|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$18.80
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$16.92 |
| Rate for Payer: Aetna Commercial |
$15.98
|
| Rate for Payer: Aetna Medicare |
$9.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.22
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: Cash Price |
$15.04
|
| Rate for Payer: Cofinity Advantage |
$13.16
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.04
|
| Rate for Payer: Healthscope Commercial |
$16.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.10
|
| Rate for Payer: PHP Commercial |
$15.98
|
| Rate for Payer: Priority Health SBD |
$11.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.22
|
| Rate for Payer: UHC Core |
$9.79
|
| Rate for Payer: UHC Exchange |
$7.39
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$383.05
|
|
|
Service Code
|
NDC 60687046801
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.32 |
| Max. Negotiated Rate |
$344.75 |
| Rate for Payer: Aetna Commercial |
$325.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.98
|
| Rate for Payer: Cash Price |
$306.44
|
| Rate for Payer: Cofinity Advantage |
$268.13
|
| Rate for Payer: Cofinity Commercial |
$329.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.44
|
| Rate for Payer: Healthscope Commercial |
$344.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.29
|
| Rate for Payer: PHP Commercial |
$325.59
|
| Rate for Payer: Priority Health SBD |
$241.32
|
|
|
ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,166.40
|
|
|
Service Code
|
HCPCS J1744
|
| Hospital Charge Code |
153436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,624.83 |
| Max. Negotiated Rate |
$3,749.76 |
| Rate for Payer: Aetna Commercial |
$3,541.44
|
| Rate for Payer: Aetna Commercial |
$1,824.08
|
| Rate for Payer: Aetna Commercial |
$6,528.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,708.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,992.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,394.89
|
| Rate for Payer: Cash Price |
$6,144.85
|
| Rate for Payer: Cash Price |
$3,333.12
|
| Rate for Payer: Cash Price |
$1,716.78
|
| Rate for Payer: Cofinity Advantage |
$2,916.48
|
| Rate for Payer: Cofinity Advantage |
$1,502.19
|
| Rate for Payer: Cofinity Advantage |
$5,376.74
|
| Rate for Payer: Cofinity Commercial |
$6,605.71
|
| Rate for Payer: Cofinity Commercial |
$1,845.54
|
| Rate for Payer: Cofinity Commercial |
$3,583.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,333.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,716.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,144.85
|
| Rate for Payer: Healthscope Commercial |
$1,931.38
|
| Rate for Payer: Healthscope Commercial |
$3,749.76
|
| Rate for Payer: Healthscope Commercial |
$6,912.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,541.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,528.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,760.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,609.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,124.80
|
| Rate for Payer: PHP Commercial |
$1,824.08
|
| Rate for Payer: PHP Commercial |
$6,528.90
|
| Rate for Payer: PHP Commercial |
$3,541.44
|
| Rate for Payer: Priority Health SBD |
$4,839.07
|
| Rate for Payer: Priority Health SBD |
$1,351.97
|
| Rate for Payer: Priority Health SBD |
$2,624.83
|
|
|
ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$7,681.06
|
|
|
Service Code
|
HCPCS J1744
|
| Hospital Charge Code |
153436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.58 |
| Max. Negotiated Rate |
$6,912.95 |
| Rate for Payer: Aetna Commercial |
$6,528.90
|
| Rate for Payer: Aetna Commercial |
$3,541.44
|
| Rate for Payer: Aetna Commercial |
$1,824.08
|
| Rate for Payer: Aetna Medicare |
$1,072.99
|
| Rate for Payer: Aetna Medicare |
$3,840.53
|
| Rate for Payer: Aetna Medicare |
$2,083.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,708.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,992.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,394.89
|
| Rate for Payer: BCBS Complete |
$1,666.56
|
| Rate for Payer: BCBS Complete |
$858.39
|
| Rate for Payer: BCBS Complete |
$3,072.42
|
| Rate for Payer: BCBS Trust/PPO |
$181.16
|
| Rate for Payer: BCBS Trust/PPO |
$181.16
|
| Rate for Payer: BCBS Trust/PPO |
$181.16
|
| Rate for Payer: BCN Commercial |
$181.16
|
| Rate for Payer: BCN Commercial |
$181.16
|
| Rate for Payer: BCN Commercial |
$181.16
|
| Rate for Payer: Cash Price |
$3,333.12
|
| Rate for Payer: Cash Price |
$1,716.78
|
| Rate for Payer: Cash Price |
$1,716.78
|
| Rate for Payer: Cash Price |
$3,333.12
|
| Rate for Payer: Cash Price |
$6,144.85
|
| Rate for Payer: Cash Price |
$6,144.85
|
| Rate for Payer: Cofinity Advantage |
$1,502.19
|
| Rate for Payer: Cofinity Advantage |
$2,916.48
|
| Rate for Payer: Cofinity Advantage |
$5,376.74
|
| Rate for Payer: Cofinity Commercial |
$1,845.54
|
| Rate for Payer: Cofinity Commercial |
$3,583.10
|
| Rate for Payer: Cofinity Commercial |
$6,605.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,333.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,144.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,716.78
|
| Rate for Payer: Healthscope Commercial |
$3,749.76
|
| Rate for Payer: Healthscope Commercial |
$6,912.95
|
| Rate for Payer: Healthscope Commercial |
$1,931.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,716.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,333.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,144.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,528.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,541.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,760.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,609.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,124.80
|
| Rate for Payer: PHP Commercial |
$3,541.44
|
| Rate for Payer: PHP Commercial |
$6,528.90
|
| Rate for Payer: PHP Commercial |
$1,824.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.47
|
| Rate for Payer: Priority Health SBD |
$4,839.07
|
| Rate for Payer: Priority Health SBD |
$2,624.83
|
| Rate for Payer: Priority Health SBD |
$1,351.97
|
| Rate for Payer: Priority Health Tiered Network |
$39.58
|
| Rate for Payer: Priority Health Tiered Network |
$39.58
|
| Rate for Payer: Priority Health Tiered Network |
$39.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.38
|
| Rate for Payer: UHC Core |
$518.38
|
| Rate for Payer: UHC Core |
$518.38
|
| Rate for Payer: UHC Core |
$518.38
|
| Rate for Payer: UHC Exchange |
$518.38
|
| Rate for Payer: UHC Exchange |
$518.38
|
| Rate for Payer: UHC Exchange |
$518.38
|
|
|
IMATINIB 100 MG TABLET
|
Facility
|
IP
|
$491.19
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
32979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$309.45 |
| Max. Negotiated Rate |
$442.07 |
| Rate for Payer: Aetna Commercial |
$417.51
|
| Rate for Payer: Aetna Commercial |
$414.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.27
|
| Rate for Payer: Cash Price |
$389.84
|
| Rate for Payer: Cash Price |
$392.95
|
| Rate for Payer: Cofinity Advantage |
$341.11
|
| Rate for Payer: Cofinity Advantage |
$343.83
|
| Rate for Payer: Cofinity Commercial |
$419.08
|
| Rate for Payer: Cofinity Commercial |
$422.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.84
|
| Rate for Payer: Healthscope Commercial |
$442.07
|
| Rate for Payer: Healthscope Commercial |
$438.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$365.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.39
|
| Rate for Payer: PHP Commercial |
$414.20
|
| Rate for Payer: PHP Commercial |
$417.51
|
| Rate for Payer: Priority Health SBD |
$307.00
|
| Rate for Payer: Priority Health SBD |
$309.45
|
|
|
IMATINIB 100 MG TABLET
|
Facility
|
OP
|
$491.19
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
32979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.48 |
| Max. Negotiated Rate |
$442.07 |
| Rate for Payer: Aetna Commercial |
$417.51
|
| Rate for Payer: Aetna Commercial |
$414.20
|
| Rate for Payer: Aetna Medicare |
$243.65
|
| Rate for Payer: Aetna Medicare |
$245.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.27
|
| Rate for Payer: BCBS Complete |
$194.92
|
| Rate for Payer: BCBS Complete |
$196.48
|
| Rate for Payer: Cash Price |
$392.95
|
| Rate for Payer: Cash Price |
$389.84
|
| Rate for Payer: Cofinity Advantage |
$343.83
|
| Rate for Payer: Cofinity Advantage |
$341.11
|
| Rate for Payer: Cofinity Commercial |
$419.08
|
| Rate for Payer: Cofinity Commercial |
$422.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.95
|
| Rate for Payer: Healthscope Commercial |
$438.57
|
| Rate for Payer: Healthscope Commercial |
$442.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$392.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$389.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$365.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.39
|
| Rate for Payer: PHP Commercial |
$414.20
|
| Rate for Payer: PHP Commercial |
$417.51
|
| Rate for Payer: Priority Health SBD |
$307.00
|
| Rate for Payer: Priority Health SBD |
$309.45
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$44.16
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
9603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$39.74 |
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.70
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cofinity Advantage |
$30.91
|
| Rate for Payer: Cofinity Commercial |
$37.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$39.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.12
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: Priority Health SBD |
$27.82
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$44.16
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
9603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$39.74 |
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Medicare |
$22.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.70
|
| Rate for Payer: BCBS Complete |
$17.66
|
| Rate for Payer: BCBS Trust/PPO |
$17.80
|
| Rate for Payer: BCN Commercial |
$17.80
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cofinity Advantage |
$30.91
|
| Rate for Payer: Cofinity Commercial |
$37.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$39.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.12
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: Priority Health SBD |
$27.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.72
|
| Rate for Payer: UHC Core |
$11.72
|
| Rate for Payer: UHC Exchange |
$11.72
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
IP
|
$9,088.59
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,725.81 |
| Max. Negotiated Rate |
$8,179.73 |
| Rate for Payer: Aetna Commercial |
$7,725.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,907.58
|
| Rate for Payer: Cash Price |
$7,270.87
|
| Rate for Payer: Cofinity Advantage |
$6,362.01
|
| Rate for Payer: Cofinity Commercial |
$7,816.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,270.87
|
| Rate for Payer: Healthscope Commercial |
$8,179.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,725.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,816.44
|
| Rate for Payer: PHP Commercial |
$7,725.30
|
| Rate for Payer: Priority Health SBD |
$5,725.81
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
OP
|
$9,088.59
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$8,179.73 |
| Rate for Payer: Aetna Commercial |
$7,725.30
|
| Rate for Payer: Aetna Medicare |
$51.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,907.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.16
|
| Rate for Payer: BCBS Complete |
$27.31
|
| Rate for Payer: BCBS MAPPO |
$49.73
|
| Rate for Payer: BCBS Trust/PPO |
$123.12
|
| Rate for Payer: BCN Commercial |
$123.12
|
| Rate for Payer: BCN Medicare Advantage |
$49.73
|
| Rate for Payer: Cash Price |
$7,270.87
|
| Rate for Payer: Cash Price |
$7,270.87
|
| Rate for Payer: Cofinity Advantage |
$6,362.01
|
| Rate for Payer: Cofinity Commercial |
$7,816.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,270.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.73
|
| Rate for Payer: Healthscope Commercial |
$8,179.73
|
| Rate for Payer: Mclaren Medicaid |
$26.01
|
| Rate for Payer: Mclaren Medicare |
$49.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.22
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,725.30
|
| Rate for Payer: Nomi Health Commercial |
$149.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,816.44
|
| Rate for Payer: PACE Medicare |
$47.24
|
| Rate for Payer: PACE SWMI |
$49.73
|
| Rate for Payer: PHP Commercial |
$7,725.30
|
| Rate for Payer: PHP Medicare Advantage |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$154.42
|
| Rate for Payer: Priority Health Medicare |
$49.73
|
| Rate for Payer: Priority Health SBD |
$5,725.81
|
| Rate for Payer: Priority Health Tiered Network |
$123.54
|
| Rate for Payer: Railroad Medicare Medicare |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.98
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.73
|
| Rate for Payer: UHC Exchange |
$80.98
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: VA VA |
$49.73
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
OP
|
$18,177.18
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
172845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$16,359.46 |
| Rate for Payer: Aetna Commercial |
$15,450.60
|
| Rate for Payer: Aetna Medicare |
$51.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,815.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.16
|
| Rate for Payer: BCBS Complete |
$27.31
|
| Rate for Payer: BCBS MAPPO |
$49.73
|
| Rate for Payer: BCBS Trust/PPO |
$123.12
|
| Rate for Payer: BCN Commercial |
$123.12
|
| Rate for Payer: BCN Medicare Advantage |
$49.73
|
| Rate for Payer: Cash Price |
$14,541.74
|
| Rate for Payer: Cash Price |
$14,541.74
|
| Rate for Payer: Cofinity Advantage |
$12,724.03
|
| Rate for Payer: Cofinity Commercial |
$15,632.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,541.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.73
|
| Rate for Payer: Healthscope Commercial |
$16,359.46
|
| Rate for Payer: Mclaren Medicaid |
$26.01
|
| Rate for Payer: Mclaren Medicare |
$49.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.22
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,450.60
|
| Rate for Payer: Nomi Health Commercial |
$149.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,632.89
|
| Rate for Payer: PACE Medicare |
$47.24
|
| Rate for Payer: PACE SWMI |
$49.73
|
| Rate for Payer: PHP Commercial |
$15,450.60
|
| Rate for Payer: PHP Medicare Advantage |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$154.42
|
| Rate for Payer: Priority Health Medicare |
$49.73
|
| Rate for Payer: Priority Health SBD |
$11,451.62
|
| Rate for Payer: Priority Health Tiered Network |
$123.54
|
| Rate for Payer: Railroad Medicare Medicare |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.98
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.73
|
| Rate for Payer: UHC Exchange |
$80.98
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: VA VA |
$49.73
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
IP
|
$18,177.18
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
172845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,451.62 |
| Max. Negotiated Rate |
$16,359.46 |
| Rate for Payer: Aetna Commercial |
$15,450.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,815.17
|
| Rate for Payer: Cash Price |
$14,541.74
|
| Rate for Payer: Cofinity Advantage |
$12,724.03
|
| Rate for Payer: Cofinity Commercial |
$15,632.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,541.74
|
| Rate for Payer: Healthscope Commercial |
$16,359.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,450.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,632.89
|
| Rate for Payer: PHP Commercial |
$15,450.60
|
| Rate for Payer: Priority Health SBD |
$11,451.62
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$9,178.00
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,782.14 |
| Max. Negotiated Rate |
$8,260.20 |
| Rate for Payer: Aetna Commercial |
$7,801.30
|
| Rate for Payer: Aetna Commercial |
$11,701.95
|
| Rate for Payer: Aetna Commercial |
$975.16
|
| Rate for Payer: Aetna Commercial |
$1,950.33
|
| Rate for Payer: Aetna Commercial |
$3,900.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,982.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,948.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,491.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,965.70
|
| Rate for Payer: Cash Price |
$1,835.60
|
| Rate for Payer: Cash Price |
$7,342.40
|
| Rate for Payer: Cash Price |
$11,013.60
|
| Rate for Payer: Cash Price |
$917.80
|
| Rate for Payer: Cash Price |
$3,670.88
|
| Rate for Payer: Cofinity Advantage |
$3,212.02
|
| Rate for Payer: Cofinity Advantage |
$1,606.15
|
| Rate for Payer: Cofinity Advantage |
$6,424.60
|
| Rate for Payer: Cofinity Advantage |
$803.08
|
| Rate for Payer: Cofinity Advantage |
$9,636.90
|
| Rate for Payer: Cofinity Commercial |
$7,893.08
|
| Rate for Payer: Cofinity Commercial |
$1,973.27
|
| Rate for Payer: Cofinity Commercial |
$3,946.20
|
| Rate for Payer: Cofinity Commercial |
$11,839.62
|
| Rate for Payer: Cofinity Commercial |
$986.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,835.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$917.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,013.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,670.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,342.40
|
| Rate for Payer: Healthscope Commercial |
$2,065.05
|
| Rate for Payer: Healthscope Commercial |
$8,260.20
|
| Rate for Payer: Healthscope Commercial |
$12,390.30
|
| Rate for Payer: Healthscope Commercial |
$1,032.53
|
| Rate for Payer: Healthscope Commercial |
$4,129.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,950.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$975.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,801.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,900.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,701.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,720.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,325.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,441.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$860.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,883.50
|
| Rate for Payer: PHP Commercial |
$975.16
|
| Rate for Payer: PHP Commercial |
$3,900.31
|
| Rate for Payer: PHP Commercial |
$7,801.30
|
| Rate for Payer: PHP Commercial |
$11,701.95
|
| Rate for Payer: PHP Commercial |
$1,950.33
|
| Rate for Payer: Priority Health SBD |
$2,890.82
|
| Rate for Payer: Priority Health SBD |
$1,445.54
|
| Rate for Payer: Priority Health SBD |
$8,673.21
|
| Rate for Payer: Priority Health SBD |
$722.77
|
| Rate for Payer: Priority Health SBD |
$5,782.14
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$2,294.50
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$2,065.05 |
| Rate for Payer: Aetna Commercial |
$1,950.33
|
| Rate for Payer: Aetna Commercial |
$11,701.95
|
| Rate for Payer: Aetna Commercial |
$7,801.30
|
| Rate for Payer: Aetna Commercial |
$3,900.31
|
| Rate for Payer: Aetna Commercial |
$975.16
|
| Rate for Payer: Aetna Medicare |
$51.04
|
| Rate for Payer: Aetna Medicare |
$51.04
|
| Rate for Payer: Aetna Medicare |
$51.04
|
| Rate for Payer: Aetna Medicare |
$51.04
|
| Rate for Payer: Aetna Medicare |
$51.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,491.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,948.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,982.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,965.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS Trust/PPO |
$118.64
|
| Rate for Payer: BCBS Trust/PPO |
$118.64
|
| Rate for Payer: BCBS Trust/PPO |
$118.64
|
| Rate for Payer: BCBS Trust/PPO |
$118.64
|
| Rate for Payer: BCBS Trust/PPO |
$118.64
|
| Rate for Payer: BCN Commercial |
$118.64
|
| Rate for Payer: BCN Commercial |
$118.64
|
| Rate for Payer: BCN Commercial |
$118.64
|
| Rate for Payer: BCN Commercial |
$118.64
|
| Rate for Payer: BCN Commercial |
$118.64
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: Cash Price |
$11,013.60
|
| Rate for Payer: Cash Price |
$917.80
|
| Rate for Payer: Cash Price |
$917.80
|
| Rate for Payer: Cash Price |
$7,342.40
|
| Rate for Payer: Cash Price |
$7,342.40
|
| Rate for Payer: Cash Price |
$3,670.88
|
| Rate for Payer: Cash Price |
$3,670.88
|
| Rate for Payer: Cash Price |
$1,835.60
|
| Rate for Payer: Cash Price |
$1,835.60
|
| Rate for Payer: Cash Price |
$11,013.60
|
| Rate for Payer: Cofinity Advantage |
$803.08
|
| Rate for Payer: Cofinity Advantage |
$9,636.90
|
| Rate for Payer: Cofinity Advantage |
$3,212.02
|
| Rate for Payer: Cofinity Advantage |
$6,424.60
|
| Rate for Payer: Cofinity Advantage |
$1,606.15
|
| Rate for Payer: Cofinity Commercial |
$7,893.08
|
| Rate for Payer: Cofinity Commercial |
$986.63
|
| Rate for Payer: Cofinity Commercial |
$3,946.20
|
| Rate for Payer: Cofinity Commercial |
$1,973.27
|
| Rate for Payer: Cofinity Commercial |
$11,839.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,835.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,670.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,342.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$917.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,013.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Healthscope Commercial |
$1,032.53
|
| Rate for Payer: Healthscope Commercial |
$12,390.30
|
| Rate for Payer: Healthscope Commercial |
$2,065.05
|
| Rate for Payer: Healthscope Commercial |
$4,129.74
|
| Rate for Payer: Healthscope Commercial |
$8,260.20
|
| Rate for Payer: Mclaren Medicaid |
$25.67
|
| Rate for Payer: Mclaren Medicaid |
$25.67
|
| Rate for Payer: Mclaren Medicaid |
$25.67
|
| Rate for Payer: Mclaren Medicaid |
$25.67
|
| Rate for Payer: Mclaren Medicaid |
$25.67
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Medicaid |
$51.53
|
| Rate for Payer: Meridian Medicaid |
$51.53
|
| Rate for Payer: Meridian Medicaid |
$51.53
|
| Rate for Payer: Meridian Medicaid |
$51.53
|
| Rate for Payer: Meridian Medicaid |
$51.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,701.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,801.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,900.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,950.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$975.16
|
| Rate for Payer: Nomi Health Commercial |
$147.24
|
| Rate for Payer: Nomi Health Commercial |
$147.24
|
| Rate for Payer: Nomi Health Commercial |
$147.24
|
| Rate for Payer: Nomi Health Commercial |
$147.24
|
| Rate for Payer: Nomi Health Commercial |
$147.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,441.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,883.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,720.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,325.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$860.44
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PHP Commercial |
$1,950.33
|
| Rate for Payer: PHP Commercial |
$7,801.30
|
| Rate for Payer: PHP Commercial |
$975.16
|
| Rate for Payer: PHP Commercial |
$11,701.95
|
| Rate for Payer: PHP Commercial |
$3,900.31
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.92
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health SBD |
$8,673.21
|
| Rate for Payer: Priority Health SBD |
$2,890.82
|
| Rate for Payer: Priority Health SBD |
$5,782.14
|
| Rate for Payer: Priority Health SBD |
$1,445.54
|
| Rate for Payer: Priority Health SBD |
$722.77
|
| Rate for Payer: Priority Health Tiered Network |
$114.34
|
| Rate for Payer: Priority Health Tiered Network |
$114.34
|
| Rate for Payer: Priority Health Tiered Network |
$114.34
|
| Rate for Payer: Priority Health Tiered Network |
$114.34
|
| Rate for Payer: Priority Health Tiered Network |
$114.34
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.03
|
| Rate for Payer: UHC Core |
$78.03
|
| Rate for Payer: UHC Core |
$78.03
|
| Rate for Payer: UHC Core |
$78.03
|
| Rate for Payer: UHC Core |
$78.03
|
| Rate for Payer: UHC Core |
$78.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: VA VA |
$49.08
|
| Rate for Payer: VA VA |
$49.08
|
| Rate for Payer: VA VA |
$49.08
|
| Rate for Payer: VA VA |
$49.08
|
| Rate for Payer: VA VA |
$49.08
|
|
|
IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$2,921.34
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,840.44 |
| Max. Negotiated Rate |
$2,629.21 |
| Rate for Payer: Aetna Commercial |
$2,483.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,898.87
|
| Rate for Payer: Cash Price |
$2,337.07
|
| Rate for Payer: Cofinity Advantage |
$2,044.94
|
| Rate for Payer: Cofinity Commercial |
$2,512.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,337.07
|
| Rate for Payer: Healthscope Commercial |
$2,629.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,483.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,191.01
|
| Rate for Payer: PHP Commercial |
$2,483.14
|
| Rate for Payer: Priority Health SBD |
$1,840.44
|
|
|
IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$2,921.34
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$2,629.21 |
| Rate for Payer: Aetna Commercial |
$2,483.14
|
| Rate for Payer: Aetna Medicare |
$83.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,898.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.50
|
| Rate for Payer: BCBS Complete |
$44.16
|
| Rate for Payer: BCBS MAPPO |
$80.40
|
| Rate for Payer: BCBS Trust/PPO |
$197.93
|
| Rate for Payer: BCN Commercial |
$197.93
|
| Rate for Payer: BCN Medicare Advantage |
$80.40
|
| Rate for Payer: Cash Price |
$2,337.07
|
| Rate for Payer: Cash Price |
$2,337.07
|
| Rate for Payer: Cofinity Advantage |
$2,044.94
|
| Rate for Payer: Cofinity Commercial |
$2,512.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,337.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.40
|
| Rate for Payer: Healthscope Commercial |
$2,629.21
|
| Rate for Payer: Mclaren Medicaid |
$42.05
|
| Rate for Payer: Mclaren Medicare |
$80.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.42
|
| Rate for Payer: Meridian Medicaid |
$84.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,483.14
|
| Rate for Payer: Nomi Health Commercial |
$241.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,191.01
|
| Rate for Payer: PACE Medicare |
$76.38
|
| Rate for Payer: PACE SWMI |
$80.40
|
| Rate for Payer: PHP Commercial |
$2,483.14
|
| Rate for Payer: PHP Medicare Advantage |
$80.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$248.50
|
| Rate for Payer: Priority Health Medicare |
$80.40
|
| Rate for Payer: Priority Health SBD |
$1,840.44
|
| Rate for Payer: Priority Health Tiered Network |
$198.80
|
| Rate for Payer: Railroad Medicare Medicare |
$80.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.17
|
| Rate for Payer: UHC Core |
$130.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.40
|
| Rate for Payer: UHC Exchange |
$130.17
|
| Rate for Payer: UHC Medicaid |
$42.05
|
| Rate for Payer: UHCCP Medicaid |
$42.05
|
| Rate for Payer: VA VA |
$80.40
|
|
|
IMPACT PEPTIDE 1.5 BOLUS FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
150765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
|
|
IMPACT PEPTIDE 1.5 BOLUS FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
150765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.29
|
| Rate for Payer: UHC Core |
$34.70
|
| Rate for Payer: UHC Exchange |
$26.17
|
|
|
IMPACT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.29
|
| Rate for Payer: UHC Core |
$34.70
|
| Rate for Payer: UHC Exchange |
$26.17
|
|
|
IMPACT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
|
|
IMPACT PEPTIDE 1.5 CYCLIC FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
|
|
IMPACT PEPTIDE 1.5 CYCLIC FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.29
|
| Rate for Payer: UHC Core |
$34.70
|
| Rate for Payer: UHC Exchange |
$26.17
|
|
|
IMPACT PEPTIDE 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
|
|
IMPACT PEPTIDE 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.29
|
| Rate for Payer: UHC Core |
$34.70
|
| Rate for Payer: UHC Exchange |
$26.17
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$94,084.26
|
|
|
Service Code
|
APR-DRG 1613
|
| Min. Negotiated Rate |
$89,604.06 |
| Max. Negotiated Rate |
$94,084.26 |
| Rate for Payer: BCBS Complete |
$94,084.26
|
| Rate for Payer: Mclaren Medicaid |
$89,604.06
|
| Rate for Payer: Meridian Medicaid |
$94,084.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$89,604.06
|
| Rate for Payer: UHC Medicaid |
$89,604.06
|
| Rate for Payer: UHCCP Medicaid |
$89,604.06
|
|
