|
PENICILLIN G IV 1,600 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$18.75
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna American Axle |
$12.19
|
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.19
|
| 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 |
$8.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
|
|
PENICILLIN G IV 160 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
OP
|
$6.25
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna American Axle |
$4.06
|
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$5.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.31
|
| Rate for Payer: PHP Commercial |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health SBD |
$3.94
|
| Rate for Payer: UMR Bronson Commercial |
$2.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.69
|
|
|
PENICILLIN G IV 160 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$6.25
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna American Axle |
$4.06
|
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$5.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.31
|
| Rate for Payer: PHP Commercial |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health SBD |
$3.94
|
| Rate for Payer: UMR Bronson Commercial |
$2.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.69
|
|
|
PENICILLIN G IV 3 MILLION UNITS IVPB 100 ML (IV PREMIX)
|
Facility
|
IP
|
$82.80
|
|
|
Service Code
|
NDC 09900000160
|
| Hospital Charge Code |
500537
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna American Axle |
$53.82
|
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.82
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Commercial |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.38
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.82
|
| Rate for Payer: Priority Health SBD |
$52.16
|
| Rate for Payer: UMR Bronson Commercial |
$36.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.10
|
|
|
PENICILLIN G IV 3 MILLION UNITS IVPB 100 ML (IV PREMIX)
|
Facility
|
OP
|
$82.80
|
|
|
Service Code
|
NDC 09900000160
|
| Hospital Charge Code |
500537
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna American Axle |
$53.82
|
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna Medicare |
$41.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.82
|
| Rate for Payer: BCBS Complete |
$33.12
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Commercial |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.38
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.82
|
| Rate for Payer: Priority Health SBD |
$52.16
|
| Rate for Payer: UMR Bronson Commercial |
$30.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.10
|
|
|
PENICILLIN G IV 5 MILLION UNITS IVPB 250 ML (IV PREMIX)
|
Facility
|
OP
|
$116.96
|
|
|
Service Code
|
NDC 09900000161
|
| Hospital Charge Code |
500538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.28 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna American Axle |
$76.02
|
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna Medicare |
$58.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.02
|
| Rate for Payer: BCBS Complete |
$46.78
|
| Rate for Payer: Cash Price |
$93.57
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Cofinity Commercial |
$81.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.57
|
| Rate for Payer: Healthscope Commercial |
$105.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.42
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.02
|
| Rate for Payer: Priority Health SBD |
$73.68
|
| Rate for Payer: UMR Bronson Commercial |
$43.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.72
|
|
|
PENICILLIN G IV 5 MILLION UNITS IVPB 250 ML (IV PREMIX)
|
Facility
|
IP
|
$116.96
|
|
|
Service Code
|
NDC 09900000161
|
| Hospital Charge Code |
500538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.46 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna American Axle |
$76.02
|
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.02
|
| Rate for Payer: Cash Price |
$93.57
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Cofinity Commercial |
$81.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.57
|
| Rate for Payer: Healthscope Commercial |
$105.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.42
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.02
|
| Rate for Payer: Priority Health SBD |
$73.68
|
| Rate for Payer: UMR Bronson Commercial |
$51.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.72
|
|
|
PENICILLIN G POT 3 MILLION UNIT/50 ML-DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$96.96
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
15960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.66 |
| Max. Negotiated Rate |
$87.26 |
| Rate for Payer: Aetna American Axle |
$63.02
|
| Rate for Payer: Aetna Commercial |
$82.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.02
|
| Rate for Payer: Cash Price |
$77.57
|
| Rate for Payer: Cofinity Commercial |
$67.87
|
| Rate for Payer: Cofinity Commercial |
$83.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.57
|
| Rate for Payer: Healthscope Commercial |
$87.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.42
|
| Rate for Payer: PHP Commercial |
$82.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.02
|
| Rate for Payer: Priority Health SBD |
$61.08
|
| Rate for Payer: UMR Bronson Commercial |
$42.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.72
|
|
|
PENICILLIN G POT 3 MILLION UNIT/50 ML-DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$96.96
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
15960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$87.26 |
| Rate for Payer: Aetna American Axle |
$63.02
|
| Rate for Payer: Aetna Commercial |
$82.42
|
| Rate for Payer: Aetna Medicare |
$48.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.02
|
| Rate for Payer: BCBS Complete |
$38.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$77.57
|
| Rate for Payer: Cash Price |
$77.57
|
| Rate for Payer: Cofinity Commercial |
$67.87
|
| Rate for Payer: Cofinity Commercial |
$83.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.57
|
| Rate for Payer: Healthscope Commercial |
$87.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.42
|
| Rate for Payer: PHP Commercial |
$82.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.02
|
| Rate for Payer: Priority Health SBD |
$61.08
|
| Rate for Payer: UMR Bronson Commercial |
$35.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.72
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$93.32
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.06 |
| Max. Negotiated Rate |
$83.99 |
| Rate for Payer: Aetna American Axle |
$60.66
|
| Rate for Payer: Aetna American Axle |
$136.73
|
| Rate for Payer: Aetna American Axle |
$136.88
|
| Rate for Payer: Aetna American Axle |
$63.49
|
| Rate for Payer: Aetna American Axle |
$38.76
|
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Aetna Commercial |
$178.99
|
| Rate for Payer: Aetna Commercial |
$178.81
|
| Rate for Payer: Aetna Commercial |
$83.03
|
| Rate for Payer: Aetna Commercial |
$50.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.88
|
| Rate for Payer: Cash Price |
$74.66
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$168.46
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$168.29
|
| Rate for Payer: Cofinity Commercial |
$68.38
|
| Rate for Payer: Cofinity Commercial |
$147.25
|
| Rate for Payer: Cofinity Commercial |
$80.26
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Cofinity Commercial |
$41.74
|
| Rate for Payer: Cofinity Commercial |
$147.41
|
| Rate for Payer: Cofinity Commercial |
$181.10
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Cofinity Commercial |
$180.91
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.70
|
| Rate for Payer: Healthscope Commercial |
$189.52
|
| Rate for Payer: Healthscope Commercial |
$83.99
|
| Rate for Payer: Healthscope Commercial |
$53.67
|
| Rate for Payer: Healthscope Commercial |
$87.91
|
| Rate for Payer: Healthscope Commercial |
$189.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.81
|
| Rate for Payer: PHP Commercial |
$178.81
|
| Rate for Payer: PHP Commercial |
$83.03
|
| Rate for Payer: PHP Commercial |
$50.69
|
| Rate for Payer: PHP Commercial |
$79.32
|
| Rate for Payer: PHP Commercial |
$178.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.73
|
| Rate for Payer: Priority Health SBD |
$61.54
|
| Rate for Payer: Priority Health SBD |
$37.57
|
| Rate for Payer: Priority Health SBD |
$132.67
|
| Rate for Payer: Priority Health SBD |
$132.53
|
| Rate for Payer: Priority Health SBD |
$58.79
|
| Rate for Payer: UMR Bronson Commercial |
$92.56
|
| Rate for Payer: UMR Bronson Commercial |
$92.66
|
| Rate for Payer: UMR Bronson Commercial |
$41.06
|
| Rate for Payer: UMR Bronson Commercial |
$42.98
|
| Rate for Payer: UMR Bronson Commercial |
$26.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.99
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$210.58
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$189.52 |
| Rate for Payer: Aetna American Axle |
$136.88
|
| Rate for Payer: Aetna American Axle |
$60.66
|
| Rate for Payer: Aetna American Axle |
$38.76
|
| Rate for Payer: Aetna American Axle |
$136.73
|
| Rate for Payer: Aetna American Axle |
$63.49
|
| Rate for Payer: Aetna Commercial |
$178.99
|
| Rate for Payer: Aetna Commercial |
$178.81
|
| Rate for Payer: Aetna Commercial |
$83.03
|
| Rate for Payer: Aetna Commercial |
$50.69
|
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Aetna Medicare |
$29.82
|
| Rate for Payer: Aetna Medicare |
$46.66
|
| Rate for Payer: Aetna Medicare |
$105.29
|
| Rate for Payer: Aetna Medicare |
$105.18
|
| Rate for Payer: Aetna Medicare |
$48.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.76
|
| Rate for Payer: BCBS Complete |
$84.23
|
| Rate for Payer: BCBS Complete |
$84.14
|
| Rate for Payer: BCBS Complete |
$37.33
|
| Rate for Payer: BCBS Complete |
$39.07
|
| Rate for Payer: BCBS Complete |
$23.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$168.46
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$168.29
|
| Rate for Payer: Cash Price |
$168.46
|
| Rate for Payer: Cash Price |
$168.29
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$74.66
|
| Rate for Payer: Cash Price |
$74.66
|
| Rate for Payer: Cofinity Commercial |
$147.41
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$147.25
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Cofinity Commercial |
$41.74
|
| Rate for Payer: Cofinity Commercial |
$68.38
|
| Rate for Payer: Cofinity Commercial |
$80.26
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Cofinity Commercial |
$181.10
|
| Rate for Payer: Cofinity Commercial |
$180.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.66
|
| Rate for Payer: Healthscope Commercial |
$83.99
|
| Rate for Payer: Healthscope Commercial |
$189.32
|
| Rate for Payer: Healthscope Commercial |
$189.52
|
| Rate for Payer: Healthscope Commercial |
$53.67
|
| Rate for Payer: Healthscope Commercial |
$87.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.81
|
| Rate for Payer: PHP Commercial |
$83.03
|
| Rate for Payer: PHP Commercial |
$79.32
|
| Rate for Payer: PHP Commercial |
$178.99
|
| Rate for Payer: PHP Commercial |
$178.81
|
| Rate for Payer: PHP Commercial |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.88
|
| Rate for Payer: Priority Health SBD |
$132.67
|
| Rate for Payer: Priority Health SBD |
$61.54
|
| Rate for Payer: Priority Health SBD |
$58.79
|
| Rate for Payer: Priority Health SBD |
$132.53
|
| Rate for Payer: Priority Health SBD |
$37.57
|
| Rate for Payer: UMR Bronson Commercial |
$77.83
|
| Rate for Payer: UMR Bronson Commercial |
$22.06
|
| Rate for Payer: UMR Bronson Commercial |
$77.91
|
| Rate for Payer: UMR Bronson Commercial |
$34.53
|
| Rate for Payer: UMR Bronson Commercial |
$36.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.77
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$18.34
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna American Axle |
$11.92
|
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna Medicare |
$9.17
|
| Rate for Payer: Aetna Medicare |
$14.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Healthscope Commercial |
$16.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: PHP Commercial |
$15.59
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: Priority Health SBD |
$11.55
|
| Rate for Payer: UMR Bronson Commercial |
$6.79
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.76
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$18.34
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna American Axle |
$11.92
|
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$16.51
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.59
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: PHP Commercial |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health SBD |
$11.55
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: UMR Bronson Commercial |
$8.07
|
| Rate for Payer: UMR Bronson Commercial |
$13.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$145.70
|
|
|
Service Code
|
NDC 00093412773
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.91 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna American Axle |
$94.70
|
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna Medicare |
$72.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: BCBS Complete |
$58.28
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Commercial |
$101.99
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.70
|
| Rate for Payer: Priority Health SBD |
$91.79
|
| Rate for Payer: UMR Bronson Commercial |
$53.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.28
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$145.70
|
|
|
Service Code
|
NDC 00093412773
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna American Axle |
$94.70
|
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Commercial |
$101.99
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.70
|
| Rate for Payer: Priority Health SBD |
$91.79
|
| Rate for Payer: UMR Bronson Commercial |
$64.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.28
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 65862017501
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.04
|
| Rate for Payer: Aetna Commercial |
$147.82
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.04
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.82
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.04
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UMR Bronson Commercial |
$64.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
OP
|
$176.25
|
|
|
Service Code
|
NDC 57237004001
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.21 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna American Axle |
$114.56
|
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna Medicare |
$88.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: BCBS Complete |
$70.50
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.56
|
| Rate for Payer: Priority Health SBD |
$111.04
|
| Rate for Payer: UMR Bronson Commercial |
$65.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 65862017501
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.04
|
| Rate for Payer: Aetna Commercial |
$147.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.04
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.82
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.04
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 57237004001
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna American Axle |
$114.56
|
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.56
|
| Rate for Payer: Priority Health SBD |
$111.04
|
| Rate for Payer: UMR Bronson Commercial |
$77.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
|
PENTAMIDINE 300 MG IM INJECTION
|
Facility
|
OP
|
$168.58
|
|
|
Service Code
|
NDC 63323011310
|
| Hospital Charge Code |
299999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna American Axle |
$109.58
|
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna Medicare |
$84.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: BCBS Complete |
$67.43
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.58
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$62.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.44
|
|
|
PENTAMIDINE 300 MG IM INJECTION
|
Facility
|
IP
|
$168.58
|
|
|
Service Code
|
NDC 63323011310
|
| Hospital Charge Code |
299999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.18 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna American Axle |
$109.58
|
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.58
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$74.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.44
|
|
|
PENTAMIDINE 300 MG IM INJECTION
|
Facility
|
IP
|
$168.58
|
|
|
Service Code
|
NDC 63323011301
|
| Hospital Charge Code |
299999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.18 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.01
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Aetna American Axle |
$109.58
|
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.58
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$74.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.44
|
|
|
PENTAMIDINE 300 MG IM INJECTION
|
Facility
|
OP
|
$168.58
|
|
|
Service Code
|
NDC 63323011301
|
| Hospital Charge Code |
299999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna American Axle |
$109.58
|
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna Medicare |
$84.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: BCBS Complete |
$67.43
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.58
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$62.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.44
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION
|
Facility
|
OP
|
$261.52
|
|
|
Service Code
|
HCPCS J2545
|
| Hospital Charge Code |
28235
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.51 |
| Max. Negotiated Rate |
$235.37 |
| Rate for Payer: Aetna American Axle |
$216.67
|
| Rate for Payer: Aetna Commercial |
$283.34
|
| Rate for Payer: Aetna Commercial |
$190.75
|
| Rate for Payer: Aetna Commercial |
$222.29
|
| Rate for Payer: Aetna Medicare |
$130.76
|
| Rate for Payer: Aetna Medicare |
$112.20
|
| Rate for Payer: Aetna Medicare |
$166.67
|
| Rate for Payer: Aetna American Axle |
$169.99
|
| Rate for Payer: Aetna American Axle |
$145.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.67
|
| Rate for Payer: BCBS Complete |
$89.76
|
| Rate for Payer: BCBS Complete |
$133.34
|
| Rate for Payer: BCBS Complete |
$104.61
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Cash Price |
$179.53
|
| Rate for Payer: Cash Price |
$179.53
|
| Rate for Payer: Cash Price |
$209.22
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Cash Price |
$209.22
|
| Rate for Payer: Cofinity Commercial |
$157.09
|
| Rate for Payer: Cofinity Commercial |
$233.34
|
| Rate for Payer: Cofinity Commercial |
$286.67
|
| Rate for Payer: Cofinity Commercial |
$224.91
|
| Rate for Payer: Cofinity Commercial |
$183.06
|
| Rate for Payer: Cofinity Commercial |
$192.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.22
|
| Rate for Payer: Healthscope Commercial |
$235.37
|
| Rate for Payer: Healthscope Commercial |
$201.97
|
| Rate for Payer: Healthscope Commercial |
$300.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.34
|
| Rate for Payer: PHP Commercial |
$283.34
|
| Rate for Payer: PHP Commercial |
$222.29
|
| Rate for Payer: PHP Commercial |
$190.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.39
|
| Rate for Payer: Priority Health Narrow Network |
$63.51
|
| Rate for Payer: Priority Health Narrow Network |
$63.51
|
| Rate for Payer: Priority Health Narrow Network |
$63.51
|
| Rate for Payer: Priority Health SBD |
$164.76
|
| Rate for Payer: Priority Health SBD |
$141.38
|
| Rate for Payer: Priority Health SBD |
$210.00
|
| Rate for Payer: UMR Bronson Commercial |
$83.03
|
| Rate for Payer: UMR Bronson Commercial |
$96.76
|
| Rate for Payer: UMR Bronson Commercial |
$123.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.00
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$224.41
|
|
|
Service Code
|
HCPCS J2545
|
| Hospital Charge Code |
28235
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.74 |
| Max. Negotiated Rate |
$201.97 |
| Rate for Payer: Aetna American Axle |
$145.87
|
| Rate for Payer: Aetna American Axle |
$169.99
|
| Rate for Payer: Aetna American Axle |
$216.67
|
| Rate for Payer: Aetna Commercial |
$222.29
|
| Rate for Payer: Aetna Commercial |
$190.75
|
| Rate for Payer: Aetna Commercial |
$283.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.99
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Cash Price |
$209.22
|
| Rate for Payer: Cash Price |
$179.53
|
| Rate for Payer: Cofinity Commercial |
$192.99
|
| Rate for Payer: Cofinity Commercial |
$224.91
|
| Rate for Payer: Cofinity Commercial |
$183.06
|
| Rate for Payer: Cofinity Commercial |
$286.67
|
| Rate for Payer: Cofinity Commercial |
$233.34
|
| Rate for Payer: Cofinity Commercial |
$157.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.22
|
| Rate for Payer: Healthscope Commercial |
$235.37
|
| Rate for Payer: Healthscope Commercial |
$201.97
|
| Rate for Payer: Healthscope Commercial |
$300.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.29
|
| Rate for Payer: PHP Commercial |
$283.34
|
| Rate for Payer: PHP Commercial |
$222.29
|
| Rate for Payer: PHP Commercial |
$190.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.87
|
| Rate for Payer: Priority Health SBD |
$210.00
|
| Rate for Payer: Priority Health SBD |
$164.76
|
| Rate for Payer: Priority Health SBD |
$141.38
|
| Rate for Payer: UMR Bronson Commercial |
$98.74
|
| Rate for Payer: UMR Bronson Commercial |
$146.67
|
| Rate for Payer: UMR Bronson Commercial |
$115.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.14
|
|
