|
PEPTAMEN AF CONTINUOUS FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
168955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Commercial |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.46
|
| Rate for Payer: PHP Commercial |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.88
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
PEPTAMEN AF CYCLIC FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF CYCLIC FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF CYCLIC FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Commercial |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.46
|
| Rate for Payer: PHP Commercial |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.88
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
PEPTAMEN AF CYCLIC FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.46
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Commercial |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.46
|
| Rate for Payer: PHP Commercial |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.88
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$23.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 98716066360
|
| Hospital Charge Code |
200078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Commercial |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.46
|
| Rate for Payer: PHP Commercial |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.88
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
PEPTAMEN AF INTERMITTENT FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.46
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Commercial |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.46
|
| Rate for Payer: PHP Commercial |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.88
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$23.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
PEPTAMEN INTENSE VHP BOLUS FEED
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.72
|
|
|
PEPTAMEN INTENSE VHP BOLUS FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.72
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.72
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.72
|
|
|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.72
|
|
|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.21
|
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.72
|
|
|
PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,035.68
|
|
|
Service Code
|
HCPCS J2547
|
| Hospital Charge Code |
119324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.70 |
| Max. Negotiated Rate |
$932.11 |
| Rate for Payer: Aetna American Axle |
$673.19
|
| Rate for Payer: Aetna Commercial |
$880.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.19
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cofinity Commercial |
$724.98
|
| Rate for Payer: Cofinity Commercial |
$890.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$724.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.54
|
| Rate for Payer: Healthscope Commercial |
$932.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$724.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$776.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$880.33
|
| Rate for Payer: PHP Commercial |
$880.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.19
|
| Rate for Payer: Priority Health SBD |
$652.48
|
| Rate for Payer: UMR Bronson Commercial |
$455.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$776.76
|
|
|
PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,035.68
|
|
|
Service Code
|
HCPCS J2547
|
| Hospital Charge Code |
119324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$932.11 |
| Rate for Payer: Aetna American Axle |
$673.19
|
| Rate for Payer: Aetna Commercial |
$880.33
|
| Rate for Payer: Aetna Medicare |
$1.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.10
|
| Rate for Payer: BCBS Complete |
$0.95
|
| Rate for Payer: BCBS MAPPO |
$1.68
|
| Rate for Payer: BCBS Trust/PPO |
$4.23
|
| Rate for Payer: BCN Commercial |
$4.23
|
| Rate for Payer: BCN Medicare Advantage |
$1.68
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cofinity Commercial |
$890.68
|
| Rate for Payer: Cofinity Commercial |
$724.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$724.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.68
|
| Rate for Payer: Healthscope Commercial |
$932.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$724.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$776.76
|
| Rate for Payer: Mclaren Medicaid |
$0.90
|
| Rate for Payer: Mclaren Medicare |
$1.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.76
|
| Rate for Payer: Meridian Medicaid |
$0.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$880.33
|
| Rate for Payer: Nomi Health Commercial |
$5.04
|
| Rate for Payer: PACE Medicare |
$1.60
|
| Rate for Payer: PACE SWMI |
$1.68
|
| Rate for Payer: PHP Commercial |
$880.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.82
|
| Rate for Payer: Priority Health Medicare |
$1.68
|
| Rate for Payer: Priority Health Narrow Network |
$3.86
|
| Rate for Payer: Priority Health SBD |
$652.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.68
|
| Rate for Payer: UHC Exchange |
$3.21
|
| Rate for Payer: UHC Medicare Advantage |
$1.68
|
| Rate for Payer: UHCCP Medicaid |
$0.90
|
| Rate for Payer: UMR Bronson Commercial |
$383.20
|
| Rate for Payer: VA VA |
$1.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$776.76
|
|
|
PERAMPANEL 2 MG TABLET
|
Facility
|
IP
|
$2,136.87
|
|
|
Service Code
|
NDC 62856027230
|
| Hospital Charge Code |
169250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$940.22 |
| Max. Negotiated Rate |
$1,923.18 |
| Rate for Payer: Aetna American Axle |
$1,388.97
|
| Rate for Payer: Aetna Commercial |
$1,816.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,388.97
|
| Rate for Payer: Cash Price |
$1,709.50
|
| Rate for Payer: Cofinity Commercial |
$1,495.81
|
| Rate for Payer: Cofinity Commercial |
$1,837.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,495.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,709.50
|
| Rate for Payer: Healthscope Commercial |
$1,923.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,495.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,602.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,816.34
|
| Rate for Payer: PHP Commercial |
$1,816.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,388.97
|
| Rate for Payer: Priority Health SBD |
$1,346.23
|
| Rate for Payer: UMR Bronson Commercial |
$940.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,602.65
|
|
|
PERAMPANEL 2 MG TABLET
|
Facility
|
OP
|
$2,136.87
|
|
|
Service Code
|
NDC 62856027230
|
| Hospital Charge Code |
169250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$790.64 |
| Max. Negotiated Rate |
$1,923.18 |
| Rate for Payer: Aetna American Axle |
$1,388.97
|
| Rate for Payer: Aetna Commercial |
$1,816.34
|
| Rate for Payer: Aetna Medicare |
$1,068.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,388.97
|
| Rate for Payer: BCBS Complete |
$854.75
|
| Rate for Payer: Cash Price |
$1,709.50
|
| Rate for Payer: Cofinity Commercial |
$1,495.81
|
| Rate for Payer: Cofinity Commercial |
$1,837.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,495.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,709.50
|
| Rate for Payer: Healthscope Commercial |
$1,923.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,495.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,602.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,816.34
|
| Rate for Payer: PHP Commercial |
$1,816.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,388.97
|
| Rate for Payer: Priority Health SBD |
$1,346.23
|
| Rate for Payer: UMR Bronson Commercial |
$790.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,602.65
|
|
|
PERAMPANEL 4 MG TABLET
|
Facility
|
OP
|
$4,222.11
|
|
|
Service Code
|
NDC 62856027430
|
| Hospital Charge Code |
169251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,562.18 |
| Max. Negotiated Rate |
$3,799.90 |
| Rate for Payer: Aetna American Axle |
$2,744.37
|
| Rate for Payer: Aetna Commercial |
$3,588.79
|
| Rate for Payer: Aetna Medicare |
$2,111.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,744.37
|
| Rate for Payer: BCBS Complete |
$1,688.84
|
| Rate for Payer: Cash Price |
$3,377.69
|
| Rate for Payer: Cofinity Commercial |
$2,955.48
|
| Rate for Payer: Cofinity Commercial |
$3,631.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,955.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,377.69
|
| Rate for Payer: Healthscope Commercial |
$3,799.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,955.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,166.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,588.79
|
| Rate for Payer: PHP Commercial |
$3,588.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,744.37
|
| Rate for Payer: Priority Health SBD |
$2,659.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,562.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,166.58
|
|
|
PERAMPANEL 4 MG TABLET
|
Facility
|
IP
|
$4,222.11
|
|
|
Service Code
|
NDC 62856027430
|
| Hospital Charge Code |
169251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,857.73 |
| Max. Negotiated Rate |
$3,799.90 |
| Rate for Payer: Aetna American Axle |
$2,744.37
|
| Rate for Payer: Aetna Commercial |
$3,588.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,744.37
|
| Rate for Payer: Cash Price |
$3,377.69
|
| Rate for Payer: Cofinity Commercial |
$2,955.48
|
| Rate for Payer: Cofinity Commercial |
$3,631.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,955.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,377.69
|
| Rate for Payer: Healthscope Commercial |
$3,799.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,955.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,166.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,588.79
|
| Rate for Payer: PHP Commercial |
$3,588.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,744.37
|
| Rate for Payer: Priority Health SBD |
$2,659.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,857.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,166.58
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT) INCLUDING IMAGE GUIDANCE, IF PERFORMED
|
Facility
|
OP
|
$20,210.02
|
|
|
Service Code
|
CPT 64561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.46 |
| Max. Negotiated Rate |
$20,210.02 |
| Rate for Payer: Aetna Medicare |
$6,687.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,037.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,037.75
|
| Rate for Payer: BCBS Complete |
$3,618.92
|
| Rate for Payer: BCBS MAPPO |
$6,430.20
|
| Rate for Payer: BCBS Trust/PPO |
$8,083.44
|
| Rate for Payer: BCN Commercial |
$8,083.44
|
| Rate for Payer: BCN Medicare Advantage |
$6,430.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,430.20
|
| Rate for Payer: Mclaren Medicaid |
$3,446.59
|
| Rate for Payer: Mclaren Medicare |
$6,430.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,751.71
|
| Rate for Payer: Meridian Medicaid |
$3,618.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,394.73
|
| Rate for Payer: Nomi Health Commercial |
$13,503.42
|
| Rate for Payer: PACE Medicare |
$6,108.69
|
| Rate for Payer: PACE SWMI |
$6,430.20
|
| Rate for Payer: PHP Medicare Advantage |
$6,430.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,446.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,210.02
|
| Rate for Payer: Priority Health Medicare |
$6,430.20
|
| Rate for Payer: Priority Health Narrow Network |
$16,168.02
|
| Rate for Payer: Railroad Medicare Medicare |
$6,430.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.71
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,430.20
|
| Rate for Payer: UHC Exchange |
$292.46
|
| Rate for Payer: UHC Medicare Advantage |
$6,430.20
|
| Rate for Payer: UHCCP Medicaid |
$3,446.59
|
| Rate for Payer: VA VA |
$6,430.20
|
|
|
PERCUTANEOUS LAMINOTOMY/LAMINECTOMY (INTERLAMINAR APPROACH) FOR DECOMPRESSION OF NEURAL ELEMENTS, (WITH OR WITHOUT LIGAMENTOUS RESECTION, DISCECTOMY, FACETECTOMY AND/OR FORAMINOTOMY), ANY METHOD, UNDER INDIRECT IMAGE GUIDANCE (EG, FLUOROSCOPIC, CT), SINGLE OR MULTIPLE LEVELS, UNILATERAL OR BILATERAL; LUMBAR
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 0275T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,751.61 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,702.27
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$13,376.32
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
PERCUTANEOUS NEPHROLITHOTOMY OR PYELOLITHOTOMY, LITHOTRIPSY, STONE EXTRACTION, ANTEGRADE URETEROSCOPY, ANTEGRADE STENT PLACEMENT AND NEPHROSTOMY TUBE PLACEMENT, WHEN PERFORMED, INCLUDING IMAGING GUIDANCE; COMPLEX (EG, STONE[S] > 2 CM, BRANCHING STONES, STONES IN MULTIPLE LOCATIONS, URETER STONES, COMPLICATED ANATOMY)
|
Facility
|
OP
|
$28,475.97
|
|
|
Service Code
|
CPT 50081
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,080.33 |
| Max. Negotiated Rate |
$28,475.97 |
| Rate for Payer: Aetna Medicare |
$9,422.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,325.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,325.21
|
| Rate for Payer: BCBS Complete |
$5,099.06
|
| Rate for Payer: BCBS MAPPO |
$9,060.17
|
| Rate for Payer: BCBS Trust/PPO |
$8,078.81
|
| Rate for Payer: BCN Commercial |
$8,078.81
|
| Rate for Payer: BCN Medicare Advantage |
$9,060.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,060.17
|
| Rate for Payer: Mclaren Medicaid |
$4,856.25
|
| Rate for Payer: Mclaren Medicare |
$9,060.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,513.18
|
| Rate for Payer: Meridian Medicaid |
$5,099.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,419.20
|
| Rate for Payer: Nomi Health Commercial |
$19,026.36
|
| Rate for Payer: PACE Medicare |
$8,607.16
|
| Rate for Payer: PACE SWMI |
$9,060.17
|
| Rate for Payer: PHP Medicare Advantage |
$9,060.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,856.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,475.97
|
| Rate for Payer: Priority Health Medicare |
$9,060.17
|
| Rate for Payer: Priority Health Narrow Network |
$22,780.78
|
| Rate for Payer: Railroad Medicare Medicare |
$9,060.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.36
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,060.17
|
| Rate for Payer: UHC Exchange |
$1,080.33
|
| Rate for Payer: UHC Medicare Advantage |
$9,060.17
|
| Rate for Payer: UHCCP Medicaid |
$4,856.25
|
| Rate for Payer: VA VA |
$9,060.17
|
|
|
PERCUTANEOUS NEPHROLITHOTOMY OR PYELOLITHOTOMY, LITHOTRIPSY, STONE EXTRACTION, ANTEGRADE URETEROSCOPY, ANTEGRADE STENT PLACEMENT AND NEPHROSTOMY TUBE PLACEMENT, WHEN PERFORMED, INCLUDING IMAGING GUIDANCE; SIMPLE (EG, STONE[S] UP TO 2 CM IN SINGLE LOCATION OF KIDNEY OR RENAL PELVIS, NONBRANCHING STONES)
|
Facility
|
OP
|
$28,475.97
|
|
|
Service Code
|
CPT 50080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$669.37 |
| Max. Negotiated Rate |
$28,475.97 |
| Rate for Payer: Aetna Medicare |
$9,422.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,325.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,325.21
|
| Rate for Payer: BCBS Complete |
$5,099.06
|
| Rate for Payer: BCBS MAPPO |
$9,060.17
|
| Rate for Payer: BCBS Trust/PPO |
$6,776.90
|
| Rate for Payer: BCN Commercial |
$6,776.90
|
| Rate for Payer: BCN Medicare Advantage |
$9,060.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,060.17
|
| Rate for Payer: Mclaren Medicaid |
$4,856.25
|
| Rate for Payer: Mclaren Medicare |
$9,060.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,513.18
|
| Rate for Payer: Meridian Medicaid |
$5,099.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,419.20
|
| Rate for Payer: Nomi Health Commercial |
$19,026.36
|
| Rate for Payer: PACE Medicare |
$8,607.16
|
| Rate for Payer: PACE SWMI |
$9,060.17
|
| Rate for Payer: PHP Medicare Advantage |
$9,060.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,856.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,475.97
|
| Rate for Payer: Priority Health Medicare |
$9,060.17
|
| Rate for Payer: Priority Health Narrow Network |
$22,780.78
|
| Rate for Payer: Railroad Medicare Medicare |
$9,060.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$736.31
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,060.17
|
| Rate for Payer: UHC Exchange |
$669.37
|
| Rate for Payer: UHC Medicare Advantage |
$9,060.17
|
| Rate for Payer: UHCCP Medicaid |
$4,856.25
|
| Rate for Payer: VA VA |
$9,060.17
|
|
