|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$803.74
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$353.65 |
| Max. Negotiated Rate |
$723.37 |
| Rate for Payer: Aetna American Axle |
$522.43
|
| Rate for Payer: Aetna Commercial |
$683.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.43
|
| Rate for Payer: Cash Price |
$642.99
|
| Rate for Payer: Cofinity Advantage |
$562.62
|
| Rate for Payer: Cofinity Commercial |
$691.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.99
|
| Rate for Payer: Healthscope Commercial |
$723.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$562.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$683.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$602.80
|
| Rate for Payer: PHP Commercial |
$683.18
|
| Rate for Payer: Priority Health SBD |
$506.36
|
| Rate for Payer: UMR Bronson Commercial |
$353.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.80
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$803.74
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.99 |
| Max. Negotiated Rate |
$723.37 |
| Rate for Payer: Aetna American Axle |
$522.43
|
| Rate for Payer: Aetna Commercial |
$683.18
|
| Rate for Payer: Aetna Medicare |
$401.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.43
|
| Rate for Payer: BCBS Complete |
$321.50
|
| Rate for Payer: BCBS Trust/PPO |
$80.55
|
| Rate for Payer: BCN Commercial |
$80.55
|
| Rate for Payer: Cash Price |
$642.99
|
| Rate for Payer: Cash Price |
$642.99
|
| Rate for Payer: Cofinity Advantage |
$562.62
|
| Rate for Payer: Cofinity Commercial |
$691.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.99
|
| Rate for Payer: Healthscope Commercial |
$723.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$562.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$683.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$602.80
|
| Rate for Payer: PHP Commercial |
$683.18
|
| Rate for Payer: Priority Health SBD |
$506.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.99
|
| Rate for Payer: UHC Core |
$40.99
|
| Rate for Payer: UHC Exchange |
$40.99
|
| Rate for Payer: UMR Bronson Commercial |
$297.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.80
|
|
|
IMATINIB 100 MG TABLET
|
Facility
|
IP
|
$30,401.91
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
32979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,376.84 |
| Max. Negotiated Rate |
$27,361.72 |
| Rate for Payer: Aetna American Axle |
$19,761.24
|
| Rate for Payer: Aetna American Axle |
$196.56
|
| Rate for Payer: Aetna American Axle |
$209.88
|
| Rate for Payer: Aetna American Axle |
$659.74
|
| Rate for Payer: Aetna Commercial |
$274.46
|
| Rate for Payer: Aetna Commercial |
$25,841.62
|
| Rate for Payer: Aetna Commercial |
$862.74
|
| Rate for Payer: Aetna Commercial |
$257.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,761.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.74
|
| Rate for Payer: Cash Price |
$811.99
|
| Rate for Payer: Cash Price |
$258.32
|
| Rate for Payer: Cash Price |
$241.92
|
| Rate for Payer: Cash Price |
$24,321.53
|
| Rate for Payer: Cofinity Advantage |
$211.68
|
| Rate for Payer: Cofinity Advantage |
$710.49
|
| Rate for Payer: Cofinity Advantage |
$21,281.34
|
| Rate for Payer: Cofinity Advantage |
$226.03
|
| Rate for Payer: Cofinity Commercial |
$26,145.64
|
| Rate for Payer: Cofinity Commercial |
$872.89
|
| Rate for Payer: Cofinity Commercial |
$260.06
|
| Rate for Payer: Cofinity Commercial |
$277.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,321.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.92
|
| Rate for Payer: Healthscope Commercial |
$272.16
|
| Rate for Payer: Healthscope Commercial |
$290.61
|
| Rate for Payer: Healthscope Commercial |
$27,361.72
|
| Rate for Payer: Healthscope Commercial |
$913.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,281.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$710.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,801.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$761.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$862.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,841.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,801.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$761.24
|
| Rate for Payer: PHP Commercial |
$862.74
|
| Rate for Payer: PHP Commercial |
$25,841.62
|
| Rate for Payer: PHP Commercial |
$257.04
|
| Rate for Payer: PHP Commercial |
$274.46
|
| Rate for Payer: Priority Health SBD |
$203.43
|
| Rate for Payer: Priority Health SBD |
$639.44
|
| Rate for Payer: Priority Health SBD |
$19,153.20
|
| Rate for Payer: Priority Health SBD |
$190.51
|
| Rate for Payer: UMR Bronson Commercial |
$133.06
|
| Rate for Payer: UMR Bronson Commercial |
$13,376.84
|
| Rate for Payer: UMR Bronson Commercial |
$446.60
|
| Rate for Payer: UMR Bronson Commercial |
$142.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$761.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,801.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.18
|
|
|
IMATINIB 100 MG TABLET
|
Facility
|
OP
|
$302.40
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
32979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.89 |
| Max. Negotiated Rate |
$272.16 |
| Rate for Payer: Aetna American Axle |
$196.56
|
| Rate for Payer: Aetna American Axle |
$209.88
|
| Rate for Payer: Aetna American Axle |
$659.74
|
| Rate for Payer: Aetna American Axle |
$19,761.24
|
| Rate for Payer: Aetna Commercial |
$274.46
|
| Rate for Payer: Aetna Commercial |
$257.04
|
| Rate for Payer: Aetna Commercial |
$25,841.62
|
| Rate for Payer: Aetna Commercial |
$862.74
|
| Rate for Payer: Aetna Medicare |
$15,200.95
|
| Rate for Payer: Aetna Medicare |
$507.50
|
| Rate for Payer: Aetna Medicare |
$161.45
|
| Rate for Payer: Aetna Medicare |
$151.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,761.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.74
|
| Rate for Payer: BCBS Complete |
$406.00
|
| Rate for Payer: BCBS Complete |
$129.16
|
| Rate for Payer: BCBS Complete |
$12,160.76
|
| Rate for Payer: BCBS Complete |
$120.96
|
| Rate for Payer: Cash Price |
$241.92
|
| Rate for Payer: Cash Price |
$258.32
|
| Rate for Payer: Cash Price |
$811.99
|
| Rate for Payer: Cash Price |
$24,321.53
|
| Rate for Payer: Cofinity Advantage |
$226.03
|
| Rate for Payer: Cofinity Advantage |
$211.68
|
| Rate for Payer: Cofinity Advantage |
$710.49
|
| Rate for Payer: Cofinity Advantage |
$21,281.34
|
| Rate for Payer: Cofinity Commercial |
$260.06
|
| Rate for Payer: Cofinity Commercial |
$872.89
|
| Rate for Payer: Cofinity Commercial |
$26,145.64
|
| Rate for Payer: Cofinity Commercial |
$277.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,321.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.32
|
| Rate for Payer: Healthscope Commercial |
$913.49
|
| Rate for Payer: Healthscope Commercial |
$290.61
|
| Rate for Payer: Healthscope Commercial |
$27,361.72
|
| Rate for Payer: Healthscope Commercial |
$272.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,281.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$710.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,801.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$761.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,321.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$862.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,841.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,801.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$761.24
|
| Rate for Payer: PHP Commercial |
$257.04
|
| Rate for Payer: PHP Commercial |
$25,841.62
|
| Rate for Payer: PHP Commercial |
$274.46
|
| Rate for Payer: PHP Commercial |
$862.74
|
| Rate for Payer: Priority Health SBD |
$19,153.20
|
| Rate for Payer: Priority Health SBD |
$203.43
|
| Rate for Payer: Priority Health SBD |
$190.51
|
| Rate for Payer: Priority Health SBD |
$639.44
|
| Rate for Payer: UMR Bronson Commercial |
$11,248.71
|
| Rate for Payer: UMR Bronson Commercial |
$111.89
|
| Rate for Payer: UMR Bronson Commercial |
$119.47
|
| Rate for Payer: UMR Bronson Commercial |
$375.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$761.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,801.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.80
|
|
|
IMETELSTAT 188 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47,790.67
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
207512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21,027.89 |
| Max. Negotiated Rate |
$43,011.60 |
| Rate for Payer: Aetna American Axle |
$31,063.94
|
| Rate for Payer: Aetna Commercial |
$40,622.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31,063.94
|
| Rate for Payer: Cash Price |
$38,232.54
|
| Rate for Payer: Cofinity Advantage |
$33,453.47
|
| Rate for Payer: Cofinity Commercial |
$41,099.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,232.54
|
| Rate for Payer: Healthscope Commercial |
$43,011.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,453.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,843.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,622.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35,843.00
|
| Rate for Payer: PHP Commercial |
$40,622.07
|
| Rate for Payer: Priority Health SBD |
$30,108.12
|
| Rate for Payer: UMR Bronson Commercial |
$21,027.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,843.00
|
|
|
IMETELSTAT 188 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47,790.67
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
207512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$43,011.60 |
| Rate for Payer: Aetna American Axle |
$31,063.94
|
| Rate for Payer: Aetna Commercial |
$40,622.07
|
| Rate for Payer: Aetna Medicare |
$60.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31,063.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.71
|
| Rate for Payer: BCBS Complete |
$31.95
|
| Rate for Payer: BCBS MAPPO |
$58.17
|
| Rate for Payer: BCBS Trust/PPO |
$189.05
|
| Rate for Payer: BCN Commercial |
$189.05
|
| Rate for Payer: BCN Medicare Advantage |
$58.17
|
| Rate for Payer: Cash Price |
$38,232.54
|
| Rate for Payer: Cash Price |
$38,232.54
|
| Rate for Payer: Cofinity Advantage |
$33,453.47
|
| Rate for Payer: Cofinity Commercial |
$41,099.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,232.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.17
|
| Rate for Payer: Healthscope Commercial |
$43,011.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,453.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,843.00
|
| Rate for Payer: Mclaren Medicaid |
$58.17
|
| Rate for Payer: Mclaren Medicare |
$58.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.08
|
| Rate for Payer: Meridian Medicaid |
$61.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,622.07
|
| Rate for Payer: Nomi Health Commercial |
$174.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35,843.00
|
| Rate for Payer: PACE Medicare |
$55.26
|
| Rate for Payer: PACE SWMI |
$58.17
|
| Rate for Payer: PHP Commercial |
$40,622.07
|
| Rate for Payer: PHP Medicare Advantage |
$58.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$179.85
|
| Rate for Payer: Priority Health Medicare |
$58.17
|
| Rate for Payer: Priority Health SBD |
$30,108.12
|
| Rate for Payer: Priority Health Tiered Network |
$143.88
|
| Rate for Payer: Railroad Medicare Medicare |
$58.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.20
|
| Rate for Payer: UHC Core |
$96.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.17
|
| Rate for Payer: UHC Exchange |
$96.20
|
| Rate for Payer: UHC Medicaid |
$30.42
|
| Rate for Payer: UHCCP Medicaid |
$30.42
|
| Rate for Payer: UMR Bronson Commercial |
$17,682.55
|
| Rate for Payer: VA VA |
$58.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,843.00
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$135.13
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
9603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.72 |
| 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 Medicare |
$67.56
|
| Rate for Payer: Aetna Medicare |
$22.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.70
|
| Rate for Payer: BCBS Complete |
$17.66
|
| Rate for Payer: BCBS Complete |
$54.05
|
| Rate for Payer: BCBS Trust/PPO |
$23.01
|
| Rate for Payer: BCBS Trust/PPO |
$23.01
|
| Rate for Payer: BCN Commercial |
$23.01
|
| Rate for Payer: BCN Commercial |
$23.01
|
| Rate for Payer: Cash Price |
$108.10
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cash Price |
$108.10
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cofinity Advantage |
$94.59
|
| Rate for Payer: Cofinity Advantage |
$30.91
|
| Rate for Payer: Cofinity Commercial |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$37.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$121.62
|
| Rate for Payer: Healthscope Commercial |
$39.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.35
|
| Rate for Payer: PHP Commercial |
$114.86
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: Priority Health SBD |
$85.13
|
| Rate for Payer: Priority Health SBD |
$27.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.72
|
| Rate for Payer: UHC Core |
$11.72
|
| Rate for Payer: UHC Core |
$11.72
|
| Rate for Payer: UHC Exchange |
$11.72
|
| Rate for Payer: UHC Exchange |
$11.72
|
| Rate for Payer: UMR Bronson Commercial |
$50.00
|
| Rate for Payer: UMR Bronson Commercial |
$16.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.12
|
|
|
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) |
$87.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.70
|
| Rate for Payer: Cash Price |
$108.10
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cofinity Advantage |
$30.91
|
| Rate for Payer: Cofinity Advantage |
$94.59
|
| Rate for Payer: Cofinity Commercial |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$116.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$121.62
|
| Rate for Payer: Healthscope Commercial |
$39.74
|
| 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 |
$101.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.12
|
| Rate for Payer: PHP Commercial |
$114.86
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: Priority Health SBD |
$27.82
|
| Rate for Payer: Priority Health SBD |
$85.13
|
| Rate for Payer: UMR Bronson Commercial |
$59.46
|
| Rate for Payer: UMR Bronson Commercial |
$19.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.12
|
|
|
IMIPENEM-CILASTATIN-RELEBACTAM 1.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$982.17
|
|
|
Service Code
|
HCPCS J0742
|
| Hospital Charge Code |
192562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$883.95 |
| Rate for Payer: Aetna American Axle |
$638.41
|
| Rate for Payer: Aetna Commercial |
$834.84
|
| Rate for Payer: Aetna Medicare |
$491.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.41
|
| Rate for Payer: BCBS Complete |
$392.87
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$785.74
|
| Rate for Payer: Cash Price |
$785.74
|
| Rate for Payer: Cofinity Advantage |
$687.52
|
| Rate for Payer: Cofinity Commercial |
$844.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.74
|
| Rate for Payer: Healthscope Commercial |
$883.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$687.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$736.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$785.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$736.63
|
| Rate for Payer: PHP Commercial |
$834.84
|
| Rate for Payer: Priority Health SBD |
$618.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.29
|
| Rate for Payer: UHC Core |
$4.29
|
| Rate for Payer: UHC Exchange |
$4.29
|
| Rate for Payer: UMR Bronson Commercial |
$363.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.63
|
|
|
IMIPENEM-CILASTATIN-RELEBACTAM 1.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$982.17
|
|
|
Service Code
|
HCPCS J0742
|
| Hospital Charge Code |
192562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.15 |
| Max. Negotiated Rate |
$883.95 |
| Rate for Payer: Aetna American Axle |
$638.41
|
| Rate for Payer: Aetna Commercial |
$834.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.41
|
| Rate for Payer: Cash Price |
$785.74
|
| Rate for Payer: Cofinity Advantage |
$687.52
|
| Rate for Payer: Cofinity Commercial |
$844.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.74
|
| Rate for Payer: Healthscope Commercial |
$883.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$687.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$736.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$736.63
|
| Rate for Payer: PHP Commercial |
$834.84
|
| Rate for Payer: Priority Health SBD |
$618.77
|
| Rate for Payer: UMR Bronson Commercial |
$432.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.63
|
|
|
IMIPRAMINE 10 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 69584042510
|
| Hospital Charge Code |
3860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
IMIPRAMINE 10 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 49884005401
|
| 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 Advantage |
$274.71
|
| 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 |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| 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 10 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 49884005401
|
| Hospital Charge Code |
3860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| 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 |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.09
|
| Rate for Payer: UHC Core |
$204.47
|
| Rate for Payer: UHC Exchange |
$154.23
|
| Rate for Payer: UMR Bronson Commercial |
$145.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
IMIPRAMINE 10 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 69584042510
|
| Hospital Charge Code |
3860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.54
|
| Rate for Payer: UHC Core |
$68.56
|
| Rate for Payer: UHC Exchange |
$51.72
|
| Rate for Payer: UMR Bronson Commercial |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
IMIPRAMINE 25 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 64380017001
|
| 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 Advantage |
$148.29
|
| 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 |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| 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
|
|
|
IMIPRAMINE 25 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 69584042610
|
| Hospital Charge Code |
3861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UMR Bronson Commercial |
$61.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
IMIPRAMINE 25 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 49884005501
|
| 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 Advantage |
$148.29
|
| 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 |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| 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
|
|
|
IMIPRAMINE 25 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 69584042610
|
| Hospital Charge Code |
3861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$69.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.12
|
| Rate for Payer: UHC Core |
$72.24
|
| Rate for Payer: UHC Exchange |
$54.49
|
| Rate for Payer: UMR Bronson Commercial |
$51.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
IMIPRAMINE 25 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 49884005501
|
| Hospital Charge Code |
3861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna American Axle |
$137.70
|
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna Medicare |
$105.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.70
|
| Rate for Payer: BCBS Complete |
$84.74
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Advantage |
$148.29
|
| 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 |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.70
|
| Rate for Payer: UHC Core |
$110.37
|
| Rate for Payer: UHC Exchange |
$83.26
|
| Rate for Payer: UMR Bronson Commercial |
$78.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
IMIPRAMINE 25 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 64380017001
|
| Hospital Charge Code |
3861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna American Axle |
$137.70
|
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna Medicare |
$105.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.70
|
| Rate for Payer: BCBS Complete |
$84.74
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Advantage |
$148.29
|
| 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 |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.70
|
| Rate for Payer: UHC Core |
$110.37
|
| Rate for Payer: UHC Exchange |
$83.26
|
| Rate for Payer: UMR Bronson Commercial |
$78.38
|
| 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
|
$9,088.59
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$8,179.73 |
| Rate for Payer: Aetna American Axle |
$5,907.58
|
| Rate for Payer: Aetna Commercial |
$7,725.30
|
| Rate for Payer: Aetna Medicare |
$51.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,907.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.16
|
| Rate for Payer: BCBS Complete |
$27.31
|
| Rate for Payer: BCBS MAPPO |
$49.73
|
| Rate for Payer: BCBS Trust/PPO |
$159.13
|
| Rate for Payer: BCN Commercial |
$159.13
|
| Rate for Payer: BCN Medicare Advantage |
$49.73
|
| Rate for Payer: Cash Price |
$7,270.87
|
| Rate for Payer: Cash Price |
$7,270.87
|
| Rate for Payer: Cofinity Advantage |
$6,362.01
|
| Rate for Payer: Cofinity Commercial |
$7,816.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,270.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.73
|
| Rate for Payer: Healthscope Commercial |
$8,179.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,362.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,816.44
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$49.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.22
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,725.30
|
| Rate for Payer: Nomi Health Commercial |
$149.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,816.44
|
| Rate for Payer: PACE Medicare |
$47.24
|
| Rate for Payer: PACE SWMI |
$49.73
|
| Rate for Payer: PHP Commercial |
$7,725.30
|
| Rate for Payer: PHP Medicare Advantage |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$154.42
|
| Rate for Payer: Priority Health Medicare |
$49.73
|
| Rate for Payer: Priority Health SBD |
$5,725.81
|
| Rate for Payer: Priority Health Tiered Network |
$123.54
|
| Rate for Payer: Railroad Medicare Medicare |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.98
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.73
|
| Rate for Payer: UHC Exchange |
$80.98
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UMR Bronson Commercial |
$3,362.78
|
| Rate for Payer: VA VA |
$49.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,816.44
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
IP
|
$9,088.59
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,998.98 |
| Max. Negotiated Rate |
$8,179.73 |
| Rate for Payer: Aetna American Axle |
$5,907.58
|
| Rate for Payer: Aetna Commercial |
$7,725.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,907.58
|
| Rate for Payer: Cash Price |
$7,270.87
|
| Rate for Payer: Cofinity Advantage |
$6,362.01
|
| Rate for Payer: Cofinity Commercial |
$7,816.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,270.87
|
| Rate for Payer: Healthscope Commercial |
$8,179.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,362.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,816.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,725.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,816.44
|
| Rate for Payer: PHP Commercial |
$7,725.30
|
| Rate for Payer: Priority Health SBD |
$5,725.81
|
| Rate for Payer: UMR Bronson Commercial |
$3,998.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,816.44
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
OP
|
$18,177.18
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
172845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$16,359.46 |
| Rate for Payer: Aetna American Axle |
$11,815.17
|
| Rate for Payer: Aetna Commercial |
$15,450.60
|
| Rate for Payer: Aetna Medicare |
$51.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,815.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.16
|
| Rate for Payer: BCBS Complete |
$27.31
|
| Rate for Payer: BCBS MAPPO |
$49.73
|
| Rate for Payer: BCBS Trust/PPO |
$159.13
|
| Rate for Payer: BCN Commercial |
$159.13
|
| Rate for Payer: BCN Medicare Advantage |
$49.73
|
| Rate for Payer: Cash Price |
$14,541.74
|
| Rate for Payer: Cash Price |
$14,541.74
|
| Rate for Payer: Cofinity Advantage |
$12,724.03
|
| Rate for Payer: Cofinity Commercial |
$15,632.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,541.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.73
|
| Rate for Payer: Healthscope Commercial |
$16,359.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,724.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,632.89
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$49.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.22
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,450.60
|
| Rate for Payer: Nomi Health Commercial |
$149.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,632.89
|
| Rate for Payer: PACE Medicare |
$47.24
|
| Rate for Payer: PACE SWMI |
$49.73
|
| Rate for Payer: PHP Commercial |
$15,450.60
|
| Rate for Payer: PHP Medicare Advantage |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$154.42
|
| Rate for Payer: Priority Health Medicare |
$49.73
|
| Rate for Payer: Priority Health SBD |
$11,451.62
|
| Rate for Payer: Priority Health Tiered Network |
$123.54
|
| Rate for Payer: Railroad Medicare Medicare |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.98
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.73
|
| Rate for Payer: UHC Exchange |
$80.98
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UMR Bronson Commercial |
$6,725.56
|
| Rate for Payer: VA VA |
$49.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,632.89
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,147.25
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$1,032.53 |
| Rate for Payer: Aetna American Axle |
$745.71
|
| Rate for Payer: Aetna American Axle |
$1,491.42
|
| Rate for Payer: Aetna American Axle |
$5,965.70
|
| Rate for Payer: Aetna American Axle |
$2,982.59
|
| Rate for Payer: Aetna American Axle |
$8,948.55
|
| Rate for Payer: Aetna Commercial |
$7,801.30
|
| Rate for Payer: Aetna Commercial |
$975.16
|
| Rate for Payer: Aetna Commercial |
$1,950.33
|
| Rate for Payer: Aetna Commercial |
$11,701.95
|
| Rate for Payer: Aetna Commercial |
$3,900.31
|
| Rate for Payer: Aetna Medicare |
$51.04
|
| Rate for Payer: Aetna Medicare |
$51.04
|
| Rate for Payer: Aetna Medicare |
$51.04
|
| Rate for Payer: Aetna Medicare |
$51.04
|
| Rate for Payer: Aetna Medicare |
$51.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,491.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,948.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,965.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,982.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS Trust/PPO |
$153.34
|
| Rate for Payer: BCBS Trust/PPO |
$153.34
|
| Rate for Payer: BCBS Trust/PPO |
$153.34
|
| Rate for Payer: BCBS Trust/PPO |
$153.34
|
| Rate for Payer: BCBS Trust/PPO |
$153.34
|
| Rate for Payer: BCN Commercial |
$153.34
|
| Rate for Payer: BCN Commercial |
$153.34
|
| Rate for Payer: BCN Commercial |
$153.34
|
| Rate for Payer: BCN Commercial |
$153.34
|
| Rate for Payer: BCN Commercial |
$153.34
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: Cash Price |
$917.80
|
| Rate for Payer: Cash Price |
$917.80
|
| Rate for Payer: Cash Price |
$7,342.40
|
| Rate for Payer: Cash Price |
$3,670.88
|
| Rate for Payer: Cash Price |
$11,013.60
|
| Rate for Payer: Cash Price |
$7,342.40
|
| Rate for Payer: Cash Price |
$3,670.88
|
| Rate for Payer: Cash Price |
$1,835.60
|
| Rate for Payer: Cash Price |
$1,835.60
|
| Rate for Payer: Cash Price |
$11,013.60
|
| Rate for Payer: Cofinity Advantage |
$803.08
|
| Rate for Payer: Cofinity Advantage |
$1,606.15
|
| Rate for Payer: Cofinity Advantage |
$6,424.60
|
| Rate for Payer: Cofinity Advantage |
$3,212.02
|
| Rate for Payer: Cofinity Advantage |
$9,636.90
|
| Rate for Payer: Cofinity Commercial |
$3,946.20
|
| Rate for Payer: Cofinity Commercial |
$986.63
|
| Rate for Payer: Cofinity Commercial |
$7,893.08
|
| Rate for Payer: Cofinity Commercial |
$1,973.27
|
| Rate for Payer: Cofinity Commercial |
$11,839.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$917.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,013.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,835.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,670.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,342.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Healthscope Commercial |
$8,260.20
|
| Rate for Payer: Healthscope Commercial |
$1,032.53
|
| Rate for Payer: Healthscope Commercial |
$4,129.74
|
| Rate for Payer: Healthscope Commercial |
$2,065.05
|
| Rate for Payer: Healthscope Commercial |
$12,390.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,212.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$803.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,636.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,424.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,606.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,720.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,441.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,325.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$860.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,883.50
|
| Rate for Payer: Mclaren Medicaid |
$49.08
|
| Rate for Payer: Mclaren Medicaid |
$49.08
|
| Rate for Payer: Mclaren Medicaid |
$49.08
|
| Rate for Payer: Mclaren Medicaid |
$49.08
|
| Rate for Payer: Mclaren Medicaid |
$49.08
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Medicaid |
$51.53
|
| Rate for Payer: Meridian Medicaid |
$51.53
|
| Rate for Payer: Meridian Medicaid |
$51.53
|
| Rate for Payer: Meridian Medicaid |
$51.53
|
| Rate for Payer: Meridian Medicaid |
$51.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,701.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$975.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,950.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,900.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,801.30
|
| Rate for Payer: Nomi Health Commercial |
$147.24
|
| Rate for Payer: Nomi Health Commercial |
$147.24
|
| Rate for Payer: Nomi Health Commercial |
$147.24
|
| Rate for Payer: Nomi Health Commercial |
$147.24
|
| Rate for Payer: Nomi Health Commercial |
$147.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,883.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,325.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,720.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,441.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$860.44
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PHP Commercial |
$3,900.31
|
| Rate for Payer: PHP Commercial |
$1,950.33
|
| Rate for Payer: PHP Commercial |
$975.16
|
| Rate for Payer: PHP Commercial |
$11,701.95
|
| Rate for Payer: PHP Commercial |
$7,801.30
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.92
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health SBD |
$2,890.82
|
| Rate for Payer: Priority Health SBD |
$1,445.54
|
| Rate for Payer: Priority Health SBD |
$8,673.21
|
| Rate for Payer: Priority Health SBD |
$5,782.14
|
| Rate for Payer: Priority Health SBD |
$722.77
|
| Rate for Payer: Priority Health Tiered Network |
$114.34
|
| Rate for Payer: Priority Health Tiered Network |
$114.34
|
| Rate for Payer: Priority Health Tiered Network |
$114.34
|
| Rate for Payer: Priority Health Tiered Network |
$114.34
|
| Rate for Payer: Priority Health Tiered Network |
$114.34
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.03
|
| Rate for Payer: UHC Core |
$78.03
|
| Rate for Payer: UHC Core |
$78.03
|
| Rate for Payer: UHC Core |
$78.03
|
| Rate for Payer: UHC Core |
$78.03
|
| Rate for Payer: UHC Core |
$78.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: UMR Bronson Commercial |
$848.97
|
| Rate for Payer: UMR Bronson Commercial |
$3,395.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,697.78
|
| Rate for Payer: UMR Bronson Commercial |
$424.48
|
| Rate for Payer: UMR Bronson Commercial |
$5,093.79
|
| Rate for Payer: VA VA |
$49.08
|
| Rate for Payer: VA VA |
$49.08
|
| Rate for Payer: VA VA |
$49.08
|
| Rate for Payer: VA VA |
$49.08
|
| Rate for Payer: VA VA |
$49.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,441.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,720.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$860.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,325.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,883.50
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$4,588.60
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,018.98 |
| Max. Negotiated Rate |
$4,129.74 |
| Rate for Payer: Aetna American Axle |
$2,982.59
|
| Rate for Payer: Aetna American Axle |
$1,491.42
|
| Rate for Payer: Aetna American Axle |
$5,965.70
|
| Rate for Payer: Aetna American Axle |
$8,948.55
|
| Rate for Payer: Aetna American Axle |
$745.71
|
| Rate for Payer: Aetna Commercial |
$975.16
|
| Rate for Payer: Aetna Commercial |
$1,950.33
|
| Rate for Payer: Aetna Commercial |
$3,900.31
|
| Rate for Payer: Aetna Commercial |
$7,801.30
|
| Rate for Payer: Aetna Commercial |
$11,701.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,982.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,491.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,948.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,965.70
|
| Rate for Payer: Cash Price |
$1,835.60
|
| Rate for Payer: Cash Price |
$11,013.60
|
| Rate for Payer: Cash Price |
$7,342.40
|
| Rate for Payer: Cash Price |
$3,670.88
|
| Rate for Payer: Cash Price |
$917.80
|
| Rate for Payer: Cofinity Advantage |
$803.08
|
| Rate for Payer: Cofinity Advantage |
$6,424.60
|
| Rate for Payer: Cofinity Advantage |
$9,636.90
|
| Rate for Payer: Cofinity Advantage |
$3,212.02
|
| Rate for Payer: Cofinity Advantage |
$1,606.15
|
| Rate for Payer: Cofinity Commercial |
$7,893.08
|
| Rate for Payer: Cofinity Commercial |
$986.63
|
| Rate for Payer: Cofinity Commercial |
$11,839.62
|
| Rate for Payer: Cofinity Commercial |
$1,973.27
|
| Rate for Payer: Cofinity Commercial |
$3,946.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,670.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$917.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,835.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,013.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,342.40
|
| Rate for Payer: Healthscope Commercial |
$1,032.53
|
| Rate for Payer: Healthscope Commercial |
$12,390.30
|
| Rate for Payer: Healthscope Commercial |
$2,065.05
|
| Rate for Payer: Healthscope Commercial |
$4,129.74
|
| Rate for Payer: Healthscope Commercial |
$8,260.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,636.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,424.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$803.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,606.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,212.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$860.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,325.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,720.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,441.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,883.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$975.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,900.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,950.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,701.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,801.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$860.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,720.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,325.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,883.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,441.45
|
| Rate for Payer: PHP Commercial |
$1,950.33
|
| Rate for Payer: PHP Commercial |
$975.16
|
| Rate for Payer: PHP Commercial |
$3,900.31
|
| Rate for Payer: PHP Commercial |
$7,801.30
|
| Rate for Payer: PHP Commercial |
$11,701.95
|
| Rate for Payer: Priority Health SBD |
$2,890.82
|
| Rate for Payer: Priority Health SBD |
$5,782.14
|
| Rate for Payer: Priority Health SBD |
$8,673.21
|
| Rate for Payer: Priority Health SBD |
$722.77
|
| Rate for Payer: Priority Health SBD |
$1,445.54
|
| Rate for Payer: UMR Bronson Commercial |
$6,057.48
|
| Rate for Payer: UMR Bronson Commercial |
$4,038.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,009.58
|
| Rate for Payer: UMR Bronson Commercial |
$504.79
|
| Rate for Payer: UMR Bronson Commercial |
$2,018.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,441.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,720.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,883.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$860.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,325.25
|
|
