Commercial |
$2,845.80
|
| Rate for Payer: Aetna Medicare |
$1,671.70
|
| Rate for Payer: Aetna Medicare |
$2,381.12
|
| Rate for Payer: Aetna Medicare |
$2,441.25
|
| Rate for Payer: Aetna Medicare |
$2,335.38
|
| Rate for Payer: Aetna Medicare |
$1,540.35
|
| Rate for Payer: Aetna Medicare |
$1,674.00
|
| Rate for Payer: Aetna Medicare |
$92.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,173.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,035.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,173.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,095.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,002.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,176.20
|
| Rate for Payer: BCBS Complete |
$1,339.20
|
| Rate for Payer: BCBS Complete |
$73.94
|
| Rate for Payer: BCBS Complete |
$1,868.30
|
| Rate for Payer: BCBS Complete |
$1,337.36
|
| Rate for Payer: BCBS Complete |
$1,232.28
|
| Rate for Payer: BCBS Complete |
$1,953.00
|
| Rate for Payer: BCBS Complete |
$1,904.90
|
| Rate for Payer: Cash Price |
$3,809.80
|
| Rate for Payer: Cash Price |
$2,674.72
|
| Rate for Payer: Cash Price |
$147.88
|
| Rate for Payer: Cash Price |
$2,464.56
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$3,736.60
|
| Rate for Payer: Cash Price |
$3,906.00
|
| Rate for Payer: Cofinity Commercial |
$3,333.57
|
| Rate for Payer: Cofinity Commercial |
$2,156.49
|
| Rate for Payer: Cofinity Commercial |
$4,095.53
|
| Rate for Payer: Cofinity Commercial |
$4,016.84
|
| Rate for Payer: Cofinity Commercial |
$3,269.53
|
| Rate for Payer: Cofinity Commercial |
$158.97
|
| Rate for Payer: Cofinity Commercial |
$4,198.95
|
| Rate for Payer: Cofinity Commercial |
$3,417.75
|
| Rate for Payer: Cofinity Commercial |
$2,649.40
|
| Rate for Payer: Cofinity Commercial |
$2,879.28
|
| Rate for Payer: Cofinity Commercial |
$129.40
|
| Rate for Payer: Cofinity Commercial |
$2,875.32
|
| Rate for Payer: Cofinity Commercial |
$2,340.38
|
| Rate for Payer: Cofinity Commercial |
$2,343.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,417.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,269.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,333.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,156.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,343.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,340.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,906.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,809.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,464.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,736.60
|
| Rate for Payer: Healthscope Commercial |
$166.37
|
| Rate for Payer: Healthscope Commercial |
$4,394.25
|
| Rate for Payer: Healthscope Commercial |
$4,286.02
|
| Rate for Payer: Healthscope Commercial |
$3,013.20
|
| Rate for Payer: Healthscope Commercial |
$2,772.63
|
| Rate for Payer: Healthscope Commercial |
$4,203.68
|
| Rate for Payer: Healthscope Commercial |
$3,009.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,340.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,343.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,269.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,333.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,417.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,156.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,507.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,503.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,571.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,661.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,511.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,310.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,845.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,618.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,047.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,970.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,150.12
|
| Rate for Payer: PHP Commercial |
$2,841.89
|
| Rate for Payer: PHP Commercial |
$4,047.91
|
| Rate for Payer: PHP Commercial |
$3,970.14
|
| Rate for Payer: PHP Commercial |
$4,150.12
|
| Rate for Payer: PHP Commercial |
$2,618.59
|
| Rate for Payer: PHP Commercial |
$157.12
|
| Rate for Payer: PHP Commercial |
$2,845.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,173.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,173.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,035.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,095.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,002.45
|
| Rate for Payer: Priority Health SBD |
$3,075.97
|
| Rate for Payer: Priority Health SBD |
$3,000.22
|
| Rate for Payer: Priority Health SBD |
$2,109.24
|
| Rate for Payer: Priority Health SBD |
$2,106.34
|
| Rate for Payer: Priority Health SBD |
$2,942.57
|
| Rate for Payer: Priority Health SBD |
$116.46
|
| Rate for Payer: Priority Health SBD |
$1,940.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,139.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,238.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,237.06
|
| Rate for Payer: UMR Bronson Commercial |
$68.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,762.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,728.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,806.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,503.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,571.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,310.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,511.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,661.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,507.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.64
|
|
|
PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$4,120.69
|
|
|
Service Code
|
NDC 50458009801
|
| Hospital Charge Code |
12912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,524.66 |
| Max. Negotiated Rate |
$3,708.62 |
| Rate for Payer: Aetna American Axle |
$2,678.45
|
| Rate for Payer: Aetna Commercial |
$3,502.59
|
| Rate for Payer: Aetna Medicare |
$2,060.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,678.45
|
| Rate for Payer: BCBS Complete |
$1,648.28
|
| Rate for Payer: Cash Price |
$3,296.55
|
| Rate for Payer: Cofinity Commercial |
$2,884.48
|
| Rate for Payer: Cofinity Commercial |
$3,543.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,884.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,296.55
|
| Rate for Payer: Healthscope Commercial |
$3,708.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,884.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,090.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,502.59
|
| Rate for Payer: PHP Commercial |
$3,502.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,678.45
|
| Rate for Payer: Priority Health SBD |
$2,596.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,524.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,090.52
|
|
|
PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$4,120.69
|
|
|
Service Code
|
NDC 50458009801
|
| Hospital Charge Code |
12912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,813.10 |
| Max. Negotiated Rate |
$3,708.62 |
| Rate for Payer: Aetna American Axle |
$2,678.45
|
| Rate for Payer: Aetna Commercial |
$3,502.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,678.45
|
| Rate for Payer: Cash Price |
$3,296.55
|
| Rate for Payer: Cofinity Commercial |
$2,884.48
|
| Rate for Payer: Cofinity Commercial |
$3,543.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,884.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,296.55
|
| Rate for Payer: Healthscope Commercial |
$3,708.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,884.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,090.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,502.59
|
| Rate for Payer: PHP Commercial |
$3,502.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,678.45
|
| Rate for Payer: Priority Health SBD |
$2,596.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,813.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,090.52
|
|
|
PENTOSTATIN 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11,130.54
|
|
|
Service Code
|
HCPCS J9268
|
| Hospital Charge Code |
10910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,897.44 |
| Max. Negotiated Rate |
$10,017.49 |
| Rate for Payer: Aetna American Axle |
$7,234.85
|
| Rate for Payer: Aetna Commercial |
$9,460.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,234.85
|
| Rate for Payer: Cash Price |
$8,904.43
|
| Rate for Payer: Cofinity Commercial |
$7,791.38
|
| Rate for Payer: Cofinity Commercial |
$9,572.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,791.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,904.43
|
| Rate for Payer: Healthscope Commercial |
$10,017.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,791.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,347.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,460.96
|
| Rate for Payer: PHP Commercial |
$9,460.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,234.85
|
| Rate for Payer: Priority Health SBD |
$7,012.24
|
| Rate for Payer: UMR Bronson Commercial |
$4,897.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,347.91
|
|
|
PENTOSTATIN 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,130.54
|
|
|
Service Code
|
HCPCS J9268
|
| Hospital Charge Code |
10910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,397.97 |
| Max. Negotiated Rate |
$10,017.49 |
| Rate for Payer: Aetna American Axle |
$7,234.85
|
| Rate for Payer: Aetna Commercial |
$9,460.96
|
| Rate for Payer: Aetna Medicare |
$2,712.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,234.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,260.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,260.20
|
| Rate for Payer: BCBS Complete |
$1,467.87
|
| Rate for Payer: BCBS MAPPO |
$2,608.16
|
| Rate for Payer: BCN Medicare Advantage |
$2,608.16
|
| Rate for Payer: Cash Price |
$8,904.43
|
| Rate for Payer: Cash Price |
$8,904.43
|
| Rate for Payer: Cofinity Commercial |
$9,572.26
|
| Rate for Payer: Cofinity Commercial |
$7,791.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,791.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,904.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,608.16
|
| Rate for Payer: Healthscope Commercial |
$10,017.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,791.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,347.91
|
| Rate for Payer: Mclaren Medicaid |
$1,397.97
|
| Rate for Payer: Mclaren Medicare |
$2,608.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,738.57
|
| Rate for Payer: Meridian Medicaid |
$1,467.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,999.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,460.96
|
| Rate for Payer: PACE Medicare |
$2,477.75
|
| Rate for Payer: PACE SWMI |
$2,608.16
|
| Rate for Payer: PHP Commercial |
$9,460.96
|
| Rate for Payer: PHP Medicare Advantage |
$2,608.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,397.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,234.85
|
| Rate for Payer: Priority Health Medicare |
$2,608.16
|
| Rate for Payer: Priority Health SBD |
$7,012.24
|
| Rate for Payer: Railroad Medicare Medicare |
$2,608.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,341.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,608.16
|
| Rate for Payer: UHC Exchange |
$4,984.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,608.16
|
| Rate for Payer: UHCCP Medicaid |
$1,397.97
|
| Rate for Payer: UMR Bronson Commercial |
$4,118.30
|
| Rate for Payer: VA VA |
$2,608.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,347.91
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 00904544861
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna American Axle |
$144.50
|
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna Medicare |
$111.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| Rate for Payer: UMR Bronson Commercial |
$82.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$374.30
|
|
|
Service Code
|
NDC 60505003306
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.49 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna American Axle |
$243.29
|
| Rate for Payer: Aetna Commercial |
$318.15
|
| Rate for Payer: Aetna Medicare |
$187.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.29
|
| Rate for Payer: BCBS Complete |
$149.72
|
| Rate for Payer: Cash Price |
$299.44
|
| Rate for Payer: Cofinity Commercial |
$262.01
|
| Rate for Payer: Cofinity Commercial |
$321.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.44
|
| Rate for Payer: Healthscope Commercial |
$336.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: PHP Commercial |
$318.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.29
|
| Rate for Payer: Priority Health SBD |
$235.81
|
| Rate for Payer: UMR Bronson Commercial |
$138.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.73
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$374.30
|
|
|
Service Code
|
NDC 60505003306
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.69 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna American Axle |
$243.29
|
| Rate for Payer: Aetna Commercial |
$318.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.29
|
| Rate for Payer: Cash Price |
$299.44
|
| Rate for Payer: Cofinity Commercial |
$262.01
|
| Rate for Payer: Cofinity Commercial |
$321.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.44
|
| Rate for Payer: Healthscope Commercial |
$336.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: PHP Commercial |
$318.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.29
|
| Rate for Payer: Priority Health SBD |
$235.81
|
| Rate for Payer: UMR Bronson Commercial |
$164.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.73
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 00904544861
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna American Axle |
$144.50
|
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| Rate for Payer: UMR Bronson Commercial |
$97.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
PEPTAMEN AF BOLUS FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
150863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF BOLUS FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
150863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Commercial |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.88
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.17
|
|
|
PEPTAMEN AF BOLUS FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
150863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF BOLUS FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
150863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Commercial |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.88
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$23.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.17
|
|
