|
PEPTAMEN AF CONTINUOUS FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
168955
|
|
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
|
|
|
PEPTAMEN AF CONTINUOUS FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
168955
|
|
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 CYCLIC FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200079
|
|
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 CYCLIC FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200079
|
|
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 CYCLIC FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200079
|
|
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 CYCLIC FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200079
|
|
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
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200078
|
|
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
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200078
|
|
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 INTERMITTENT FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200078
|
|
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 INTERMITTENT FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200078
|
|
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 INTENSE VHP BOLUS FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
PEPTAMEN INTENSE VHP BOLUS FEED
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,035.68
|
|
|
Service Code
|
HCPCS J2547
|
| Hospital Charge Code |
119324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$932.11 |
| Rate for Payer: Aetna American Axle |
$673.19
|
| Rate for Payer: Aetna Commercial |
$880.33
|
| Rate for Payer: Aetna Medicare |
$1.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.10
|
| Rate for Payer: BCBS Complete |
$0.95
|
| Rate for Payer: BCBS MAPPO |
$1.68
|
| Rate for Payer: BCN Medicare Advantage |
$1.68
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cofinity Commercial |
$724.98
|
| Rate for Payer: Cofinity Commercial |
$890.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$724.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.68
|
| Rate for Payer: Healthscope Commercial |
$932.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$724.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$776.76
|
| Rate for Payer: Mclaren Medicaid |
$0.90
|
| Rate for Payer: Mclaren Medicare |
$1.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.76
|
| Rate for Payer: Meridian Medicaid |
$0.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$880.33
|
| Rate for Payer: PACE Medicare |
$1.60
|
| Rate for Payer: PACE SWMI |
$1.68
|
| Rate for Payer: PHP Commercial |
$880.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.19
|
| Rate for Payer: Priority Health Medicare |
$1.68
|
| Rate for Payer: Priority Health SBD |
$652.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.68
|
| Rate for Payer: UHC Exchange |
$3.21
|
| Rate for Payer: UHC Medicare Advantage |
$1.68
|
| Rate for Payer: UHCCP Medicaid |
$0.90
|
| Rate for Payer: UMR Bronson Commercial |
$383.20
|
| Rate for Payer: VA VA |
$1.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$776.76
|
|
|
PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,035.68
|
|
|
Service Code
|
HCPCS J2547
|
| Hospital Charge Code |
119324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.70 |
| Max. Negotiated Rate |
$932.11 |
| Rate for Payer: Aetna American Axle |
$673.19
|
| Rate for Payer: Aetna Commercial |
$880.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.19
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cofinity Commercial |
$724.98
|
| Rate for Payer: Cofinity Commercial |
$890.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$724.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.54
|
| Rate for Payer: Healthscope Commercial |
$932.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$724.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$776.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$880.33
|
| Rate for Payer: PHP Commercial |
$880.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.19
|
| Rate for Payer: Priority Health SBD |
$652.48
|
| Rate for Payer: UMR Bronson Commercial |
$455.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$776.76
|
|
|
PERAMPANEL 2 MG TABLET
|
Facility
|
OP
|
$2,136.87
|
|
|
Service Code
|
NDC 62856027230
|
| Hospital Charge Code |
169250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$790.64 |
| Max. Negotiated Rate |
$1,923.18 |
| Rate for Payer: Aetna American Axle |
$1,388.97
|
| Rate for Payer: Aetna Commercial |
$1,816.34
|
| Rate for Payer: Aetna Medicare |
$1,068.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,388.97
|
| Rate for Payer: BCBS Complete |
$854.75
|
| Rate for Payer: Cash Price |
$1,709.50
|
| Rate for Payer: Cofinity Commercial |
$1,495.81
|
| Rate for Payer: Cofinity Commercial |
$1,837.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,495.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,709.50
|
| Rate for Payer: Healthscope Commercial |
$1,923.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,495.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,602.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,816.34
|
| Rate for Payer: PHP Commercial |
$1,816.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,388.97
|
| Rate for Payer: Priority Health SBD |
$1,346.23
|
| Rate for Payer: UMR Bronson Commercial |
$790.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,602.65
|
|
|
PERAMPANEL 2 MG TABLET
|
Facility
|
IP
|
$2,136.87
|
|
|
Service Code
|
NDC 62856027230
|
| Hospital Charge Code |
169250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$940.22 |
| Max. Negotiated Rate |
$1,923.18 |
| Rate for Payer: Aetna American Axle |
$1,388.97
|
| Rate for Payer: Aetna Commercial |
$1,816.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,388.97
|
| Rate for Payer: Cash Price |
$1,709.50
|
| Rate for Payer: Cofinity Commercial |
$1,495.81
|
| Rate for Payer: Cofinity Commercial |
$1,837.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,495.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,709.50
|
| Rate for Payer: Healthscope Commercial |
$1,923.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,495.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,602.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,816.34
|
| Rate for Payer: PHP Commercial |
$1,816.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,388.97
|
| Rate for Payer: Priority Health SBD |
$1,346.23
|
| Rate for Payer: UMR Bronson Commercial |
$940.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,602.65
|
|
|
PERAMPANEL 4 MG TABLET
|
Facility
|
OP
|
$4,222.11
|
|
|
Service Code
|
NDC 62856027430
|
| Hospital Charge Code |
169251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,562.18 |
| Max. Negotiated Rate |
$3,799.90 |
| Rate for Payer: Aetna American Axle |
$2,744.37
|
| Rate for Payer: Aetna Commercial |
$3,588.79
|
| Rate for Payer: Aetna Medicare |
$2,111.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,744.37
|
| Rate for Payer: BCBS Complete |
$1,688.84
|
| Rate for Payer: Cash Price |
$3,377.69
|
| Rate for Payer: Cofinity Commercial |
$2,955.48
|
| Rate for Payer: Cofinity Commercial |
$3,631.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,955.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,377.69
|
| Rate for Payer: Healthscope Commercial |
$3,799.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,955.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,166.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,588.79
|
| Rate for Payer: PHP Commercial |
$3,588.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,744.37
|
| Rate for Payer: Priority Health SBD |
$2,659.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,562.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,166.58
|
|
|
PERAMPANEL 4 MG TABLET
|
Facility
|
IP
|
$4,222.11
|
|
|
Service Code
|
NDC 62856027430
|
| Hospital Charge Code |
169251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,857.73 |
| Max. Negotiated Rate |
$3,799.90 |
| Rate for Payer: Aetna American Axle |
$2,744.37
|
| Rate for Payer: Aetna Commercial |
$3,588.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,744.37
|
| Rate for Payer: Cash Price |
$3,377.69
|
| Rate for Payer: Cofinity Commercial |
$2,955.48
|
| Rate for Payer: Cofinity Commercial |
$3,631.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,955.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,377.69
|
| Rate for Payer: Healthscope Commercial |
$3,799.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,955.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,166.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,588.79
|
| Rate for Payer: PHP Commercial |
$3,588.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,744.37
|
| Rate for Payer: Priority Health SBD |
$2,659.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,857.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,166.58
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT) INCLUDING IMAGE GUIDANCE, IF PERFORMED
|
Facility
|
OP
|
$18,017.25
|
|
|
Service Code
|
CPT 64561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,430.76 |
| Max. Negotiated Rate |
$18,017.25 |
| Rate for Payer: Aetna Medicare |
$6,656.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,000.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,000.84
|
| Rate for Payer: BCBS Complete |
$3,602.30
|
| Rate for Payer: BCBS MAPPO |
$6,400.67
|
| Rate for Payer: BCN Medicare Advantage |
$6,400.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,400.67
|
| Rate for Payer: Mclaren Medicaid |
$3,430.76
|
| Rate for Payer: Mclaren Medicare |
$6,400.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,720.70
|
| Rate for Payer: Meridian Medicaid |
$3,602.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,360.77
|
| Rate for Payer: PACE Medicare |
$6,080.64
|
| Rate for Payer: PACE SWMI |
$6,400.67
|
| Rate for Payer: PHP Medicare Advantage |
$6,400.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,430.76
|
| Rate for Payer: Priority Health Medicare |
$6,400.67
|
| Rate for Payer: Railroad Medicare Medicare |
$6,400.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,017.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,400.67
|
| Rate for Payer: UHC Exchange |
$12,232.32
|
| Rate for Payer: UHC Medicare Advantage |
$6,400.67
|
| Rate for Payer: UHCCP Medicaid |
$3,430.76
|
| Rate for Payer: VA VA |
$6,400.67
|
|
|
PERCUTANEOUS LAMINOTOMY/LAMINECTOMY (INTERLAMINAR APPROACH) FOR DECOMPRESSION OF NEURAL ELEMENTS, (WITH OR WITHOUT LIGAMENTOUS RESECTION, DISCECTOMY, FACETECTOMY AND/OR FORAMINOTOMY), ANY METHOD, UNDER INDIRECT IMAGE GUIDANCE (EG, FLUOROSCOPIC, CT), SINGLE OR MULTIPLE LEVELS, UNILATERAL OR BILATERAL; LUMBAR
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 0275T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
PERCUTANEOUS NEPHROLITHOTOMY OR PYELOLITHOTOMY, LITHOTRIPSY, STONE EXTRACTION, ANTEGRADE URETEROSCOPY, ANTEGRADE STENT PLACEMENT AND NEPHROSTOMY TUBE PLACEMENT, WHEN PERFORMED, INCLUDING IMAGING GUIDANCE; COMPLEX (EG, STONE[S] > 2 CM, BRANCHING STONES, STONES IN MULTIPLE LOCATIONS, URETER STONES, COMPLICATED ANATOMY)
|
Facility
|
OP
|
$25,386.34
|
|
|
Service Code
|
CPT 50081
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,833.95 |
| Max. Negotiated Rate |
$25,386.34 |
| Rate for Payer: Aetna Medicare |
$9,379.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,273.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,273.20
|
| Rate for Payer: BCBS Complete |
$5,075.65
|
| Rate for Payer: BCBS MAPPO |
$9,018.56
|
| Rate for Payer: BCN Medicare Advantage |
$9,018.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,018.56
|
| Rate for Payer: Mclaren Medicaid |
$4,833.95
|
| Rate for Payer: Mclaren Medicare |
$9,018.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,469.49
|
| Rate for Payer: Meridian Medicaid |
$5,075.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,371.34
|
| Rate for Payer: PACE Medicare |
$8,567.63
|
| Rate for Payer: PACE SWMI |
$9,018.56
|
| Rate for Payer: PHP Medicare Advantage |
$9,018.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,833.95
|
| Rate for Payer: Priority Health Medicare |
$9,018.56
|
| Rate for Payer: Railroad Medicare Medicare |
$9,018.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,386.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,018.56
|
| Rate for Payer: UHC Exchange |
$17,235.37
|
| Rate for Payer: UHC Medicare Advantage |
$9,018.56
|
| Rate for Payer: UHCCP Medicaid |
$4,833.95
|
| Rate for Payer: VA VA |
$9,018.56
|
|
