|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$16.22
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Aetna Commercial |
$13.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.54
|
| Rate for Payer: Cash Price |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$13.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.98
|
| Rate for Payer: Healthscope Commercial |
$14.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.79
|
| Rate for Payer: PHP Commercial |
$13.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health SBD |
$10.22
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$16.22
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Aetna Commercial |
$13.79
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.54
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: Cash Price |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$13.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.98
|
| Rate for Payer: Healthscope Commercial |
$14.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.79
|
| Rate for Payer: PHP Commercial |
$13.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health SBD |
$10.22
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$408.90
|
|
|
Service Code
|
NDC 60687046801
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.61 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Aetna Commercial |
$347.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.79
|
| Rate for Payer: Cash Price |
$327.12
|
| Rate for Payer: Cofinity Commercial |
$286.23
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.12
|
| Rate for Payer: Healthscope Commercial |
$368.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.56
|
| Rate for Payer: PHP Commercial |
$347.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.79
|
| Rate for Payer: Priority Health SBD |
$257.61
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$408.90
|
|
|
Service Code
|
NDC 60687046801
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.56 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Aetna Commercial |
$347.56
|
| Rate for Payer: Aetna Medicare |
$204.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.79
|
| Rate for Payer: BCBS Complete |
$163.56
|
| Rate for Payer: Cash Price |
$327.12
|
| Rate for Payer: Cofinity Commercial |
$286.23
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.12
|
| Rate for Payer: Healthscope Commercial |
$368.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.56
|
| Rate for Payer: PHP Commercial |
$347.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.79
|
| Rate for Payer: Priority Health SBD |
$257.61
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$46.53
|
|
|
Service Code
|
NDC 68645056354
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.31 |
| Max. Negotiated Rate |
$41.88 |
| Rate for Payer: Aetna Commercial |
$39.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.24
|
| Rate for Payer: Cash Price |
$37.22
|
| Rate for Payer: Cofinity Commercial |
$32.57
|
| Rate for Payer: Cofinity Commercial |
$40.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$41.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.55
|
| Rate for Payer: PHP Commercial |
$39.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.24
|
| Rate for Payer: Priority Health SBD |
$29.31
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$4.09
|
|
|
Service Code
|
NDC 60687046811
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.66
|
| Rate for Payer: Priority Health SBD |
$2.58
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 00904585560
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.78 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health SBD |
$168.78
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 00904585560
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.16 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Medicare |
$133.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health SBD |
$168.78
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$46.53
|
|
|
Service Code
|
NDC 68645056354
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$41.88 |
| Rate for Payer: Aetna Commercial |
$39.55
|
| Rate for Payer: Aetna Medicare |
$23.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.24
|
| Rate for Payer: BCBS Complete |
$18.61
|
| Rate for Payer: Cash Price |
$37.22
|
| Rate for Payer: Cofinity Commercial |
$32.57
|
| Rate for Payer: Cofinity Commercial |
$40.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$41.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.55
|
| Rate for Payer: PHP Commercial |
$39.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.24
|
| Rate for Payer: Priority Health SBD |
$29.31
|
|
|
ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$3,124.80
|
|
|
Service Code
|
HCPCS J1744
|
| Hospital Charge Code |
153436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,968.62 |
| Max. Negotiated Rate |
$2,812.32 |
| Rate for Payer: Aetna Commercial |
$2,656.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.12
|
| Rate for Payer: Cash Price |
$2,499.84
|
| Rate for Payer: Cofinity Commercial |
$2,187.36
|
| Rate for Payer: Cofinity Commercial |
$2,687.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,187.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,499.84
|
| Rate for Payer: Healthscope Commercial |
$2,812.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,656.08
|
| Rate for Payer: PHP Commercial |
$2,656.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,031.12
|
| Rate for Payer: Priority Health SBD |
$1,968.62
|
|
|
ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$3,124.80
|
|
|
Service Code
|
HCPCS J1744
|
| Hospital Charge Code |
153436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$2,812.32 |
| Rate for Payer: Aetna Commercial |
$2,656.08
|
| Rate for Payer: Aetna Medicare |
$135.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.99
|
| Rate for Payer: BCBS Complete |
$73.38
|
| Rate for Payer: BCBS MAPPO |
$130.39
|
| Rate for Payer: BCN Medicare Advantage |
$130.39
|
| Rate for Payer: Cash Price |
$2,499.84
|
| Rate for Payer: Cash Price |
$2,499.84
|
| Rate for Payer: Cofinity Commercial |
$2,687.33
|
| Rate for Payer: Cofinity Commercial |
$2,187.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,187.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,499.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.39
|
| Rate for Payer: Healthscope Commercial |
$2,812.32
|
| Rate for Payer: Mclaren Medicaid |
$69.89
|
| Rate for Payer: Mclaren Medicare |
$130.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.91
|
| Rate for Payer: Meridian Medicaid |
$73.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,656.08
|
| Rate for Payer: PACE Medicare |
$123.87
|
| Rate for Payer: PACE SWMI |
$130.39
|
| Rate for Payer: PHP Commercial |
$2,656.08
|
| Rate for Payer: PHP Medicare Advantage |
$130.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,031.12
|
| Rate for Payer: Priority Health Medicare |
$130.39
|
| Rate for Payer: Priority Health SBD |
$1,968.62
|
| Rate for Payer: Railroad Medicare Medicare |
$130.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.39
|
| Rate for Payer: UHC Medicare Advantage |
$130.39
|
| Rate for Payer: UHCCP Medicaid |
$73.41
|
| Rate for Payer: VA VA |
$130.39
|
|
|
IMATINIB 100 MG TABLET
|
Facility
|
IP
|
$487.30
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
32979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$307.00 |
| Max. Negotiated Rate |
$438.57 |
| Rate for Payer: Aetna Commercial |
$414.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.75
|
| Rate for Payer: Cash Price |
$389.84
|
| Rate for Payer: Cofinity Commercial |
$341.11
|
| Rate for Payer: Cofinity Commercial |
$419.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.84
|
| Rate for Payer: Healthscope Commercial |
$438.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.20
|
| Rate for Payer: PHP Commercial |
$414.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.75
|
| Rate for Payer: Priority Health SBD |
$307.00
|
|
|
IMATINIB 100 MG TABLET
|
Facility
|
OP
|
$487.30
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
32979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.92 |
| Max. Negotiated Rate |
$438.57 |
| Rate for Payer: Aetna Commercial |
$414.20
|
| Rate for Payer: Aetna Medicare |
$243.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.75
|
| Rate for Payer: BCBS Complete |
$194.92
|
| Rate for Payer: Cash Price |
$389.84
|
| Rate for Payer: Cofinity Commercial |
$341.11
|
| Rate for Payer: Cofinity Commercial |
$419.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.84
|
| Rate for Payer: Healthscope Commercial |
$438.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.20
|
| Rate for Payer: PHP Commercial |
$414.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.75
|
| Rate for Payer: Priority Health SBD |
$307.00
|
|
|
IMATINIB 400 MG TABLET
|
Facility
|
OP
|
$36,516.67
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
36092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,606.67 |
| Max. Negotiated Rate |
$32,865.00 |
| Rate for Payer: Aetna Commercial |
$31,039.17
|
| Rate for Payer: Aetna Medicare |
$18,258.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23,735.84
|
| Rate for Payer: BCBS Complete |
$14,606.67
|
| Rate for Payer: Cash Price |
$29,213.34
|
| Rate for Payer: Cofinity Commercial |
$25,561.67
|
| Rate for Payer: Cofinity Commercial |
$31,404.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$25,561.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29,213.34
|
| Rate for Payer: Healthscope Commercial |
$32,865.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,039.17
|
| Rate for Payer: PHP Commercial |
$31,039.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23,735.84
|
| Rate for Payer: Priority Health SBD |
$23,005.50
|
|
|
IMATINIB 400 MG TABLET
|
Facility
|
IP
|
$36,516.67
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
36092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23,005.50 |
| Max. Negotiated Rate |
$32,865.00 |
| Rate for Payer: Aetna Commercial |
$31,039.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23,735.84
|
| Rate for Payer: Cash Price |
$29,213.34
|
| Rate for Payer: Cofinity Commercial |
$25,561.67
|
| Rate for Payer: Cofinity Commercial |
$31,404.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$25,561.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29,213.34
|
| Rate for Payer: Healthscope Commercial |
$32,865.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,039.17
|
| Rate for Payer: PHP Commercial |
$31,039.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23,735.84
|
| Rate for Payer: Priority Health SBD |
$23,005.50
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
IP
|
$8,609.08
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,423.72 |
| Max. Negotiated Rate |
$7,748.17 |
| Rate for Payer: Aetna Commercial |
$7,317.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,595.90
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cofinity Commercial |
$6,026.36
|
| Rate for Payer: Cofinity Commercial |
$7,403.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,026.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,887.26
|
| Rate for Payer: Healthscope Commercial |
$7,748.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,317.72
|
| Rate for Payer: PHP Commercial |
$7,317.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,595.90
|
| Rate for Payer: Priority Health SBD |
$5,423.72
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
OP
|
$8,609.08
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$7,748.17 |
| Rate for Payer: Aetna Commercial |
$7,317.72
|
| Rate for Payer: Aetna Medicare |
$50.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,595.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.20
|
| Rate for Payer: BCBS Complete |
$27.55
|
| Rate for Payer: BCBS MAPPO |
$48.96
|
| Rate for Payer: BCN Medicare Advantage |
$48.96
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cofinity Commercial |
$7,403.81
|
| Rate for Payer: Cofinity Commercial |
$6,026.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,026.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,887.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$7,748.17
|
| Rate for Payer: Mclaren Medicaid |
$26.24
|
| Rate for Payer: Mclaren Medicare |
$48.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.41
|
| Rate for Payer: Meridian Medicaid |
$27.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,317.72
|
| Rate for Payer: PACE Medicare |
$46.51
|
| Rate for Payer: PACE SWMI |
$48.96
|
| Rate for Payer: PHP Commercial |
$7,317.72
|
| Rate for Payer: PHP Medicare Advantage |
$48.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,595.90
|
| Rate for Payer: Priority Health Medicare |
$48.96
|
| Rate for Payer: Priority Health SBD |
$5,423.72
|
| Rate for Payer: Railroad Medicare Medicare |
$48.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.96
|
| Rate for Payer: UHC Medicare Advantage |
$48.96
|
| Rate for Payer: UHCCP Medicaid |
$27.56
|
| Rate for Payer: VA VA |
$48.96
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
OP
|
$17,218.15
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
172845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$15,496.33 |
| Rate for Payer: Aetna Commercial |
$14,635.43
|
| Rate for Payer: Aetna Medicare |
$50.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,191.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.20
|
| Rate for Payer: BCBS Complete |
$27.55
|
| Rate for Payer: BCBS MAPPO |
$48.96
|
| Rate for Payer: BCN Medicare Advantage |
$48.96
|
| Rate for Payer: Cash Price |
$13,774.52
|
| Rate for Payer: Cash Price |
$13,774.52
|
| Rate for Payer: Cofinity Commercial |
$12,052.70
|
| Rate for Payer: Cofinity Commercial |
$14,807.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,052.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,774.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$15,496.33
|
| Rate for Payer: Mclaren Medicaid |
$26.24
|
| Rate for Payer: Mclaren Medicare |
$48.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.41
|
| Rate for Payer: Meridian Medicaid |
$27.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,635.43
|
| Rate for Payer: PACE Medicare |
$46.51
|
| Rate for Payer: PACE SWMI |
$48.96
|
| Rate for Payer: PHP Commercial |
$14,635.43
|
| Rate for Payer: PHP Medicare Advantage |
$48.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,191.80
|
| Rate for Payer: Priority Health Medicare |
$48.96
|
| Rate for Payer: Priority Health SBD |
$10,847.43
|
| Rate for Payer: Railroad Medicare Medicare |
$48.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.96
|
| Rate for Payer: UHC Medicare Advantage |
$48.96
|
| Rate for Payer: UHCCP Medicaid |
$27.56
|
| Rate for Payer: VA VA |
$48.96
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
IP
|
$17,218.15
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
172845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,847.43 |
| Max. Negotiated Rate |
$15,496.33 |
| Rate for Payer: Aetna Commercial |
$14,635.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,191.80
|
| Rate for Payer: Cash Price |
$13,774.52
|
| Rate for Payer: Cofinity Commercial |
$12,052.70
|
| Rate for Payer: Cofinity Commercial |
$14,807.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,052.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,774.52
|
| Rate for Payer: Healthscope Commercial |
$15,496.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,635.43
|
| Rate for Payer: PHP Commercial |
$14,635.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,191.80
|
| Rate for Payer: Priority Health SBD |
$10,847.43
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$5,745.00
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.29 |
| Max. Negotiated Rate |
$5,170.50 |
| Rate for Payer: Aetna Commercial |
$4,883.25
|
| Rate for Payer: Aetna Commercial |
$2,441.62
|
| Rate for Payer: Aetna Commercial |
$1,220.81
|
| Rate for Payer: Aetna Commercial |
$7,324.88
|
| Rate for Payer: Aetna Commercial |
$610.41
|
| Rate for Payer: Aetna Medicare |
$47.12
|
| Rate for Payer: Aetna Medicare |
$47.12
|
| Rate for Payer: Aetna Medicare |
$47.12
|
| Rate for Payer: Aetna Medicare |
$47.12
|
| Rate for Payer: Aetna Medicare |
$47.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,867.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,734.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,601.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: Cash Price |
$4,596.00
|
| Rate for Payer: Cash Price |
$2,298.00
|
| Rate for Payer: Cash Price |
$2,298.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cash Price |
$6,894.00
|
| Rate for Payer: Cash Price |
$6,894.00
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$4,596.00
|
| Rate for Payer: Cofinity Commercial |
$617.59
|
| Rate for Payer: Cofinity Commercial |
$1,005.38
|
| Rate for Payer: Cofinity Commercial |
$502.69
|
| Rate for Payer: Cofinity Commercial |
$2,470.35
|
| Rate for Payer: Cofinity Commercial |
$1,235.17
|
| Rate for Payer: Cofinity Commercial |
$7,411.05
|
| Rate for Payer: Cofinity Commercial |
$4,940.70
|
| Rate for Payer: Cofinity Commercial |
$4,021.50
|
| Rate for Payer: Cofinity Commercial |
$2,010.75
|
| Rate for Payer: Cofinity Commercial |
$6,032.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,032.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,005.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$502.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,010.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,021.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,149.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,894.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,298.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,596.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Healthscope Commercial |
$5,170.50
|
| Rate for Payer: Healthscope Commercial |
$7,755.75
|
| Rate for Payer: Healthscope Commercial |
$646.32
|
| Rate for Payer: Healthscope Commercial |
$2,585.25
|
| Rate for Payer: Healthscope Commercial |
$1,292.62
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,441.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,883.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,324.88
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PHP Commercial |
$4,883.25
|
| Rate for Payer: PHP Commercial |
$610.41
|
| Rate for Payer: PHP Commercial |
$7,324.88
|
| Rate for Payer: PHP Commercial |
$1,220.81
|
| Rate for Payer: PHP Commercial |
$2,441.62
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,734.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,867.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,601.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.56
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health SBD |
$3,619.35
|
| Rate for Payer: Priority Health SBD |
$452.42
|
| Rate for Payer: Priority Health SBD |
$904.84
|
| Rate for Payer: Priority Health SBD |
$1,809.67
|
| Rate for Payer: Priority Health SBD |
$5,429.02
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHCCP Medicaid |
$25.51
|
| Rate for Payer: UHCCP Medicaid |
$25.51
|
| Rate for Payer: UHCCP Medicaid |
$25.51
|
| Rate for Payer: UHCCP Medicaid |
$25.51
|
| Rate for Payer: UHCCP Medicaid |
$25.51
|
| Rate for Payer: VA VA |
$45.31
|
| Rate for Payer: VA VA |
$45.31
|
| Rate for Payer: VA VA |
$45.31
|
| Rate for Payer: VA VA |
$45.31
|
| Rate for Payer: VA VA |
$45.31
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,436.25
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$904.84 |
| Max. Negotiated Rate |
$1,292.62 |
| Rate for Payer: Aetna Commercial |
$1,220.81
|
| Rate for Payer: Aetna Commercial |
$2,441.62
|
| Rate for Payer: Aetna Commercial |
$4,883.25
|
| Rate for Payer: Aetna Commercial |
$610.41
|
| Rate for Payer: Aetna Commercial |
$7,324.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,734.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,601.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,867.12
|
| Rate for Payer: Cash Price |
$6,894.00
|
| Rate for Payer: Cash Price |
$2,298.00
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$4,596.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cofinity Commercial |
$2,010.75
|
| Rate for Payer: Cofinity Commercial |
$1,005.38
|
| Rate for Payer: Cofinity Commercial |
$1,235.17
|
| Rate for Payer: Cofinity Commercial |
$7,411.05
|
| Rate for Payer: Cofinity Commercial |
$6,032.25
|
| Rate for Payer: Cofinity Commercial |
$2,470.35
|
| Rate for Payer: Cofinity Commercial |
$617.59
|
| Rate for Payer: Cofinity Commercial |
$502.69
|
| Rate for Payer: Cofinity Commercial |
$4,021.50
|
| Rate for Payer: Cofinity Commercial |
$4,940.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,032.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,005.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,021.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$502.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,010.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,596.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,149.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,298.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,894.00
|
| Rate for Payer: Healthscope Commercial |
$5,170.50
|
| Rate for Payer: Healthscope Commercial |
$2,585.25
|
| Rate for Payer: Healthscope Commercial |
$1,292.62
|
| Rate for Payer: Healthscope Commercial |
$646.32
|
| Rate for Payer: Healthscope Commercial |
$7,755.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,883.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,324.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,441.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.81
|
| Rate for Payer: PHP Commercial |
$610.41
|
| Rate for Payer: PHP Commercial |
$7,324.88
|
| Rate for Payer: PHP Commercial |
$4,883.25
|
| Rate for Payer: PHP Commercial |
$2,441.62
|
| Rate for Payer: PHP Commercial |
$1,220.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,867.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,601.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,734.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.78
|
| Rate for Payer: Priority Health SBD |
$452.42
|
| Rate for Payer: Priority Health SBD |
$1,809.67
|
| Rate for Payer: Priority Health SBD |
$3,619.35
|
| Rate for Payer: Priority Health SBD |
$904.84
|
| Rate for Payer: Priority Health SBD |
$5,429.02
|
|
|
IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$2,878.21
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$2,590.39 |
| Rate for Payer: Aetna Commercial |
$2,446.48
|
| Rate for Payer: Aetna Medicare |
$81.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,870.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.50
|
| Rate for Payer: BCBS Complete |
$44.35
|
| Rate for Payer: BCBS MAPPO |
$78.80
|
| Rate for Payer: BCN Medicare Advantage |
$78.80
|
| Rate for Payer: Cash Price |
$2,302.57
|
| Rate for Payer: Cash Price |
$2,302.57
|
| Rate for Payer: Cofinity Commercial |
$2,475.26
|
| Rate for Payer: Cofinity Commercial |
$2,014.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,014.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,302.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.80
|
| Rate for Payer: Healthscope Commercial |
$2,590.39
|
| Rate for Payer: Mclaren Medicaid |
$42.24
|
| Rate for Payer: Mclaren Medicare |
$78.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.74
|
| Rate for Payer: Meridian Medicaid |
$44.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,446.48
|
| Rate for Payer: PACE Medicare |
$74.86
|
| Rate for Payer: PACE SWMI |
$78.80
|
| Rate for Payer: PHP Commercial |
$2,446.48
|
| Rate for Payer: PHP Medicare Advantage |
$78.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,870.84
|
| Rate for Payer: Priority Health Medicare |
$78.80
|
| Rate for Payer: Priority Health SBD |
$1,813.27
|
| Rate for Payer: Railroad Medicare Medicare |
$78.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.80
|
| Rate for Payer: UHC Medicare Advantage |
$78.80
|
| Rate for Payer: UHCCP Medicaid |
$44.36
|
| Rate for Payer: VA VA |
$78.80
|
|
|
IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$2,878.21
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,813.27 |
| Max. Negotiated Rate |
$2,590.39 |
| Rate for Payer: Aetna Commercial |
$2,446.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,870.84
|
| Rate for Payer: Cash Price |
$2,302.57
|
| Rate for Payer: Cofinity Commercial |
$2,014.75
|
| Rate for Payer: Cofinity Commercial |
$2,475.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,014.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,302.57
|
| Rate for Payer: Healthscope Commercial |
$2,590.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,446.48
|
| Rate for Payer: PHP Commercial |
$2,446.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,870.84
|
| Rate for Payer: Priority Health SBD |
$1,813.27
|
|
|
IMPACT PEPTIDE/VITAL 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 Commercial |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.62
|
| 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: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.29
|
| Rate for Payer: Priority Health SBD |
$41.96
|
|
|
IMPACT PEPTIDE/VITAL 1.5 BOLUS FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
150765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.64 |
| 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 Commercial |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.62
|
| 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: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.29
|
| Rate for Payer: Priority Health SBD |
$41.96
|
|
