|
IMATINIB 100 MG TABLET
|
Facility
|
IP
|
$1,014.99
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
32979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$446.60 |
| Max. Negotiated Rate |
$913.49 |
| Rate for Payer: Aetna American Axle |
$659.74
|
| Rate for Payer: Aetna American Axle |
$19,761.24
|
| Rate for Payer: Aetna Commercial |
$862.74
|
| Rate for Payer: Aetna Commercial |
$25,841.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,761.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.74
|
| Rate for Payer: Cash Price |
$24,321.53
|
| Rate for Payer: Cash Price |
$811.99
|
| Rate for Payer: Cofinity Commercial |
$26,145.64
|
| Rate for Payer: Cofinity Commercial |
$710.49
|
| Rate for Payer: Cofinity Commercial |
$872.89
|
| Rate for Payer: Cofinity Commercial |
$21,281.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,321.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.99
|
| Rate for Payer: Healthscope Commercial |
$913.49
|
| Rate for Payer: Healthscope Commercial |
$27,361.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$710.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,281.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,801.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$761.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$862.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25,841.62
|
| Rate for Payer: PHP Commercial |
$862.74
|
| Rate for Payer: PHP Commercial |
$25,841.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,281.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.49
|
| Rate for Payer: Priority Health SBD |
$639.44
|
| Rate for Payer: Priority Health SBD |
$19,153.20
|
| Rate for Payer: UMR Bronson Commercial |
$446.60
|
| Rate for Payer: UMR Bronson Commercial |
$13,376.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,801.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$761.24
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$135.13
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
9603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.46 |
| Max. Negotiated Rate |
$121.62 |
| Rate for Payer: Aetna American Axle |
$87.83
|
| Rate for Payer: Aetna American Axle |
$28.70
|
| Rate for Payer: Aetna Commercial |
$114.86
|
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.83
|
| Rate for Payer: Cash Price |
$108.10
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cofinity Commercial |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$94.59
|
| Rate for Payer: Cofinity Commercial |
$30.91
|
| Rate for Payer: Cofinity Commercial |
$116.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.10
|
| Rate for Payer: Healthscope Commercial |
$39.74
|
| Rate for Payer: Healthscope Commercial |
$121.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.54
|
| Rate for Payer: PHP Commercial |
$114.86
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.91
|
| Rate for Payer: Priority Health SBD |
$85.13
|
| Rate for Payer: Priority Health SBD |
$27.82
|
| Rate for Payer: UMR Bronson Commercial |
$19.43
|
| Rate for Payer: UMR Bronson Commercial |
$59.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.35
|
|
|
IMIPENEM-CILASTATIN-RELEBACTAM 1.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,057.86
|
|
|
Service Code
|
HCPCS J0742
|
| Hospital Charge Code |
192562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$465.46 |
| Max. Negotiated Rate |
$952.07 |
| Rate for Payer: Aetna American Axle |
$687.61
|
| Rate for Payer: Aetna Commercial |
$899.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$687.61
|
| Rate for Payer: Cash Price |
$846.29
|
| Rate for Payer: Cofinity Commercial |
$740.50
|
| Rate for Payer: Cofinity Commercial |
$909.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$846.29
|
| Rate for Payer: Healthscope Commercial |
$952.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$740.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$793.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$899.18
|
| Rate for Payer: PHP Commercial |
$899.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.50
|
| Rate for Payer: Priority Health SBD |
$666.45
|
| Rate for Payer: UMR Bronson Commercial |
$465.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$793.40
|
|
|
IMIPRAMINE 10 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 49884-054-01
|
| Hospital Charge Code |
3860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.68 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$274.72
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$333.58
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.72
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
IMIPRAMINE 25 MG TABLET
|
Facility
|
IP
|
$180.95
|
|
|
Service Code
|
NDC 64380-170-01
|
| Hospital Charge Code |
3861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna American Axle |
$117.62
|
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.62
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$126.66
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.81
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.66
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: UMR Bronson Commercial |
$79.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.71
|
|
|
IMIPRAMINE 25 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 49884-055-01
|
| Hospital Charge Code |
3861
|
|
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: 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 Multiplan/Beech St/PHCS |
$180.07
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.30
|
| 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
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
OP
|
$8,228.38
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$7,405.54 |
| Rate for Payer: Aetna American Axle |
$5,348.45
|
| Rate for Payer: Aetna Commercial |
$6,994.12
|
| Rate for Payer: Aetna Medicare |
$51.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,348.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.23
|
| Rate for Payer: BCBS Complete |
$28.60
|
| Rate for Payer: BCBS MAPPO |
$49.79
|
| Rate for Payer: BCBS Trust/PPO |
$160.87
|
| Rate for Payer: BCN Medicare Advantage |
$49.79
|
| Rate for Payer: Cash Price |
$6,582.70
|
| Rate for Payer: Cash Price |
$6,582.70
|
| Rate for Payer: Cofinity Commercial |
$5,759.87
|
| Rate for Payer: Cofinity Commercial |
$7,076.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,582.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.79
|
| Rate for Payer: Healthscope Commercial |
$7,405.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,759.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,171.28
|
| Rate for Payer: Mclaren Medicaid |
$27.23
|
| Rate for Payer: Mclaren Medicare |
$49.79
|
| Rate for Payer: Meridian Medicaid |
$28.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,994.12
|
| Rate for Payer: PACE Medicare |
$47.30
|
| Rate for Payer: PACE SWMI |
$49.79
|
| Rate for Payer: PHP Commercial |
$6,994.12
|
| Rate for Payer: PHP Medicare Advantage |
$49.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,759.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.69
|
| Rate for Payer: Priority Health Medicare |
$49.79
|
| Rate for Payer: Priority Health Narrow Network |
$115.75
|
| Rate for Payer: Priority Health SBD |
$5,183.88
|
| Rate for Payer: Railroad Medicare Medicare |
$49.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.79
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: UMR Bronson Commercial |
$3,044.50
|
| Rate for Payer: VA VA |
$49.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,171.28
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
IP
|
$8,228.38
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,620.49 |
| Max. Negotiated Rate |
$7,405.54 |
| Rate for Payer: Aetna American Axle |
$5,348.45
|
| Rate for Payer: Aetna Commercial |
$6,994.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,348.45
|
| Rate for Payer: Cash Price |
$6,582.70
|
| Rate for Payer: Cofinity Commercial |
$5,759.87
|
| Rate for Payer: Cofinity Commercial |
$7,076.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,582.70
|
| Rate for Payer: Healthscope Commercial |
$7,405.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,759.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,171.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,994.12
|
| Rate for Payer: PHP Commercial |
$6,994.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,759.87
|
| Rate for Payer: Priority Health SBD |
$5,183.88
|
| Rate for Payer: UMR Bronson Commercial |
$3,620.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,171.28
|
|
|
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 |
$631.95 |
| Max. Negotiated Rate |
$1,292.62 |
| Rate for Payer: Aetna American Axle |
$933.56
|
| Rate for Payer: Aetna American Axle |
$3,734.25
|
| Rate for Payer: Aetna American Axle |
$5,601.38
|
| Rate for Payer: Aetna American Axle |
$466.78
|
| Rate for Payer: Aetna American Axle |
$1,867.12
|
| Rate for Payer: Aetna Commercial |
$4,883.25
|
| Rate for Payer: Aetna Commercial |
$7,324.88
|
| Rate for Payer: Aetna Commercial |
$2,441.62
|
| Rate for Payer: Aetna Commercial |
$610.41
|
| Rate for Payer: Aetna Commercial |
$1,220.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,867.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,601.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,734.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.56
|
| Rate for Payer: Cash Price |
$4,596.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$6,894.00
|
| Rate for Payer: Cash Price |
$2,298.00
|
| Rate for Payer: Cofinity Commercial |
$4,940.70
|
| Rate for Payer: Cofinity Commercial |
$1,005.38
|
| Rate for Payer: Cofinity Commercial |
$1,235.18
|
| Rate for Payer: Cofinity Commercial |
$2,010.75
|
| Rate for Payer: Cofinity Commercial |
$2,470.35
|
| Rate for Payer: Cofinity Commercial |
$4,021.50
|
| Rate for Payer: Cofinity Commercial |
$502.69
|
| Rate for Payer: Cofinity Commercial |
$617.59
|
| Rate for Payer: Cofinity Commercial |
$6,032.25
|
| Rate for Payer: Cofinity Commercial |
$7,411.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,596.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,894.00
|
| 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: Healthscope Commercial |
$2,585.25
|
| Rate for Payer: Healthscope Commercial |
$7,755.75
|
| Rate for Payer: Healthscope Commercial |
$5,170.50
|
| Rate for Payer: Healthscope Commercial |
$646.32
|
| Rate for Payer: Healthscope Commercial |
$1,292.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,010.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$502.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,032.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,005.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,021.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,463.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$538.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,154.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,077.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,308.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,883.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,220.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,441.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$610.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,324.88
|
| Rate for Payer: PHP Commercial |
$2,441.62
|
| Rate for Payer: PHP Commercial |
$4,883.25
|
| Rate for Payer: PHP Commercial |
$1,220.81
|
| Rate for Payer: PHP Commercial |
$7,324.88
|
| Rate for Payer: PHP Commercial |
$610.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,010.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,032.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,021.50
|
| Rate for Payer: Priority Health SBD |
$904.84
|
| Rate for Payer: Priority Health SBD |
$452.42
|
| Rate for Payer: Priority Health SBD |
$1,809.68
|
| Rate for Payer: Priority Health SBD |
$3,619.35
|
| Rate for Payer: Priority Health SBD |
$5,429.02
|
| Rate for Payer: UMR Bronson Commercial |
$2,527.80
|
| Rate for Payer: UMR Bronson Commercial |
$631.95
|
| Rate for Payer: UMR Bronson Commercial |
$315.98
|
| Rate for Payer: UMR Bronson Commercial |
$3,791.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,263.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,077.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,154.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$538.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,308.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,463.12
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$2,872.50
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$2,585.25 |
| Rate for Payer: Aetna American Axle |
$1,867.12
|
| Rate for Payer: Aetna American Axle |
$933.56
|
| Rate for Payer: Aetna American Axle |
$5,601.38
|
| Rate for Payer: Aetna American Axle |
$466.78
|
| Rate for Payer: Aetna Commercial |
$2,441.62
|
| Rate for Payer: Aetna Commercial |
$610.41
|
| Rate for Payer: Aetna Commercial |
$7,324.88
|
| Rate for Payer: Aetna Commercial |
$1,220.81
|
| Rate for Payer: Aetna Medicare |
$45.92
|
| Rate for Payer: Aetna Medicare |
$45.92
|
| Rate for Payer: Aetna Medicare |
$45.92
|
| Rate for Payer: Aetna Medicare |
$45.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.56
|
| 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: Aetna New Business (MI Preferred) |
$466.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.19
|
| Rate for Payer: BCBS Complete |
$25.36
|
| Rate for Payer: BCBS Complete |
$25.36
|
| Rate for Payer: BCBS Complete |
$25.36
|
| Rate for Payer: BCBS Complete |
$25.36
|
| Rate for Payer: BCBS MAPPO |
$44.15
|
| Rate for Payer: BCBS MAPPO |
$44.15
|
| Rate for Payer: BCBS MAPPO |
$44.15
|
| Rate for Payer: BCBS MAPPO |
$44.15
|
| Rate for Payer: BCBS Trust/PPO |
$142.66
|
| Rate for Payer: BCBS Trust/PPO |
$142.66
|
| Rate for Payer: BCBS Trust/PPO |
$142.66
|
| Rate for Payer: BCBS Trust/PPO |
$142.66
|
| Rate for Payer: BCN Medicare Advantage |
$44.15
|
| Rate for Payer: BCN Medicare Advantage |
$44.15
|
| Rate for Payer: BCN Medicare Advantage |
$44.15
|
| Rate for Payer: BCN Medicare Advantage |
$44.15
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$6,894.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$2,298.00
|
| Rate for Payer: Cash Price |
$6,894.00
|
| Rate for Payer: Cash Price |
$2,298.00
|
| Rate for Payer: Cofinity Commercial |
$6,032.25
|
| Rate for Payer: Cofinity Commercial |
$617.59
|
| Rate for Payer: Cofinity Commercial |
$502.69
|
| Rate for Payer: Cofinity Commercial |
$1,235.18
|
| Rate for Payer: Cofinity Commercial |
$7,411.05
|
| Rate for Payer: Cofinity Commercial |
$1,005.38
|
| Rate for Payer: Cofinity Commercial |
$2,470.35
|
| Rate for Payer: Cofinity Commercial |
$2,010.75
|
| 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: Health Alliance Plan Medicare Advantage |
$44.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.15
|
| Rate for Payer: Healthscope Commercial |
$7,755.75
|
| Rate for Payer: Healthscope Commercial |
$1,292.62
|
| Rate for Payer: Healthscope Commercial |
$646.32
|
| Rate for Payer: Healthscope Commercial |
$2,585.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$502.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,032.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,010.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,005.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,154.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,463.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,077.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$538.60
|
| Rate for Payer: Mclaren Medicaid |
$24.15
|
| Rate for Payer: Mclaren Medicaid |
$24.15
|
| Rate for Payer: Mclaren Medicaid |
$24.15
|
| Rate for Payer: Mclaren Medicaid |
$24.15
|
| Rate for Payer: Mclaren Medicare |
$44.15
|
| Rate for Payer: Mclaren Medicare |
$44.15
|
| Rate for Payer: Mclaren Medicare |
$44.15
|
| Rate for Payer: Mclaren Medicare |
$44.15
|
| Rate for Payer: Meridian Medicaid |
$25.36
|
| Rate for Payer: Meridian Medicaid |
$25.36
|
| Rate for Payer: Meridian Medicaid |
$25.36
|
| Rate for Payer: Meridian Medicaid |
$25.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$610.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,441.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,324.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,220.81
|
| Rate for Payer: PACE Medicare |
$41.94
|
| Rate for Payer: PACE Medicare |
$41.94
|
| Rate for Payer: PACE Medicare |
$41.94
|
| Rate for Payer: PACE Medicare |
$41.94
|
| Rate for Payer: PACE SWMI |
$44.15
|
| Rate for Payer: PACE SWMI |
$44.15
|
| Rate for Payer: PACE SWMI |
$44.15
|
| Rate for Payer: PACE SWMI |
$44.15
|
| 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 |
$44.15
|
| Rate for Payer: PHP Medicare Advantage |
$44.15
|
| Rate for Payer: PHP Medicare Advantage |
$44.15
|
| Rate for Payer: PHP Medicare Advantage |
$44.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,010.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,032.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.57
|
| Rate for Payer: Priority Health Medicare |
$44.15
|
| Rate for Payer: Priority Health Medicare |
$44.15
|
| Rate for Payer: Priority Health Medicare |
$44.15
|
| Rate for Payer: Priority Health Medicare |
$44.15
|
| Rate for Payer: Priority Health Narrow Network |
$104.46
|
| Rate for Payer: Priority Health Narrow Network |
$104.46
|
| Rate for Payer: Priority Health Narrow Network |
$104.46
|
| Rate for Payer: Priority Health Narrow Network |
$104.46
|
| Rate for Payer: Priority Health SBD |
$1,809.68
|
| Rate for Payer: Priority Health SBD |
$452.42
|
| Rate for Payer: Priority Health SBD |
$904.84
|
| Rate for Payer: Priority Health SBD |
$5,429.02
|
| Rate for Payer: Railroad Medicare Medicare |
$44.15
|
| Rate for Payer: Railroad Medicare Medicare |
$44.15
|
| Rate for Payer: Railroad Medicare Medicare |
$44.15
|
| Rate for Payer: Railroad Medicare Medicare |
$44.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.15
|
| Rate for Payer: UHC Medicare Advantage |
$45.48
|
| Rate for Payer: UHC Medicare Advantage |
$45.48
|
| Rate for Payer: UHC Medicare Advantage |
$45.48
|
| Rate for Payer: UHC Medicare Advantage |
$45.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,062.82
|
| Rate for Payer: UMR Bronson Commercial |
$3,188.48
|
| Rate for Payer: UMR Bronson Commercial |
$531.41
|
| Rate for Payer: UMR Bronson Commercial |
$265.71
|
| Rate for Payer: VA VA |
$44.15
|
| Rate for Payer: VA VA |
$44.15
|
| Rate for Payer: VA VA |
$44.15
|
| Rate for Payer: VA VA |
$44.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,077.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$538.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,154.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,463.12
|
|
|
IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$5,666.83
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.94 |
| Max. Negotiated Rate |
$5,100.15 |
| Rate for Payer: Aetna American Axle |
$3,683.44
|
| Rate for Payer: Aetna Commercial |
$4,816.81
|
| Rate for Payer: Aetna Medicare |
$81.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,683.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.12
|
| Rate for Payer: BCBS Complete |
$45.09
|
| Rate for Payer: BCBS MAPPO |
$78.50
|
| Rate for Payer: BCBS Trust/PPO |
$253.67
|
| Rate for Payer: BCN Medicare Advantage |
$78.50
|
| Rate for Payer: Cash Price |
$4,533.46
|
| Rate for Payer: Cash Price |
$4,533.46
|
| Rate for Payer: Cofinity Commercial |
$3,966.78
|
| Rate for Payer: Cofinity Commercial |
$4,873.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,533.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.50
|
| Rate for Payer: Healthscope Commercial |
$5,100.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,966.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,250.12
|
| Rate for Payer: Mclaren Medicaid |
$42.94
|
| Rate for Payer: Mclaren Medicare |
$78.50
|
| Rate for Payer: Meridian Medicaid |
$45.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,816.81
|
| Rate for Payer: PACE Medicare |
$74.58
|
| Rate for Payer: PACE SWMI |
$78.50
|
| Rate for Payer: PHP Commercial |
$4,816.81
|
| Rate for Payer: PHP Medicare Advantage |
$78.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,966.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.86
|
| Rate for Payer: Priority Health Medicare |
$78.50
|
| Rate for Payer: Priority Health Narrow Network |
$179.89
|
| Rate for Payer: Priority Health SBD |
$3,570.10
|
| Rate for Payer: Railroad Medicare Medicare |
$78.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.50
|
| Rate for Payer: UHC Medicare Advantage |
$80.86
|
| Rate for Payer: UMR Bronson Commercial |
$2,096.73
|
| Rate for Payer: VA VA |
$78.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,250.12
|
|
|
IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$5,666.83
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,493.41 |
| Max. Negotiated Rate |
$5,100.15 |
| Rate for Payer: Aetna American Axle |
$3,683.44
|
| Rate for Payer: Aetna Commercial |
$4,816.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,683.44
|
| Rate for Payer: Cash Price |
$4,533.46
|
| Rate for Payer: Cofinity Commercial |
$3,966.78
|
| Rate for Payer: Cofinity Commercial |
$4,873.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,533.46
|
| Rate for Payer: Healthscope Commercial |
$5,100.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,966.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,250.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,816.81
|
| Rate for Payer: PHP Commercial |
$4,816.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,966.78
|
| Rate for Payer: Priority Health SBD |
$3,570.10
|
| Rate for Payer: UMR Bronson Commercial |
$2,493.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,250.12
|
|
|
IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$2,833.44
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.94 |
| Max. Negotiated Rate |
$2,550.10 |
| Rate for Payer: Aetna American Axle |
$1,841.74
|
| Rate for Payer: Aetna Commercial |
$2,408.42
|
| Rate for Payer: Aetna Medicare |
$81.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,841.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.12
|
| Rate for Payer: BCBS Complete |
$45.09
|
| Rate for Payer: BCBS MAPPO |
$78.50
|
| Rate for Payer: BCBS Trust/PPO |
$253.67
|
| Rate for Payer: BCN Medicare Advantage |
$78.50
|
| Rate for Payer: Cash Price |
$2,266.75
|
| Rate for Payer: Cash Price |
$2,266.75
|
| Rate for Payer: Cofinity Commercial |
$1,983.41
|
| Rate for Payer: Cofinity Commercial |
$2,436.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.50
|
| Rate for Payer: Healthscope Commercial |
$2,550.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,983.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,125.08
|
| Rate for Payer: Mclaren Medicaid |
$42.94
|
| Rate for Payer: Mclaren Medicare |
$78.50
|
| Rate for Payer: Meridian Medicaid |
$45.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,408.42
|
| Rate for Payer: PACE Medicare |
$74.58
|
| Rate for Payer: PACE SWMI |
$78.50
|
| Rate for Payer: PHP Commercial |
$2,408.42
|
| Rate for Payer: PHP Medicare Advantage |
$78.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,983.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.86
|
| Rate for Payer: Priority Health Medicare |
$78.50
|
| Rate for Payer: Priority Health Narrow Network |
$179.89
|
| Rate for Payer: Priority Health SBD |
$1,785.07
|
| Rate for Payer: Railroad Medicare Medicare |
$78.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.50
|
| Rate for Payer: UHC Medicare Advantage |
$80.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,048.37
|
| Rate for Payer: VA VA |
$78.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,125.08
|
|
|
IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$2,833.44
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,246.71 |
| Max. Negotiated Rate |
$2,550.10 |
| Rate for Payer: Aetna American Axle |
$1,841.74
|
| Rate for Payer: Aetna Commercial |
$2,408.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,841.74
|
| Rate for Payer: Cash Price |
$2,266.75
|
| Rate for Payer: Cofinity Commercial |
$1,983.41
|
| Rate for Payer: Cofinity Commercial |
$2,436.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.75
|
| Rate for Payer: Healthscope Commercial |
$2,550.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,983.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,125.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,408.42
|
| Rate for Payer: PHP Commercial |
$2,408.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,983.41
|
| Rate for Payer: Priority Health SBD |
$1,785.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,246.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,125.08
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,828.13
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
172293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$6,145.32 |
| Rate for Payer: Aetna American Axle |
$4,438.28
|
| Rate for Payer: Aetna American Axle |
$2,219.15
|
| Rate for Payer: Aetna American Axle |
$1,109.58
|
| Rate for Payer: Aetna Commercial |
$2,901.96
|
| Rate for Payer: Aetna Commercial |
$1,450.98
|
| Rate for Payer: Aetna Commercial |
$5,803.91
|
| Rate for Payer: Aetna Medicare |
$46.78
|
| Rate for Payer: Aetna Medicare |
$46.78
|
| Rate for Payer: Aetna Medicare |
$46.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,109.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,438.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,219.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.22
|
| Rate for Payer: BCBS Complete |
$25.84
|
| Rate for Payer: BCBS Complete |
$25.84
|
| Rate for Payer: BCBS Complete |
$25.84
|
| Rate for Payer: BCBS MAPPO |
$44.98
|
| Rate for Payer: BCBS MAPPO |
$44.98
|
| Rate for Payer: BCBS MAPPO |
$44.98
|
| Rate for Payer: BCBS Trust/PPO |
$145.33
|
| Rate for Payer: BCBS Trust/PPO |
$145.33
|
| Rate for Payer: BCBS Trust/PPO |
$145.33
|
| Rate for Payer: BCN Medicare Advantage |
$44.98
|
| Rate for Payer: BCN Medicare Advantage |
$44.98
|
| Rate for Payer: BCN Medicare Advantage |
$44.98
|
| Rate for Payer: Cash Price |
$1,365.63
|
| Rate for Payer: Cash Price |
$5,462.50
|
| Rate for Payer: Cash Price |
$5,462.50
|
| Rate for Payer: Cash Price |
$1,365.63
|
| Rate for Payer: Cash Price |
$2,731.26
|
| Rate for Payer: Cash Price |
$2,731.26
|
| Rate for Payer: Cofinity Commercial |
$2,389.85
|
| Rate for Payer: Cofinity Commercial |
$1,194.93
|
| Rate for Payer: Cofinity Commercial |
$1,468.05
|
| Rate for Payer: Cofinity Commercial |
$2,936.10
|
| Rate for Payer: Cofinity Commercial |
$4,779.69
|
| Rate for Payer: Cofinity Commercial |
$5,872.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,365.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,462.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,731.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.98
|
| Rate for Payer: Healthscope Commercial |
$3,072.66
|
| Rate for Payer: Healthscope Commercial |
$1,536.34
|
| Rate for Payer: Healthscope Commercial |
$6,145.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,779.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,389.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,194.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,560.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,121.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,280.28
|
| Rate for Payer: Mclaren Medicaid |
$24.60
|
| Rate for Payer: Mclaren Medicaid |
$24.60
|
| Rate for Payer: Mclaren Medicaid |
$24.60
|
| Rate for Payer: Mclaren Medicare |
$44.98
|
| Rate for Payer: Mclaren Medicare |
$44.98
|
| Rate for Payer: Mclaren Medicare |
$44.98
|
| Rate for Payer: Meridian Medicaid |
$25.84
|
| Rate for Payer: Meridian Medicaid |
$25.84
|
| Rate for Payer: Meridian Medicaid |
$25.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,901.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,803.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,450.98
|
| Rate for Payer: PACE Medicare |
$42.73
|
| Rate for Payer: PACE Medicare |
$42.73
|
| Rate for Payer: PACE Medicare |
$42.73
|
| Rate for Payer: PACE SWMI |
$44.98
|
| Rate for Payer: PACE SWMI |
$44.98
|
| Rate for Payer: PACE SWMI |
$44.98
|
| Rate for Payer: PHP Commercial |
$2,901.96
|
| Rate for Payer: PHP Commercial |
$1,450.98
|
| Rate for Payer: PHP Commercial |
$5,803.91
|
| Rate for Payer: PHP Medicare Advantage |
$44.98
|
| Rate for Payer: PHP Medicare Advantage |
$44.98
|
| Rate for Payer: PHP Medicare Advantage |
$44.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,779.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,194.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,389.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.52
|
| Rate for Payer: Priority Health Medicare |
$44.98
|
| Rate for Payer: Priority Health Medicare |
$44.98
|
| Rate for Payer: Priority Health Medicare |
$44.98
|
| Rate for Payer: Priority Health Narrow Network |
$105.22
|
| Rate for Payer: Priority Health Narrow Network |
$105.22
|
| Rate for Payer: Priority Health Narrow Network |
$105.22
|
| Rate for Payer: Priority Health SBD |
$1,075.44
|
| Rate for Payer: Priority Health SBD |
$4,301.72
|
| Rate for Payer: Priority Health SBD |
$2,150.86
|
| Rate for Payer: Railroad Medicare Medicare |
$44.98
|
| Rate for Payer: Railroad Medicare Medicare |
$44.98
|
| Rate for Payer: Railroad Medicare Medicare |
$44.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.98
|
| Rate for Payer: UHC Medicare Advantage |
$46.33
|
| Rate for Payer: UHC Medicare Advantage |
$46.33
|
| Rate for Payer: UHC Medicare Advantage |
$46.33
|
| Rate for Payer: UMR Bronson Commercial |
$2,526.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,263.21
|
| Rate for Payer: UMR Bronson Commercial |
$631.60
|
| Rate for Payer: VA VA |
$44.98
|
| Rate for Payer: VA VA |
$44.98
|
| Rate for Payer: VA VA |
$44.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,560.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,280.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,121.10
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,980.14
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
171063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,751.26 |
| Max. Negotiated Rate |
$3,582.13 |
| Rate for Payer: Aetna American Axle |
$2,587.09
|
| Rate for Payer: Aetna Commercial |
$3,383.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,587.09
|
| Rate for Payer: Cash Price |
$3,184.11
|
| Rate for Payer: Cofinity Commercial |
$2,786.10
|
| Rate for Payer: Cofinity Commercial |
$3,422.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,184.11
|
| Rate for Payer: Healthscope Commercial |
$3,582.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,786.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,985.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,383.12
|
| Rate for Payer: PHP Commercial |
$3,383.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,786.10
|
| Rate for Payer: Priority Health SBD |
$2,507.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,751.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,985.10
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,980.14
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
171063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$3,582.13 |
| Rate for Payer: Aetna American Axle |
$2,587.09
|
| Rate for Payer: Aetna American Axle |
$1,293.55
|
| Rate for Payer: Aetna Commercial |
$1,691.56
|
| Rate for Payer: Aetna Commercial |
$3,383.12
|
| Rate for Payer: Aetna Medicare |
$50.22
|
| Rate for Payer: Aetna Medicare |
$50.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,587.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,293.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.36
|
| Rate for Payer: BCBS Complete |
$27.74
|
| Rate for Payer: BCBS Complete |
$27.74
|
| Rate for Payer: BCBS MAPPO |
$48.29
|
| Rate for Payer: BCBS MAPPO |
$48.29
|
| Rate for Payer: BCBS Trust/PPO |
$156.05
|
| Rate for Payer: BCBS Trust/PPO |
$156.05
|
| Rate for Payer: BCN Medicare Advantage |
$48.29
|
| Rate for Payer: BCN Medicare Advantage |
$48.29
|
| Rate for Payer: Cash Price |
$3,184.11
|
| Rate for Payer: Cash Price |
$1,592.06
|
| Rate for Payer: Cash Price |
$3,184.11
|
| Rate for Payer: Cash Price |
$1,592.06
|
| Rate for Payer: Cofinity Commercial |
$1,711.46
|
| Rate for Payer: Cofinity Commercial |
$1,393.05
|
| Rate for Payer: Cofinity Commercial |
$2,786.10
|
| Rate for Payer: Cofinity Commercial |
$3,422.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,592.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,184.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.29
|
| Rate for Payer: Healthscope Commercial |
$1,791.06
|
| Rate for Payer: Healthscope Commercial |
$3,582.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,393.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,786.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,492.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,985.10
|
| Rate for Payer: Mclaren Medicaid |
$26.41
|
| Rate for Payer: Mclaren Medicaid |
$26.41
|
| Rate for Payer: Mclaren Medicare |
$48.29
|
| Rate for Payer: Mclaren Medicare |
$48.29
|
| Rate for Payer: Meridian Medicaid |
$27.74
|
| Rate for Payer: Meridian Medicaid |
$27.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,691.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,383.12
|
| Rate for Payer: PACE Medicare |
$45.88
|
| Rate for Payer: PACE Medicare |
$45.88
|
| Rate for Payer: PACE SWMI |
$48.29
|
| Rate for Payer: PACE SWMI |
$48.29
|
| Rate for Payer: PHP Commercial |
$3,383.12
|
| Rate for Payer: PHP Commercial |
$1,691.56
|
| Rate for Payer: PHP Medicare Advantage |
$48.29
|
| Rate for Payer: PHP Medicare Advantage |
$48.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,393.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,786.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.76
|
| Rate for Payer: Priority Health Medicare |
$48.29
|
| Rate for Payer: Priority Health Medicare |
$48.29
|
| Rate for Payer: Priority Health Narrow Network |
$111.81
|
| Rate for Payer: Priority Health Narrow Network |
$111.81
|
| Rate for Payer: Priority Health SBD |
$1,253.74
|
| Rate for Payer: Priority Health SBD |
$2,507.49
|
| Rate for Payer: Railroad Medicare Medicare |
$48.29
|
| Rate for Payer: Railroad Medicare Medicare |
$48.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.29
|
| Rate for Payer: UHC Medicare Advantage |
$49.74
|
| Rate for Payer: UHC Medicare Advantage |
$49.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,472.65
|
| Rate for Payer: UMR Bronson Commercial |
$736.33
|
| Rate for Payer: VA VA |
$48.29
|
| Rate for Payer: VA VA |
$48.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,492.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,985.10
|
|
|
IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,414.07
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
171059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$3,072.66 |
| Rate for Payer: Aetna American Axle |
$2,219.15
|
| Rate for Payer: Aetna Commercial |
$2,901.96
|
| Rate for Payer: Aetna Medicare |
$46.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,219.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.22
|
| Rate for Payer: BCBS Complete |
$25.84
|
| Rate for Payer: BCBS MAPPO |
$44.98
|
| Rate for Payer: BCBS Trust/PPO |
$145.33
|
| Rate for Payer: BCN Medicare Advantage |
$44.98
|
| Rate for Payer: Cash Price |
$2,731.26
|
| Rate for Payer: Cash Price |
$2,731.26
|
| Rate for Payer: Cofinity Commercial |
$2,936.10
|
| Rate for Payer: Cofinity Commercial |
$2,389.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,731.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.98
|
| Rate for Payer: Healthscope Commercial |
$3,072.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,389.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,560.55
|
| Rate for Payer: Mclaren Medicaid |
$24.60
|
| Rate for Payer: Mclaren Medicare |
$44.98
|
| Rate for Payer: Meridian Medicaid |
$25.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,901.96
|
| Rate for Payer: PACE Medicare |
$42.73
|
| Rate for Payer: PACE SWMI |
$44.98
|
| Rate for Payer: PHP Commercial |
$2,901.96
|
| Rate for Payer: PHP Medicare Advantage |
$44.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,389.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.52
|
| Rate for Payer: Priority Health Medicare |
$44.98
|
| Rate for Payer: Priority Health Narrow Network |
$105.22
|
| Rate for Payer: Priority Health SBD |
$2,150.86
|
| Rate for Payer: Railroad Medicare Medicare |
$44.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.98
|
| Rate for Payer: UHC Medicare Advantage |
$46.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,263.21
|
| Rate for Payer: VA VA |
$44.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,560.55
|
|
|
IMPACT ORAL LIQUID CUSTOM
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 4390035818
|
| Hospital Charge Code |
150859
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| 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: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.61
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.62
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$29.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE 1.5 BOLUS FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 4390097399
|
| Hospital Charge Code |
150765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.37
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.01
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$59.20
|
|
|
Service Code
|
NDC 7007462720
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$53.28 |
| Rate for Payer: Aetna American Axle |
$38.48
|
| Rate for Payer: Aetna Commercial |
$50.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.48
|
| Rate for Payer: Cash Price |
$47.36
|
| Rate for Payer: Cofinity Commercial |
$41.44
|
| Rate for Payer: Cofinity Commercial |
$50.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.36
|
| Rate for Payer: Healthscope Commercial |
$53.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.32
|
| Rate for Payer: PHP Commercial |
$50.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.44
|
| Rate for Payer: Priority Health SBD |
$37.30
|
| Rate for Payer: UMR Bronson Commercial |
$26.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.40
|
|
|
IMPACT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 4390097399
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.37
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.01
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 4390097370
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| 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: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.61
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.62
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$29.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE 1.5 CYCLIC FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 4390097399
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.37
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.01
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE 1.5 CYCLIC FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 4390097370
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| 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: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.61
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.62
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$29.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
