|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$322.35
|
|
|
Service Code
|
NDC 45802026937
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.83 |
| Max. Negotiated Rate |
$290.12 |
| Rate for Payer: Aetna American Axle |
$209.53
|
| Rate for Payer: Aetna Commercial |
$274.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.53
|
| Rate for Payer: Cash Price |
$257.88
|
| Rate for Payer: Cofinity Commercial |
$225.64
|
| Rate for Payer: Cofinity Commercial |
$277.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.88
|
| Rate for Payer: Healthscope Commercial |
$290.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.00
|
| Rate for Payer: PHP Commercial |
$274.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.53
|
| Rate for Payer: Priority Health SBD |
$203.08
|
| Rate for Payer: UMR Bronson Commercial |
$141.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.76
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$322.35
|
|
|
Service Code
|
NDC 00472024260
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.83 |
| Max. Negotiated Rate |
$290.12 |
| Rate for Payer: Aetna American Axle |
$209.53
|
| Rate for Payer: Aetna Commercial |
$274.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.53
|
| Rate for Payer: Cash Price |
$257.88
|
| Rate for Payer: Cofinity Commercial |
$225.64
|
| Rate for Payer: Cofinity Commercial |
$277.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.88
|
| Rate for Payer: Healthscope Commercial |
$290.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.00
|
| Rate for Payer: PHP Commercial |
$274.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.53
|
| Rate for Payer: Priority Health SBD |
$203.08
|
| Rate for Payer: UMR Bronson Commercial |
$141.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.76
|
|
|
PERPHENAZINE 2 MG TABLET
|
Facility
|
IP
|
$201.40
|
|
|
Service Code
|
NDC 00603506021
|
| Hospital Charge Code |
6157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$88.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
PERPHENAZINE 2 MG TABLET
|
Facility
|
OP
|
$201.40
|
|
|
Service Code
|
NDC 00603506021
|
| Hospital Charge Code |
6157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.52 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna Medicare |
$100.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: BCBS Complete |
$80.56
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$74.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
PERPHENAZINE 2 MG TABLET
|
Facility
|
OP
|
$301.15
|
|
|
Service Code
|
NDC 52536016201
|
| Hospital Charge Code |
6157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.43 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Aetna American Axle |
$195.75
|
| Rate for Payer: Aetna Commercial |
$255.98
|
| Rate for Payer: Aetna Medicare |
$150.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.75
|
| Rate for Payer: BCBS Complete |
$120.46
|
| Rate for Payer: Cash Price |
$240.92
|
| Rate for Payer: Cofinity Commercial |
$210.80
|
| Rate for Payer: Cofinity Commercial |
$258.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.92
|
| Rate for Payer: Healthscope Commercial |
$271.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.98
|
| Rate for Payer: PHP Commercial |
$255.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.75
|
| Rate for Payer: Priority Health SBD |
$189.72
|
| Rate for Payer: UMR Bronson Commercial |
$111.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.86
|
|
|
PERPHENAZINE 2 MG TABLET
|
Facility
|
IP
|
$301.15
|
|
|
Service Code
|
NDC 52536016201
|
| Hospital Charge Code |
6157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.51 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Aetna American Axle |
$195.75
|
| Rate for Payer: Aetna Commercial |
$255.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.75
|
| Rate for Payer: Cash Price |
$240.92
|
| Rate for Payer: Cofinity Commercial |
$210.80
|
| Rate for Payer: Cofinity Commercial |
$258.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.92
|
| Rate for Payer: Healthscope Commercial |
$271.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.98
|
| Rate for Payer: PHP Commercial |
$255.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.75
|
| Rate for Payer: Priority Health SBD |
$189.72
|
| Rate for Payer: UMR Bronson Commercial |
$132.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.86
|
|
|
PERPHENAZINE 4 MG TABLET
|
Facility
|
OP
|
$456.96
|
|
|
Service Code
|
HCPCS Q0175
|
| Hospital Charge Code |
6158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$411.26 |
| Rate for Payer: Aetna American Axle |
$297.02
|
| Rate for Payer: Aetna Commercial |
$388.42
|
| Rate for Payer: Aetna Medicare |
$228.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.02
|
| Rate for Payer: BCBS Complete |
$182.78
|
| Rate for Payer: BCBS Trust/PPO |
$1.88
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$365.57
|
| Rate for Payer: Cash Price |
$365.57
|
| Rate for Payer: Cofinity Commercial |
$319.87
|
| Rate for Payer: Cofinity Commercial |
$392.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$319.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.57
|
| Rate for Payer: Healthscope Commercial |
$411.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.42
|
| Rate for Payer: PHP Commercial |
$388.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.02
|
| Rate for Payer: Priority Health SBD |
$287.88
|
| Rate for Payer: UMR Bronson Commercial |
$169.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.72
|
|
|
PERPHENAZINE 4 MG TABLET
|
Facility
|
IP
|
$456.96
|
|
|
Service Code
|
HCPCS Q0175
|
| Hospital Charge Code |
6158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.06 |
| Max. Negotiated Rate |
$411.26 |
| Rate for Payer: Aetna American Axle |
$297.02
|
| Rate for Payer: Aetna Commercial |
$388.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.02
|
| Rate for Payer: Cash Price |
$365.57
|
| Rate for Payer: Cofinity Commercial |
$319.87
|
| Rate for Payer: Cofinity Commercial |
$392.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$319.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.57
|
| Rate for Payer: Healthscope Commercial |
$411.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.42
|
| Rate for Payer: PHP Commercial |
$388.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.02
|
| Rate for Payer: Priority Health SBD |
$287.88
|
| Rate for Payer: UMR Bronson Commercial |
$201.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.72
|
|
|
PERPHENAZINE 8 MG TABLET
|
Facility
|
OP
|
$529.44
|
|
|
Service Code
|
NDC 00904660161
|
| Hospital Charge Code |
6159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.89 |
| Max. Negotiated Rate |
$476.50 |
| Rate for Payer: Aetna American Axle |
$344.14
|
| Rate for Payer: Aetna Commercial |
$450.02
|
| Rate for Payer: Aetna Medicare |
$264.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.14
|
| Rate for Payer: BCBS Complete |
$211.78
|
| Rate for Payer: Cash Price |
$423.55
|
| Rate for Payer: Cofinity Commercial |
$370.61
|
| Rate for Payer: Cofinity Commercial |
$455.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.55
|
| Rate for Payer: Healthscope Commercial |
$476.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.02
|
| Rate for Payer: PHP Commercial |
$450.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.14
|
| Rate for Payer: Priority Health SBD |
$333.55
|
| Rate for Payer: UMR Bronson Commercial |
$195.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.08
|
|
|
PERPHENAZINE 8 MG TABLET
|
Facility
|
IP
|
$529.44
|
|
|
Service Code
|
NDC 00904660161
|
| Hospital Charge Code |
6159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.95 |
| Max. Negotiated Rate |
$476.50 |
| Rate for Payer: Aetna American Axle |
$344.14
|
| Rate for Payer: Aetna Commercial |
$450.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.14
|
| Rate for Payer: Cash Price |
$423.55
|
| Rate for Payer: Cofinity Commercial |
$370.61
|
| Rate for Payer: Cofinity Commercial |
$455.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.55
|
| Rate for Payer: Healthscope Commercial |
$476.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.02
|
| Rate for Payer: PHP Commercial |
$450.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.14
|
| Rate for Payer: Priority Health SBD |
$333.55
|
| Rate for Payer: UMR Bronson Commercial |
$232.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.08
|
|
|
PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30,624.01
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
160029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,474.56 |
| Max. Negotiated Rate |
$27,561.61 |
| Rate for Payer: Aetna American Axle |
$19,905.61
|
| Rate for Payer: Aetna Commercial |
$26,030.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,905.61
|
| Rate for Payer: Cash Price |
$24,499.21
|
| Rate for Payer: Cofinity Commercial |
$21,436.81
|
| Rate for Payer: Cofinity Commercial |
$26,336.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,436.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,499.21
|
| Rate for Payer: Healthscope Commercial |
$27,561.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,436.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,968.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,030.41
|
| Rate for Payer: PHP Commercial |
$26,030.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,905.61
|
| Rate for Payer: Priority Health SBD |
$19,293.13
|
| Rate for Payer: UMR Bronson Commercial |
$13,474.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,968.01
|
|
|
PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30,624.01
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
160029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$27,561.61 |
| Rate for Payer: Aetna American Axle |
$19,905.61
|
| Rate for Payer: Aetna Commercial |
$26,030.41
|
| Rate for Payer: Aetna Medicare |
$16.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,905.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.24
|
| Rate for Payer: BCBS Complete |
$9.11
|
| Rate for Payer: BCBS MAPPO |
$16.19
|
| Rate for Payer: BCBS Trust/PPO |
$42.63
|
| Rate for Payer: BCN Commercial |
$42.63
|
| Rate for Payer: BCN Medicare Advantage |
$16.19
|
| Rate for Payer: Cash Price |
$24,499.21
|
| Rate for Payer: Cash Price |
$24,499.21
|
| Rate for Payer: Cofinity Commercial |
$26,336.65
|
| Rate for Payer: Cofinity Commercial |
$21,436.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,436.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,499.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.19
|
| Rate for Payer: Healthscope Commercial |
$27,561.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,436.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,968.01
|
| Rate for Payer: Mclaren Medicaid |
$8.68
|
| Rate for Payer: Mclaren Medicare |
$16.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.00
|
| Rate for Payer: Meridian Medicaid |
$9.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,030.41
|
| Rate for Payer: Nomi Health Commercial |
$48.57
|
| Rate for Payer: PACE Medicare |
$15.38
|
| Rate for Payer: PACE SWMI |
$16.19
|
| Rate for Payer: PHP Commercial |
$26,030.41
|
| Rate for Payer: PHP Medicare Advantage |
$16.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,905.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.40
|
| Rate for Payer: Priority Health Medicare |
$16.19
|
| Rate for Payer: Priority Health Narrow Network |
$37.12
|
| Rate for Payer: Priority Health SBD |
$19,293.13
|
| Rate for Payer: Railroad Medicare Medicare |
$16.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.19
|
| Rate for Payer: UHC Exchange |
$30.94
|
| Rate for Payer: UHC Medicare Advantage |
$16.19
|
| Rate for Payer: UHCCP Medicaid |
$8.68
|
| Rate for Payer: UMR Bronson Commercial |
$11,330.88
|
| Rate for Payer: VA VA |
$16.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,968.01
|
|
|
PERTUZUMAB 600 MG-TRASTUZUMAB 600 MG-HYALURONID-ZZXF/10 ML SUBCUT SOLN
|
Facility
|
OP
|
$41,655.17
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
194378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.24 |
| Max. Negotiated Rate |
$37,489.65 |
| Rate for Payer: Aetna American Axle |
$27,075.86
|
| Rate for Payer: Aetna Commercial |
$35,406.89
|
| Rate for Payer: Aetna Medicare |
$66.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,075.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.85
|
| Rate for Payer: BCBS Complete |
$35.95
|
| Rate for Payer: BCBS MAPPO |
$63.88
|
| Rate for Payer: BCBS Trust/PPO |
$174.11
|
| Rate for Payer: BCN Commercial |
$174.11
|
| Rate for Payer: BCN Medicare Advantage |
$63.88
|
| Rate for Payer: Cash Price |
$33,324.14
|
| Rate for Payer: Cash Price |
$33,324.14
|
| Rate for Payer: Cofinity Commercial |
$35,823.45
|
| Rate for Payer: Cofinity Commercial |
$29,158.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$29,158.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,324.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.88
|
| Rate for Payer: Healthscope Commercial |
$37,489.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29,158.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,241.38
|
| Rate for Payer: Mclaren Medicaid |
$34.24
|
| Rate for Payer: Mclaren Medicare |
$63.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.07
|
| Rate for Payer: Meridian Medicaid |
$35.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,406.89
|
| Rate for Payer: Nomi Health Commercial |
$191.64
|
| Rate for Payer: PACE Medicare |
$60.69
|
| Rate for Payer: PACE SWMI |
$63.88
|
| Rate for Payer: PHP Commercial |
$35,406.89
|
| Rate for Payer: PHP Medicare Advantage |
$63.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27,075.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.85
|
| Rate for Payer: Priority Health Medicare |
$63.88
|
| Rate for Payer: Priority Health Narrow Network |
$148.68
|
| Rate for Payer: Priority Health SBD |
$26,242.76
|
| Rate for Payer: Railroad Medicare Medicare |
$63.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.88
|
| Rate for Payer: UHC Exchange |
$122.08
|
| Rate for Payer: UHC Medicare Advantage |
$63.88
|
| Rate for Payer: UHCCP Medicaid |
$34.24
|
| Rate for Payer: UMR Bronson Commercial |
$15,412.41
|
| Rate for Payer: VA VA |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,241.38
|
|
|
PERTUZUMAB 600 MG-TRASTUZUMAB 600 MG-HYALURONID-ZZXF/10 ML SUBCUT SOLN
|
Facility
|
IP
|
$41,655.17
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
194378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,328.27 |
| Max. Negotiated Rate |
$37,489.65 |
| Rate for Payer: Aetna American Axle |
$27,075.86
|
| Rate for Payer: Aetna Commercial |
$35,406.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,075.86
|
| Rate for Payer: Cash Price |
$33,324.14
|
| Rate for Payer: Cofinity Commercial |
$29,158.62
|
| Rate for Payer: Cofinity Commercial |
$35,823.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$29,158.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,324.14
|
| Rate for Payer: Healthscope Commercial |
$37,489.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29,158.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,241.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,406.89
|
| Rate for Payer: PHP Commercial |
$35,406.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27,075.86
|
| Rate for Payer: Priority Health SBD |
$26,242.76
|
| Rate for Payer: UMR Bronson Commercial |
$18,328.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,241.38
|
|
|
PE/TROP/CYC/KETOR (PF) 10-1-0.5% OPH (EYE DROP #4)
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
NDC 09900000895
|
| Hospital Charge Code |
180468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna Medicare |
$25.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$18.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
PE/TROP/CYC/KETOR (PF) 10-1-0.5% OPH (EYE DROP #4)
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
NDC 09900000895
|
| Hospital Charge Code |
180468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
OP
|
$199.50
|
|
|
Service Code
|
NDC 65162068110
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna American Axle |
$129.68
|
| Rate for Payer: Aetna Commercial |
$169.58
|
| Rate for Payer: Aetna Medicare |
$99.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: BCBS Complete |
$79.80
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.58
|
| Rate for Payer: PHP Commercial |
$169.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.68
|
| Rate for Payer: Priority Health SBD |
$125.68
|
| Rate for Payer: UMR Bronson Commercial |
$73.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
OP
|
$238.45
|
|
|
Service Code
|
NDC 75826011410
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.23 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna American Axle |
$154.99
|
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna Medicare |
$119.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.99
|
| Rate for Payer: BCBS Complete |
$95.38
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$166.92
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: Priority Health SBD |
$150.22
|
| Rate for Payer: UMR Bronson Commercial |
$88.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 75826011410
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.92 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna American Axle |
$154.99
|
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.99
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$166.92
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: Priority Health SBD |
$150.22
|
| Rate for Payer: UMR Bronson Commercial |
$104.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
OP
|
$379.68
|
|
|
Service Code
|
NDC 69367016204
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.48 |
| Max. Negotiated Rate |
$341.71 |
| Rate for Payer: Aetna American Axle |
$246.79
|
| Rate for Payer: Aetna Commercial |
$322.73
|
| Rate for Payer: Aetna Medicare |
$189.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.79
|
| Rate for Payer: BCBS Complete |
$151.87
|
| Rate for Payer: Cash Price |
$303.74
|
| Rate for Payer: Cofinity Commercial |
$265.78
|
| Rate for Payer: Cofinity Commercial |
$326.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$265.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.74
|
| Rate for Payer: Healthscope Commercial |
$341.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.73
|
| Rate for Payer: PHP Commercial |
$322.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.79
|
| Rate for Payer: Priority Health SBD |
$239.20
|
| Rate for Payer: UMR Bronson Commercial |
$140.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.76
|
|
|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
IP
|
$199.50
|
|
|
Service Code
|
NDC 65162068110
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna American Axle |
$129.68
|
| Rate for Payer: Aetna Commercial |
$169.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.58
|
| Rate for Payer: PHP Commercial |
$169.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.68
|
| Rate for Payer: Priority Health SBD |
$125.68
|
| Rate for Payer: UMR Bronson Commercial |
$87.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
OP
|
$282.15
|
|
|
Service Code
|
NDC 51293081001
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$253.94 |
| Rate for Payer: Aetna American Axle |
$183.40
|
| Rate for Payer: Aetna Commercial |
$239.83
|
| Rate for Payer: Aetna Medicare |
$141.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.40
|
| Rate for Payer: BCBS Complete |
$112.86
|
| Rate for Payer: Cash Price |
$225.72
|
| Rate for Payer: Cofinity Commercial |
$197.50
|
| Rate for Payer: Cofinity Commercial |
$242.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.72
|
| Rate for Payer: Healthscope Commercial |
$253.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.83
|
| Rate for Payer: PHP Commercial |
$239.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.40
|
| Rate for Payer: Priority Health SBD |
$177.75
|
| Rate for Payer: UMR Bronson Commercial |
$104.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.61
|
|
|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
IP
|
$379.68
|
|
|
Service Code
|
NDC 69367016204
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.06 |
| Max. Negotiated Rate |
$341.71 |
| Rate for Payer: Aetna American Axle |
$246.79
|
| Rate for Payer: Aetna Commercial |
$322.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.79
|
| Rate for Payer: Cash Price |
$303.74
|
| Rate for Payer: Cofinity Commercial |
$265.78
|
| Rate for Payer: Cofinity Commercial |
$326.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$265.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.74
|
| Rate for Payer: Healthscope Commercial |
$341.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.73
|
| Rate for Payer: PHP Commercial |
$322.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.79
|
| Rate for Payer: Priority Health SBD |
$239.20
|
| Rate for Payer: UMR Bronson Commercial |
$167.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.76
|
|
|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 42192080101
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.21 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna American Axle |
$137.70
|
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.70
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$148.30
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.70
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UMR Bronson Commercial |
$93.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
PHENAZOPYRIDINE 100 MG TABLET
|
Facility
|
IP
|
$282.15
|
|
|
Service Code
|
NDC 51293081001
|
| Hospital Charge Code |
6193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$253.94 |
| Rate for Payer: Aetna American Axle |
$183.40
|
| Rate for Payer: Aetna Commercial |
$239.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.40
|
| Rate for Payer: Cash Price |
$225.72
|
| Rate for Payer: Cofinity Commercial |
$197.50
|
| Rate for Payer: Cofinity Commercial |
$242.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.72
|
| Rate for Payer: Healthscope Commercial |
$253.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.83
|
| Rate for Payer: PHP Commercial |
$239.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.40
|
| Rate for Payer: Priority Health SBD |
$177.75
|
| Rate for Payer: UMR Bronson Commercial |
$124.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.61
|
|
