|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,226.02
|
|
|
Service Code
|
HCPCS Q5108
|
| Hospital Charge Code |
187520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.16 |
| Max. Negotiated Rate |
$4,703.42 |
| Rate for Payer: Aetna American Axle |
$3,396.91
|
| Rate for Payer: Aetna American Axle |
$3,650.40
|
| Rate for Payer: Aetna Commercial |
$4,442.12
|
| Rate for Payer: Aetna Commercial |
$4,773.60
|
| Rate for Payer: Aetna Medicare |
$130.31
|
| Rate for Payer: Aetna Medicare |
$130.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,396.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,650.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.62
|
| Rate for Payer: BCBS Complete |
$70.52
|
| Rate for Payer: BCBS Complete |
$70.52
|
| Rate for Payer: BCBS MAPPO |
$125.30
|
| Rate for Payer: BCBS MAPPO |
$125.30
|
| Rate for Payer: BCBS Trust/PPO |
$358.67
|
| Rate for Payer: BCBS Trust/PPO |
$358.67
|
| Rate for Payer: BCN Commercial |
$358.67
|
| Rate for Payer: BCN Commercial |
$358.67
|
| Rate for Payer: BCN Medicare Advantage |
$125.30
|
| Rate for Payer: BCN Medicare Advantage |
$125.30
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cash Price |
$4,180.82
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cash Price |
$4,180.82
|
| Rate for Payer: Cofinity Commercial |
$4,829.76
|
| Rate for Payer: Cofinity Commercial |
$3,931.20
|
| Rate for Payer: Cofinity Commercial |
$3,658.21
|
| Rate for Payer: Cofinity Commercial |
$4,494.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,658.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,931.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,180.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,492.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.30
|
| Rate for Payer: Healthscope Commercial |
$5,054.40
|
| Rate for Payer: Healthscope Commercial |
$4,703.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,658.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,931.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,919.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,212.00
|
| Rate for Payer: Mclaren Medicaid |
$67.16
|
| Rate for Payer: Mclaren Medicaid |
$67.16
|
| Rate for Payer: Mclaren Medicare |
$125.30
|
| Rate for Payer: Mclaren Medicare |
$125.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.56
|
| Rate for Payer: Meridian Medicaid |
$70.52
|
| Rate for Payer: Meridian Medicaid |
$70.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,442.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,773.60
|
| Rate for Payer: Nomi Health Commercial |
$375.90
|
| Rate for Payer: Nomi Health Commercial |
$375.90
|
| Rate for Payer: PACE Medicare |
$119.04
|
| Rate for Payer: PACE Medicare |
$119.04
|
| Rate for Payer: PACE SWMI |
$125.30
|
| Rate for Payer: PACE SWMI |
$125.30
|
| Rate for Payer: PHP Commercial |
$4,773.60
|
| Rate for Payer: PHP Commercial |
$4,442.12
|
| Rate for Payer: PHP Medicare Advantage |
$125.30
|
| Rate for Payer: PHP Medicare Advantage |
$125.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,396.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,650.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.08
|
| Rate for Payer: Priority Health Medicare |
$125.30
|
| Rate for Payer: Priority Health Medicare |
$125.30
|
| Rate for Payer: Priority Health Narrow Network |
$312.06
|
| Rate for Payer: Priority Health Narrow Network |
$312.06
|
| Rate for Payer: Priority Health SBD |
$3,292.39
|
| Rate for Payer: Priority Health SBD |
$3,538.08
|
| Rate for Payer: Railroad Medicare Medicare |
$125.30
|
| Rate for Payer: Railroad Medicare Medicare |
$125.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.30
|
| Rate for Payer: UHC Exchange |
$239.46
|
| Rate for Payer: UHC Exchange |
$239.46
|
| Rate for Payer: UHC Medicare Advantage |
$125.30
|
| Rate for Payer: UHC Medicare Advantage |
$125.30
|
| Rate for Payer: UHCCP Medicaid |
$67.16
|
| Rate for Payer: UHCCP Medicaid |
$67.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,933.63
|
| Rate for Payer: UMR Bronson Commercial |
$2,077.92
|
| Rate for Payer: VA VA |
$125.30
|
| Rate for Payer: VA VA |
$125.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,919.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,212.00
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,616.00
|
|
|
Service Code
|
HCPCS Q5108
|
| Hospital Charge Code |
187520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,471.04 |
| Max. Negotiated Rate |
$5,054.40 |
| Rate for Payer: Aetna American Axle |
$3,650.40
|
| Rate for Payer: Aetna Commercial |
$4,773.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,650.40
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cofinity Commercial |
$3,931.20
|
| Rate for Payer: Cofinity Commercial |
$4,829.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,931.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,492.80
|
| Rate for Payer: Healthscope Commercial |
$5,054.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,931.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,212.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,773.60
|
| Rate for Payer: PHP Commercial |
$4,773.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,650.40
|
| Rate for Payer: Priority Health SBD |
$3,538.08
|
| Rate for Payer: UMR Bronson Commercial |
$2,471.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,212.00
|
|
|
PEGINTERFERON ALFA-2A 180 MCG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$3,187.04
|
|
|
Service Code
|
HCPCS S0145
|
| Hospital Charge Code |
34034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$944.18 |
| Max. Negotiated Rate |
$2,868.34 |
| Rate for Payer: Aetna American Axle |
$2,071.58
|
| Rate for Payer: Aetna Commercial |
$2,708.98
|
| Rate for Payer: Aetna Medicare |
$1,593.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,071.58
|
| Rate for Payer: BCBS Complete |
$1,274.82
|
| Rate for Payer: Cash Price |
$2,549.63
|
| Rate for Payer: Cash Price |
$2,549.63
|
| Rate for Payer: Cofinity Commercial |
$2,740.85
|
| Rate for Payer: Cofinity Commercial |
$2,230.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,230.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,549.63
|
| Rate for Payer: Healthscope Commercial |
$2,868.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,230.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,390.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,708.98
|
| Rate for Payer: PHP Commercial |
$2,708.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,071.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,180.23
|
| Rate for Payer: Priority Health Narrow Network |
$944.18
|
| Rate for Payer: Priority Health SBD |
$2,007.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,179.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,390.28
|
|
|
PEGINTERFERON ALFA-2A 180 MCG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$3,187.04
|
|
|
Service Code
|
HCPCS S0145
|
| Hospital Charge Code |
34034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,402.30 |
| Max. Negotiated Rate |
$2,868.34 |
| Rate for Payer: Aetna American Axle |
$2,071.58
|
| Rate for Payer: Aetna Commercial |
$2,708.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,071.58
|
| Rate for Payer: Cash Price |
$2,549.63
|
| Rate for Payer: Cofinity Commercial |
$2,230.93
|
| Rate for Payer: Cofinity Commercial |
$2,740.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,230.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,549.63
|
| Rate for Payer: Healthscope Commercial |
$2,868.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,230.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,390.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,708.98
|
| Rate for Payer: PHP Commercial |
$2,708.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,071.58
|
| Rate for Payer: Priority Health SBD |
$2,007.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,402.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,390.28
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$76,228.88
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33,540.71 |
| Max. Negotiated Rate |
$68,605.99 |
| Rate for Payer: Aetna American Axle |
$49,548.77
|
| Rate for Payer: Aetna Commercial |
$64,794.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49,548.77
|
| Rate for Payer: Cash Price |
$60,983.10
|
| Rate for Payer: Cofinity Commercial |
$53,360.22
|
| Rate for Payer: Cofinity Commercial |
$65,556.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$53,360.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60,983.10
|
| Rate for Payer: Healthscope Commercial |
$68,605.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53,360.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57,171.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64,794.55
|
| Rate for Payer: PHP Commercial |
$64,794.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49,548.77
|
| Rate for Payer: Priority Health SBD |
$48,024.19
|
| Rate for Payer: UMR Bronson Commercial |
$33,540.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57,171.66
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$76,228.88
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,902.83 |
| Max. Negotiated Rate |
$68,605.99 |
| Rate for Payer: Aetna American Axle |
$49,548.77
|
| Rate for Payer: Aetna Commercial |
$64,794.55
|
| Rate for Payer: Aetna Medicare |
$3,692.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49,548.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,437.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,437.56
|
| Rate for Payer: BCBS Complete |
$1,997.97
|
| Rate for Payer: BCBS MAPPO |
$3,550.05
|
| Rate for Payer: BCBS Trust/PPO |
$9,572.11
|
| Rate for Payer: BCN Commercial |
$9,572.11
|
| Rate for Payer: BCN Medicare Advantage |
$3,550.05
|
| Rate for Payer: Cash Price |
$60,983.10
|
| Rate for Payer: Cash Price |
$60,983.10
|
| Rate for Payer: Cofinity Commercial |
$65,556.84
|
| Rate for Payer: Cofinity Commercial |
$53,360.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$53,360.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60,983.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,550.05
|
| Rate for Payer: Healthscope Commercial |
$68,605.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53,360.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57,171.66
|
| Rate for Payer: Mclaren Medicaid |
$1,902.83
|
| Rate for Payer: Mclaren Medicare |
$3,550.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,727.55
|
| Rate for Payer: Meridian Medicaid |
$1,997.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,082.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64,794.55
|
| Rate for Payer: Nomi Health Commercial |
$10,650.15
|
| Rate for Payer: PACE Medicare |
$3,372.55
|
| Rate for Payer: PACE SWMI |
$3,550.05
|
| Rate for Payer: PHP Commercial |
$64,794.55
|
| Rate for Payer: PHP Medicare Advantage |
$3,550.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,902.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49,548.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,021.71
|
| Rate for Payer: Priority Health Medicare |
$3,550.05
|
| Rate for Payer: Priority Health Narrow Network |
$8,017.37
|
| Rate for Payer: Priority Health SBD |
$48,024.19
|
| Rate for Payer: Railroad Medicare Medicare |
$3,550.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,993.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,550.05
|
| Rate for Payer: UHC Exchange |
$6,784.50
|
| Rate for Payer: UHC Medicare Advantage |
$3,550.05
|
| Rate for Payer: UHCCP Medicaid |
$1,902.83
|
| Rate for Payer: UMR Bronson Commercial |
$28,204.69
|
| Rate for Payer: VA VA |
$3,550.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57,171.66
|
|
|
PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 57410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,824.41
|
| Rate for Payer: BCN Commercial |
$2,824.41
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.02
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$102.75
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
PELVIC FIXATION (ATTACHMENT OF CAUDAL END OF INSTRUMENTATION TO PELVIC BONY STRUCTURES) OTHER THAN SACRUM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,329.19
|
|
|
Service Code
|
CPT 22848
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$352.76 |
| Max. Negotiated Rate |
$1,329.19 |
| Rate for Payer: BCBS Trust/PPO |
$1,329.19
|
| Rate for Payer: BCN Commercial |
$1,329.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.04
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$352.76
|
|
|
PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, HYPOGASTRIC, AND OBTURATOR NODES (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,953.99
|
|
|
Service Code
|
CPT 38770
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$780.54 |
| Max. Negotiated Rate |
$2,953.99 |
| Rate for Payer: BCBS Trust/PPO |
$2,953.99
|
| Rate for Payer: BCN Commercial |
$2,953.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.59
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$780.54
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25,961.54
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,423.08 |
| Max. Negotiated Rate |
$23,365.39 |
| Rate for Payer: Aetna American Axle |
$16,875.00
|
| Rate for Payer: Aetna Commercial |
$22,067.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,875.00
|
| Rate for Payer: Cash Price |
$20,769.23
|
| Rate for Payer: Cofinity Commercial |
$18,173.08
|
| Rate for Payer: Cofinity Commercial |
$22,326.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,173.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,769.23
|
| Rate for Payer: Healthscope Commercial |
$23,365.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,173.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,471.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,067.31
|
| Rate for Payer: PHP Commercial |
$22,067.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,875.00
|
| Rate for Payer: Priority Health SBD |
$16,355.77
|
| Rate for Payer: UMR Bronson Commercial |
$11,423.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,471.16
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25,961.54
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$23,365.39 |
| Rate for Payer: Aetna American Axle |
$16,875.00
|
| Rate for Payer: Aetna Commercial |
$22,067.31
|
| Rate for Payer: Aetna Medicare |
$59.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,875.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.00
|
| Rate for Payer: BCBS Complete |
$32.42
|
| Rate for Payer: BCBS MAPPO |
$57.60
|
| Rate for Payer: BCBS Trust/PPO |
$156.96
|
| Rate for Payer: BCN Commercial |
$156.96
|
| Rate for Payer: BCN Medicare Advantage |
$57.60
|
| Rate for Payer: Cash Price |
$20,769.23
|
| Rate for Payer: Cash Price |
$20,769.23
|
| Rate for Payer: Cofinity Commercial |
$22,326.92
|
| Rate for Payer: Cofinity Commercial |
$18,173.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,173.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,769.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.60
|
| Rate for Payer: Healthscope Commercial |
$23,365.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,173.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,471.16
|
| Rate for Payer: Mclaren Medicaid |
$30.87
|
| Rate for Payer: Mclaren Medicare |
$57.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.48
|
| Rate for Payer: Meridian Medicaid |
$32.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,067.31
|
| Rate for Payer: Nomi Health Commercial |
$172.80
|
| Rate for Payer: PACE Medicare |
$54.72
|
| Rate for Payer: PACE SWMI |
$57.60
|
| Rate for Payer: PHP Commercial |
$22,067.31
|
| Rate for Payer: PHP Medicare Advantage |
$57.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,875.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.55
|
| Rate for Payer: Priority Health Medicare |
$57.60
|
| Rate for Payer: Priority Health Narrow Network |
$134.04
|
| Rate for Payer: Priority Health SBD |
$16,355.77
|
| Rate for Payer: Railroad Medicare Medicare |
$57.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.60
|
| Rate for Payer: UHC Exchange |
$110.08
|
| Rate for Payer: UHC Medicare Advantage |
$57.60
|
| Rate for Payer: UHCCP Medicaid |
$30.87
|
| Rate for Payer: UMR Bronson Commercial |
$9,605.77
|
| Rate for Payer: VA VA |
$57.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,471.16
|
|
|
PEMETREXED DISODIUM 1,000 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$748.42
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
200483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$673.58 |
| Rate for Payer: Aetna American Axle |
$486.47
|
| Rate for Payer: Aetna Commercial |
$636.16
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: Cash Price |
$598.74
|
| Rate for Payer: Cash Price |
$598.74
|
| Rate for Payer: Cofinity Commercial |
$643.64
|
| Rate for Payer: Cofinity Commercial |
$523.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$523.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Healthscope Commercial |
$673.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$523.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.32
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.16
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PHP Commercial |
$636.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health SBD |
$471.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UMR Bronson Commercial |
$276.92
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.32
|
|
|
PEMETREXED DISODIUM 1,000 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$748.42
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
200483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$329.30 |
| Max. Negotiated Rate |
$673.58 |
| Rate for Payer: Cofinity Commercial |
$523.89
|
| Rate for Payer: Cofinity Commercial |
$643.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$523.89
|
| Rate for Payer: Aetna American Axle |
$486.47
|
| Rate for Payer: Aetna Commercial |
$636.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.47
|
| Rate for Payer: Cash Price |
$598.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.74
|
| Rate for Payer: Healthscope Commercial |
$673.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$523.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.16
|
| Rate for Payer: PHP Commercial |
$636.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.47
|
| Rate for Payer: Priority Health SBD |
$471.50
|
| Rate for Payer: UMR Bronson Commercial |
$329.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.32
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$2,522.85
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$2,270.56 |
| Rate for Payer: Aetna American Axle |
$1,639.85
|
| Rate for Payer: Aetna American Axle |
$57.27
|
| Rate for Payer: Aetna American Axle |
$66.30
|
| Rate for Payer: Aetna American Axle |
$30.61
|
| Rate for Payer: Aetna American Axle |
$52.18
|
| Rate for Payer: Aetna American Axle |
$39.14
|
| Rate for Payer: Aetna Commercial |
$2,144.42
|
| Rate for Payer: Aetna Commercial |
$51.18
|
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Commercial |
$74.89
|
| Rate for Payer: Aetna Commercial |
$40.03
|
| Rate for Payer: Aetna Commercial |
$68.24
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,639.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: Cash Price |
$37.67
|
| Rate for Payer: Cash Price |
$37.67
|
| Rate for Payer: Cash Price |
$2,018.28
|
| Rate for Payer: Cash Price |
$64.22
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$2,018.28
|
| Rate for Payer: Cash Price |
$48.17
|
| Rate for Payer: Cash Price |
$70.49
|
| Rate for Payer: Cash Price |
$70.49
|
| Rate for Payer: Cash Price |
$64.22
|
| Rate for Payer: Cash Price |
$48.17
|
| Rate for Payer: Cofinity Commercial |
$42.15
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Cofinity Commercial |
$56.20
|
| Rate for Payer: Cofinity Commercial |
$69.04
|
| Rate for Payer: Cofinity Commercial |
$32.96
|
| Rate for Payer: Cofinity Commercial |
$40.50
|
| Rate for Payer: Cofinity Commercial |
$1,766.00
|
| Rate for Payer: Cofinity Commercial |
$2,169.65
|
| Rate for Payer: Cofinity Commercial |
$61.68
|
| Rate for Payer: Cofinity Commercial |
$75.77
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,766.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,018.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Healthscope Commercial |
$2,270.56
|
| Rate for Payer: Healthscope Commercial |
$42.38
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Commercial |
$72.25
|
| Rate for Payer: Healthscope Commercial |
$54.19
|
| Rate for Payer: Healthscope Commercial |
$79.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,766.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,892.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.16
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,144.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.89
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PHP Commercial |
$40.03
|
| Rate for Payer: PHP Commercial |
$68.24
|
| Rate for Payer: PHP Commercial |
$51.18
|
| Rate for Payer: PHP Commercial |
$2,144.42
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Commercial |
$74.89
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,639.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health SBD |
$55.51
|
| Rate for Payer: Priority Health SBD |
$29.67
|
| Rate for Payer: Priority Health SBD |
$37.93
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: Priority Health SBD |
$50.58
|
| Rate for Payer: Priority Health SBD |
$1,589.40
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UMR Bronson Commercial |
$32.60
|
| Rate for Payer: UMR Bronson Commercial |
$933.45
|
| Rate for Payer: UMR Bronson Commercial |
$29.70
|
| Rate for Payer: UMR Bronson Commercial |
$17.42
|
| Rate for Payer: UMR Bronson Commercial |
$37.74
|
| Rate for Payer: UMR Bronson Commercial |
$22.28
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,892.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$47.09
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$42.38 |
| Rate for Payer: Aetna American Axle |
$30.61
|
| Rate for Payer: Aetna Commercial |
$40.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.61
|
| Rate for Payer: Cash Price |
$37.67
|
| Rate for Payer: Cofinity Commercial |
$32.96
|
| Rate for Payer: Cofinity Commercial |
$40.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.67
|
| Rate for Payer: Healthscope Commercial |
$42.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.03
|
| Rate for Payer: PHP Commercial |
$40.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.61
|
| Rate for Payer: Priority Health SBD |
$29.67
|
| Rate for Payer: UMR Bronson Commercial |
$20.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.32
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$105.69
|
|
|
Service Code
|
HCPCS J9296
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.12 |
| Rate for Payer: Aetna American Axle |
$68.70
|
| Rate for Payer: Aetna Commercial |
$89.84
|
| Rate for Payer: Aetna Medicare |
$10.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.18
|
| Rate for Payer: BCBS Complete |
$5.48
|
| Rate for Payer: BCBS MAPPO |
$9.74
|
| Rate for Payer: BCBS Trust/PPO |
$25.93
|
| Rate for Payer: BCN Commercial |
$25.93
|
| Rate for Payer: BCN Medicare Advantage |
$9.74
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: Cofinity Commercial |
$90.89
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.74
|
| Rate for Payer: Healthscope Commercial |
$95.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.27
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$9.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.23
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.84
|
| Rate for Payer: Nomi Health Commercial |
$29.22
|
| Rate for Payer: PACE Medicare |
$9.25
|
| Rate for Payer: PACE SWMI |
$9.74
|
| Rate for Payer: PHP Commercial |
$89.84
|
| Rate for Payer: PHP Medicare Advantage |
$9.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.79
|
| Rate for Payer: Priority Health Medicare |
$9.74
|
| Rate for Payer: Priority Health Narrow Network |
$22.23
|
| Rate for Payer: Priority Health SBD |
$66.58
|
| Rate for Payer: Railroad Medicare Medicare |
$9.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.74
|
| Rate for Payer: UHC Exchange |
$18.61
|
| Rate for Payer: UHC Medicare Advantage |
$9.74
|
| Rate for Payer: UHCCP Medicaid |
$5.22
|
| Rate for Payer: UMR Bronson Commercial |
$39.11
|
| Rate for Payer: VA VA |
$9.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.27
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$17,699.27
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
37894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,787.68 |
| Max. Negotiated Rate |
$15,929.34 |
| Rate for Payer: Aetna American Axle |
$11,504.53
|
| Rate for Payer: Aetna Commercial |
$15,044.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,504.53
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cofinity Commercial |
$12,389.49
|
| Rate for Payer: Cofinity Commercial |
$15,221.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,389.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,159.42
|
| Rate for Payer: Healthscope Commercial |
$15,929.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,389.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,274.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,044.38
|
| Rate for Payer: PHP Commercial |
$15,044.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,504.53
|
| Rate for Payer: Priority Health SBD |
$11,150.54
|
| Rate for Payer: UMR Bronson Commercial |
$7,787.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,274.45
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$659.83
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
37894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$593.85 |
| Rate for Payer: Aetna American Axle |
$428.89
|
| Rate for Payer: Aetna American Axle |
$406.81
|
| Rate for Payer: Aetna American Axle |
$304.08
|
| Rate for Payer: Aetna American Axle |
$602.76
|
| Rate for Payer: Aetna American Axle |
$218.13
|
| Rate for Payer: Aetna American Axle |
$313.54
|
| Rate for Payer: Aetna American Axle |
$11,504.53
|
| Rate for Payer: Aetna Commercial |
$410.01
|
| Rate for Payer: Aetna Commercial |
$15,044.38
|
| Rate for Payer: Aetna Commercial |
$531.98
|
| Rate for Payer: Aetna Commercial |
$285.25
|
| Rate for Payer: Aetna Commercial |
$560.86
|
| Rate for Payer: Aetna Commercial |
$788.22
|
| Rate for Payer: Aetna Commercial |
$397.64
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,504.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: Cash Price |
$527.86
|
| Rate for Payer: Cash Price |
$385.90
|
| Rate for Payer: Cash Price |
$385.90
|
| Rate for Payer: Cash Price |
$500.69
|
| Rate for Payer: Cash Price |
$374.25
|
| Rate for Payer: Cash Price |
$374.25
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cash Price |
$500.69
|
| Rate for Payer: Cash Price |
$527.86
|
| Rate for Payer: Cash Price |
$268.47
|
| Rate for Payer: Cash Price |
$268.47
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cofinity Commercial |
$337.66
|
| Rate for Payer: Cofinity Commercial |
$15,221.37
|
| Rate for Payer: Cofinity Commercial |
$12,389.49
|
| Rate for Payer: Cofinity Commercial |
$797.50
|
| Rate for Payer: Cofinity Commercial |
$649.12
|
| Rate for Payer: Cofinity Commercial |
$567.45
|
| Rate for Payer: Cofinity Commercial |
$461.88
|
| Rate for Payer: Cofinity Commercial |
$234.91
|
| Rate for Payer: Cofinity Commercial |
$288.61
|
| Rate for Payer: Cofinity Commercial |
$538.24
|
| Rate for Payer: Cofinity Commercial |
$438.10
|
| Rate for Payer: Cofinity Commercial |
$327.47
|
| Rate for Payer: Cofinity Commercial |
$402.32
|
| Rate for Payer: Cofinity Commercial |
$414.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$234.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$438.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,389.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$649.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$461.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$500.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,159.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Healthscope Commercial |
$421.03
|
| Rate for Payer: Healthscope Commercial |
$593.85
|
| Rate for Payer: Healthscope Commercial |
$302.03
|
| Rate for Payer: Healthscope Commercial |
$834.59
|
| Rate for Payer: Healthscope Commercial |
$15,929.34
|
| Rate for Payer: Healthscope Commercial |
$434.13
|
| Rate for Payer: Healthscope Commercial |
$563.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$461.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,389.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$438.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,274.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$469.40
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Mclaren Medicare |
$5.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: Meridian Medicaid |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$531.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,044.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.86
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: Nomi Health Commercial |
$15.81
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE Medicare |
$5.01
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PHP Commercial |
$531.98
|
| Rate for Payer: PHP Commercial |
$788.22
|
| Rate for Payer: PHP Commercial |
$560.86
|
| Rate for Payer: PHP Commercial |
$397.64
|
| Rate for Payer: PHP Commercial |
$15,044.38
|
| Rate for Payer: PHP Commercial |
$410.01
|
| Rate for Payer: PHP Commercial |
$285.25
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,504.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.04
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.63
|
| Rate for Payer: Priority Health SBD |
$415.69
|
| Rate for Payer: Priority Health SBD |
$11,150.54
|
| Rate for Payer: Priority Health SBD |
$303.89
|
| Rate for Payer: Priority Health SBD |
$294.72
|
| Rate for Payer: Priority Health SBD |
$394.29
|
| Rate for Payer: Priority Health SBD |
$211.42
|
| Rate for Payer: Priority Health SBD |
$584.21
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UMR Bronson Commercial |
$244.14
|
| Rate for Payer: UMR Bronson Commercial |
$231.57
|
| Rate for Payer: UMR Bronson Commercial |
$343.11
|
| Rate for Payer: UMR Bronson Commercial |
$6,548.73
|
| Rate for Payer: UMR Bronson Commercial |
$178.48
|
| Rate for Payer: UMR Bronson Commercial |
$173.09
|
| Rate for Payer: UMR Bronson Commercial |
$124.17
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,274.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$469.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.69
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$998.34
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$439.27 |
| Max. Negotiated Rate |
$898.51 |
| Rate for Payer: Aetna American Axle |
$648.92
|
| Rate for Payer: Aetna Commercial |
$848.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.92
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cofinity Commercial |
$698.84
|
| Rate for Payer: Cofinity Commercial |
$858.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$698.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$798.67
|
| Rate for Payer: Healthscope Commercial |
$898.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$698.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$748.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.59
|
| Rate for Payer: PHP Commercial |
$848.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.92
|
| Rate for Payer: Priority Health SBD |
$628.95
|
| Rate for Payer: UMR Bronson Commercial |
$439.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$748.76
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$998.34
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$898.51 |
| Rate for Payer: Aetna American Axle |
$648.92
|
| Rate for Payer: Aetna Commercial |
$848.59
|
| Rate for Payer: Aetna Medicare |
$27.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.52
|
| Rate for Payer: BCBS Complete |
$15.09
|
| Rate for Payer: BCBS MAPPO |
$26.82
|
| Rate for Payer: BCBS Trust/PPO |
$68.38
|
| Rate for Payer: BCN Commercial |
$68.38
|
| Rate for Payer: BCN Medicare Advantage |
$26.82
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cofinity Commercial |
$858.57
|
| Rate for Payer: Cofinity Commercial |
$698.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$698.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$798.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.82
|
| Rate for Payer: Healthscope Commercial |
$898.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$698.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$748.76
|
| Rate for Payer: Mclaren Medicaid |
$14.38
|
| Rate for Payer: Mclaren Medicare |
$26.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.16
|
| Rate for Payer: Meridian Medicaid |
$15.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.59
|
| Rate for Payer: Nomi Health Commercial |
$80.46
|
| Rate for Payer: PACE Medicare |
$25.48
|
| Rate for Payer: PACE SWMI |
$26.82
|
| Rate for Payer: PHP Commercial |
$848.59
|
| Rate for Payer: PHP Medicare Advantage |
$26.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.14
|
| Rate for Payer: Priority Health Medicare |
$26.82
|
| Rate for Payer: Priority Health Narrow Network |
$56.11
|
| Rate for Payer: Priority Health SBD |
$628.95
|
| Rate for Payer: Railroad Medicare Medicare |
$26.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.82
|
| Rate for Payer: UHC Exchange |
$51.26
|
| Rate for Payer: UHC Medicare Advantage |
$26.82
|
| Rate for Payer: UHCCP Medicaid |
$14.38
|
| Rate for Payer: UMR Bronson Commercial |
$369.39
|
| Rate for Payer: VA VA |
$26.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$748.76
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE CUSTOM
|
Facility
|
IP
|
$998.34
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
301789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$439.27 |
| Max. Negotiated Rate |
$898.51 |
| Rate for Payer: Aetna American Axle |
$648.92
|
| Rate for Payer: Aetna Commercial |
$848.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.92
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cofinity Commercial |
$698.84
|
| Rate for Payer: Cofinity Commercial |
$858.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$698.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$798.67
|
| Rate for Payer: Healthscope Commercial |
$898.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$698.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$748.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.59
|
| Rate for Payer: PHP Commercial |
$848.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.92
|
| Rate for Payer: Priority Health SBD |
$628.95
|
| Rate for Payer: UMR Bronson Commercial |
$439.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$748.76
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE CUSTOM
|
Facility
|
OP
|
$998.34
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
301789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$898.51 |
| Rate for Payer: Aetna American Axle |
$648.92
|
| Rate for Payer: Aetna Commercial |
$848.59
|
| Rate for Payer: Aetna Medicare |
$27.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.52
|
| Rate for Payer: BCBS Complete |
$15.09
|
| Rate for Payer: BCBS MAPPO |
$26.82
|
| Rate for Payer: BCBS Trust/PPO |
$68.38
|
| Rate for Payer: BCN Commercial |
$68.38
|
| Rate for Payer: BCN Medicare Advantage |
$26.82
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cofinity Commercial |
$858.57
|
| Rate for Payer: Cofinity Commercial |
$698.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$698.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$798.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.82
|
| Rate for Payer: Healthscope Commercial |
$898.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$698.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$748.76
|
| Rate for Payer: Mclaren Medicaid |
$14.38
|
| Rate for Payer: Mclaren Medicare |
$26.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.16
|
| Rate for Payer: Meridian Medicaid |
$15.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.59
|
| Rate for Payer: Nomi Health Commercial |
$80.46
|
| Rate for Payer: PACE Medicare |
$25.48
|
| Rate for Payer: PACE SWMI |
$26.82
|
| Rate for Payer: PHP Commercial |
$848.59
|
| Rate for Payer: PHP Medicare Advantage |
$26.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.14
|
| Rate for Payer: Priority Health Medicare |
$26.82
|
| Rate for Payer: Priority Health Narrow Network |
$56.11
|
| Rate for Payer: Priority Health SBD |
$628.95
|
| Rate for Payer: Railroad Medicare Medicare |
$26.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.82
|
| Rate for Payer: UHC Exchange |
$51.26
|
| Rate for Payer: UHC Medicare Advantage |
$26.82
|
| Rate for Payer: UHCCP Medicaid |
$14.38
|
| Rate for Payer: UMR Bronson Commercial |
$369.39
|
| Rate for Payer: VA VA |
$26.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$748.76
|
|
|
PENICILLIN G IV 16,000 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
OP
|
$162.50
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna American Axle |
$105.62
|
| Rate for Payer: Aetna Commercial |
$138.12
|
| Rate for Payer: Aetna Medicare |
$81.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.62
|
| Rate for Payer: BCBS Complete |
$65.00
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cofinity Commercial |
$113.75
|
| Rate for Payer: Cofinity Commercial |
$139.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.00
|
| Rate for Payer: Healthscope Commercial |
$146.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.12
|
| Rate for Payer: PHP Commercial |
$138.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.62
|
| Rate for Payer: Priority Health SBD |
$102.38
|
| Rate for Payer: UMR Bronson Commercial |
$60.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.88
|
|
|
PENICILLIN G IV 16,000 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$162.50
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna American Axle |
$105.62
|
| Rate for Payer: Aetna Commercial |
$138.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.62
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cofinity Commercial |
$113.75
|
| Rate for Payer: Cofinity Commercial |
$139.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.00
|
| Rate for Payer: Healthscope Commercial |
$146.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.12
|
| Rate for Payer: PHP Commercial |
$138.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.62
|
| Rate for Payer: Priority Health SBD |
$102.38
|
| Rate for Payer: UMR Bronson Commercial |
$71.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.88
|
|
|
PENICILLIN G IV 1,600 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
OP
|
$18.75
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna American Axle |
$12.19
|
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna Medicare |
$9.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.19
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.94
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.19
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
|
