|
IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$5,842.67
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$5,258.40 |
| Rate for Payer: Aetna American Axle |
$3,797.74
|
| Rate for Payer: Aetna Commercial |
$4,966.27
|
| Rate for Payer: Aetna Medicare |
$83.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,797.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.50
|
| Rate for Payer: BCBS Complete |
$44.16
|
| Rate for Payer: BCBS MAPPO |
$80.40
|
| Rate for Payer: BCBS Trust/PPO |
$255.82
|
| Rate for Payer: BCN Commercial |
$255.82
|
| Rate for Payer: BCN Medicare Advantage |
$80.40
|
| Rate for Payer: Cash Price |
$4,674.14
|
| Rate for Payer: Cash Price |
$4,674.14
|
| Rate for Payer: Cofinity Advantage |
$4,089.87
|
| Rate for Payer: Cofinity Commercial |
$5,024.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,674.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.40
|
| Rate for Payer: Healthscope Commercial |
$5,258.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,089.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,382.00
|
| Rate for Payer: Mclaren Medicaid |
$80.40
|
| Rate for Payer: Mclaren Medicare |
$80.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.42
|
| Rate for Payer: Meridian Medicaid |
$84.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,966.27
|
| Rate for Payer: Nomi Health Commercial |
$241.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,382.00
|
| Rate for Payer: PACE Medicare |
$76.38
|
| Rate for Payer: PACE SWMI |
$80.40
|
| Rate for Payer: PHP Commercial |
$4,966.27
|
| Rate for Payer: PHP Medicare Advantage |
$80.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$248.50
|
| Rate for Payer: Priority Health Medicare |
$80.40
|
| Rate for Payer: Priority Health SBD |
$3,680.88
|
| Rate for Payer: Priority Health Tiered Network |
$198.80
|
| Rate for Payer: Railroad Medicare Medicare |
$80.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.17
|
| Rate for Payer: UHC Core |
$130.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.40
|
| Rate for Payer: UHC Exchange |
$130.17
|
| Rate for Payer: UHC Medicaid |
$42.05
|
| Rate for Payer: UHCCP Medicaid |
$42.05
|
| Rate for Payer: UMR Bronson Commercial |
$2,161.79
|
| Rate for Payer: VA VA |
$80.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,382.00
|
|
|
IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$5,842.67
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,570.77 |
| Max. Negotiated Rate |
$5,258.40 |
| Rate for Payer: Aetna American Axle |
$3,797.74
|
| Rate for Payer: Aetna Commercial |
$4,966.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,797.74
|
| Rate for Payer: Cash Price |
$4,674.14
|
| Rate for Payer: Cofinity Advantage |
$4,089.87
|
| Rate for Payer: Cofinity Commercial |
$5,024.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,674.14
|
| Rate for Payer: Healthscope Commercial |
$5,258.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,089.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,382.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,966.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,382.00
|
| Rate for Payer: PHP Commercial |
$4,966.27
|
| Rate for Payer: Priority Health SBD |
$3,680.88
|
| Rate for Payer: UMR Bronson Commercial |
$2,570.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,382.00
|
|
|
IMMUNE GLOB,GAMMA(IGG) 15 %-18 % RANGE-GLYCINE INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$359.94
|
|
|
Service Code
|
HCPCS J1460
|
| Hospital Charge Code |
171045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.37 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Aetna American Axle |
$233.96
|
| Rate for Payer: Aetna American Axle |
$1,084.56
|
| Rate for Payer: Aetna Commercial |
$1,418.28
|
| Rate for Payer: Aetna Commercial |
$305.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.96
|
| Rate for Payer: Cash Price |
$1,334.85
|
| Rate for Payer: Cash Price |
$287.95
|
| Rate for Payer: Cofinity Advantage |
$251.96
|
| Rate for Payer: Cofinity Advantage |
$1,167.99
|
| Rate for Payer: Cofinity Commercial |
$1,434.96
|
| Rate for Payer: Cofinity Commercial |
$309.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.85
|
| Rate for Payer: Healthscope Commercial |
$323.95
|
| Rate for Payer: Healthscope Commercial |
$1,501.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,167.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,251.42
|
| Rate for Payer: PHP Commercial |
$1,418.28
|
| Rate for Payer: PHP Commercial |
$305.95
|
| Rate for Payer: Priority Health SBD |
$226.76
|
| Rate for Payer: Priority Health SBD |
$1,051.19
|
| Rate for Payer: UMR Bronson Commercial |
$734.17
|
| Rate for Payer: UMR Bronson Commercial |
$158.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.95
|
|
|
IMMUNE GLOB,GAMMA(IGG) 15 %-18 % RANGE-GLYCINE INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$359.94
|
|
|
Service Code
|
HCPCS J1460
|
| Hospital Charge Code |
171045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Aetna American Axle |
$233.96
|
| Rate for Payer: Aetna American Axle |
$1,084.56
|
| Rate for Payer: Aetna Commercial |
$1,418.28
|
| Rate for Payer: Aetna Commercial |
$305.95
|
| Rate for Payer: Aetna Medicare |
$50.91
|
| Rate for Payer: Aetna Medicare |
$50.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.19
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS MAPPO |
$48.95
|
| Rate for Payer: BCBS MAPPO |
$48.95
|
| Rate for Payer: BCBS Trust/PPO |
$161.87
|
| Rate for Payer: BCBS Trust/PPO |
$161.87
|
| Rate for Payer: BCN Commercial |
$161.87
|
| Rate for Payer: BCN Commercial |
$161.87
|
| Rate for Payer: BCN Medicare Advantage |
$48.95
|
| Rate for Payer: BCN Medicare Advantage |
$48.95
|
| Rate for Payer: Cash Price |
$1,334.85
|
| Rate for Payer: Cash Price |
$287.95
|
| Rate for Payer: Cash Price |
$287.95
|
| Rate for Payer: Cash Price |
$1,334.85
|
| Rate for Payer: Cofinity Advantage |
$251.96
|
| Rate for Payer: Cofinity Advantage |
$1,167.99
|
| Rate for Payer: Cofinity Commercial |
$1,434.96
|
| Rate for Payer: Cofinity Commercial |
$309.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.95
|
| Rate for Payer: Healthscope Commercial |
$1,501.70
|
| Rate for Payer: Healthscope Commercial |
$323.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,167.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.95
|
| Rate for Payer: Mclaren Medicaid |
$48.95
|
| Rate for Payer: Mclaren Medicaid |
$48.95
|
| Rate for Payer: Mclaren Medicare |
$48.95
|
| Rate for Payer: Mclaren Medicare |
$48.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.40
|
| Rate for Payer: Meridian Medicaid |
$51.40
|
| Rate for Payer: Meridian Medicaid |
$51.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.95
|
| Rate for Payer: Nomi Health Commercial |
$146.85
|
| Rate for Payer: Nomi Health Commercial |
$146.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,251.42
|
| Rate for Payer: PACE Medicare |
$46.50
|
| Rate for Payer: PACE Medicare |
$46.50
|
| Rate for Payer: PACE SWMI |
$48.95
|
| Rate for Payer: PACE SWMI |
$48.95
|
| Rate for Payer: PHP Commercial |
$1,418.28
|
| Rate for Payer: PHP Commercial |
$305.95
|
| Rate for Payer: PHP Medicare Advantage |
$48.95
|
| Rate for Payer: PHP Medicare Advantage |
$48.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$154.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$154.65
|
| Rate for Payer: Priority Health Medicare |
$48.95
|
| Rate for Payer: Priority Health Medicare |
$48.95
|
| Rate for Payer: Priority Health SBD |
$1,051.19
|
| Rate for Payer: Priority Health SBD |
$226.76
|
| Rate for Payer: Priority Health Tiered Network |
$123.72
|
| Rate for Payer: Priority Health Tiered Network |
$123.72
|
| Rate for Payer: Railroad Medicare Medicare |
$48.95
|
| Rate for Payer: Railroad Medicare Medicare |
$48.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.37
|
| Rate for Payer: UHC Core |
$82.37
|
| Rate for Payer: UHC Core |
$82.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.95
|
| Rate for Payer: UHC Exchange |
$82.37
|
| Rate for Payer: UHC Exchange |
$82.37
|
| Rate for Payer: UHC Medicaid |
$25.60
|
| Rate for Payer: UHC Medicaid |
$25.60
|
| Rate for Payer: UHCCP Medicaid |
$25.60
|
| Rate for Payer: UHCCP Medicaid |
$25.60
|
| Rate for Payer: UMR Bronson Commercial |
$617.37
|
| Rate for Payer: UMR Bronson Commercial |
$133.18
|
| Rate for Payer: VA VA |
$48.95
|
| Rate for Payer: VA VA |
$48.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.42
|
|
|
IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$2,921.34
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,285.39 |
| Max. Negotiated Rate |
$2,629.21 |
| Rate for Payer: Aetna American Axle |
$1,898.87
|
| Rate for Payer: Aetna Commercial |
$2,483.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,898.87
|
| Rate for Payer: Cash Price |
$2,337.07
|
| Rate for Payer: Cofinity Advantage |
$2,044.94
|
| Rate for Payer: Cofinity Commercial |
$2,512.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,337.07
|
| Rate for Payer: Healthscope Commercial |
$2,629.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,044.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,191.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,483.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,191.01
|
| Rate for Payer: PHP Commercial |
$2,483.14
|
| Rate for Payer: Priority Health SBD |
$1,840.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,285.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,191.01
|
|
|
IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$2,921.34
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$2,629.21 |
| Rate for Payer: Aetna American Axle |
$1,898.87
|
| Rate for Payer: Aetna Commercial |
$2,483.14
|
| Rate for Payer: Aetna Medicare |
$83.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,898.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.50
|
| Rate for Payer: BCBS Complete |
$44.16
|
| Rate for Payer: BCBS MAPPO |
$80.40
|
| Rate for Payer: BCBS Trust/PPO |
$255.82
|
| Rate for Payer: BCN Commercial |
$255.82
|
| Rate for Payer: BCN Medicare Advantage |
$80.40
|
| Rate for Payer: Cash Price |
$2,337.07
|
| Rate for Payer: Cash Price |
$2,337.07
|
| Rate for Payer: Cofinity Advantage |
$2,044.94
|
| Rate for Payer: Cofinity Commercial |
$2,512.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,337.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.40
|
| Rate for Payer: Healthscope Commercial |
$2,629.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,044.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,191.01
|
| Rate for Payer: Mclaren Medicaid |
$80.40
|
| Rate for Payer: Mclaren Medicare |
$80.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.42
|
| Rate for Payer: Meridian Medicaid |
$84.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,483.14
|
| Rate for Payer: Nomi Health Commercial |
$241.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,191.01
|
| Rate for Payer: PACE Medicare |
$76.38
|
| Rate for Payer: PACE SWMI |
$80.40
|
| Rate for Payer: PHP Commercial |
$2,483.14
|
| Rate for Payer: PHP Medicare Advantage |
$80.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$248.50
|
| Rate for Payer: Priority Health Medicare |
$80.40
|
| Rate for Payer: Priority Health SBD |
$1,840.44
|
| Rate for Payer: Priority Health Tiered Network |
$198.80
|
| Rate for Payer: Railroad Medicare Medicare |
$80.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.17
|
| Rate for Payer: UHC Core |
$130.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.40
|
| Rate for Payer: UHC Exchange |
$130.17
|
| Rate for Payer: UHC Medicaid |
$42.05
|
| Rate for Payer: UHCCP Medicaid |
$42.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,080.90
|
| Rate for Payer: VA VA |
$80.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,191.01
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,221.85
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
172293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$6,499.66 |
| Rate for Payer: Aetna American Axle |
$4,694.20
|
| Rate for Payer: Aetna American Axle |
$1,173.56
|
| Rate for Payer: Aetna American Axle |
$2,347.10
|
| Rate for Payer: Aetna Commercial |
$6,138.57
|
| Rate for Payer: Aetna Commercial |
$3,069.29
|
| Rate for Payer: Aetna Commercial |
$1,534.65
|
| Rate for Payer: Aetna Medicare |
$48.92
|
| Rate for Payer: Aetna Medicare |
$48.92
|
| Rate for Payer: Aetna Medicare |
$48.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,694.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,173.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.80
|
| Rate for Payer: BCBS Complete |
$25.83
|
| Rate for Payer: BCBS Complete |
$25.83
|
| Rate for Payer: BCBS Complete |
$25.83
|
| Rate for Payer: BCBS MAPPO |
$47.04
|
| Rate for Payer: BCBS MAPPO |
$47.04
|
| Rate for Payer: BCBS MAPPO |
$47.04
|
| Rate for Payer: BCBS Trust/PPO |
$153.62
|
| Rate for Payer: BCBS Trust/PPO |
$153.62
|
| Rate for Payer: BCBS Trust/PPO |
$153.62
|
| Rate for Payer: BCN Commercial |
$153.62
|
| Rate for Payer: BCN Commercial |
$153.62
|
| Rate for Payer: BCN Commercial |
$153.62
|
| Rate for Payer: BCN Medicare Advantage |
$47.04
|
| Rate for Payer: BCN Medicare Advantage |
$47.04
|
| Rate for Payer: BCN Medicare Advantage |
$47.04
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cash Price |
$5,777.48
|
| Rate for Payer: Cash Price |
$1,444.38
|
| Rate for Payer: Cash Price |
$5,777.48
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cash Price |
$1,444.38
|
| Rate for Payer: Cofinity Advantage |
$1,263.83
|
| Rate for Payer: Cofinity Advantage |
$2,527.65
|
| Rate for Payer: Cofinity Advantage |
$5,055.30
|
| Rate for Payer: Cofinity Commercial |
$3,105.40
|
| Rate for Payer: Cofinity Commercial |
$6,210.79
|
| Rate for Payer: Cofinity Commercial |
$1,552.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,444.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,888.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,777.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.04
|
| Rate for Payer: Healthscope Commercial |
$1,624.92
|
| Rate for Payer: Healthscope Commercial |
$3,249.84
|
| Rate for Payer: Healthscope Commercial |
$6,499.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,527.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,263.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,055.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,708.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,416.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,354.10
|
| Rate for Payer: Mclaren Medicaid |
$47.04
|
| Rate for Payer: Mclaren Medicaid |
$47.04
|
| Rate for Payer: Mclaren Medicaid |
$47.04
|
| Rate for Payer: Mclaren Medicare |
$47.04
|
| Rate for Payer: Mclaren Medicare |
$47.04
|
| Rate for Payer: Mclaren Medicare |
$47.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.39
|
| Rate for Payer: Meridian Medicaid |
$49.39
|
| Rate for Payer: Meridian Medicaid |
$49.39
|
| Rate for Payer: Meridian Medicaid |
$49.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,534.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,069.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,138.57
|
| Rate for Payer: Nomi Health Commercial |
$141.12
|
| Rate for Payer: Nomi Health Commercial |
$141.12
|
| Rate for Payer: Nomi Health Commercial |
$141.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,354.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,708.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,416.39
|
| Rate for Payer: PACE Medicare |
$44.69
|
| Rate for Payer: PACE Medicare |
$44.69
|
| Rate for Payer: PACE Medicare |
$44.69
|
| Rate for Payer: PACE SWMI |
$47.04
|
| Rate for Payer: PACE SWMI |
$47.04
|
| Rate for Payer: PACE SWMI |
$47.04
|
| Rate for Payer: PHP Commercial |
$6,138.57
|
| Rate for Payer: PHP Commercial |
$1,534.65
|
| Rate for Payer: PHP Commercial |
$3,069.29
|
| Rate for Payer: PHP Medicare Advantage |
$47.04
|
| Rate for Payer: PHP Medicare Advantage |
$47.04
|
| Rate for Payer: PHP Medicare Advantage |
$47.04
|
| 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/HMO/PPO/Narrow Network |
$149.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$149.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$149.90
|
| Rate for Payer: Priority Health Medicare |
$47.04
|
| Rate for Payer: Priority Health Medicare |
$47.04
|
| Rate for Payer: Priority Health Medicare |
$47.04
|
| Rate for Payer: Priority Health SBD |
$4,549.77
|
| Rate for Payer: Priority Health SBD |
$2,274.89
|
| Rate for Payer: Priority Health SBD |
$1,137.45
|
| Rate for Payer: Priority Health Tiered Network |
$119.92
|
| Rate for Payer: Priority Health Tiered Network |
$119.92
|
| Rate for Payer: Priority Health Tiered Network |
$119.92
|
| Rate for Payer: Railroad Medicare Medicare |
$47.04
|
| Rate for Payer: Railroad Medicare Medicare |
$47.04
|
| Rate for Payer: Railroad Medicare Medicare |
$47.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.19
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.04
|
| Rate for Payer: UHC Exchange |
$78.19
|
| Rate for Payer: UHC Exchange |
$78.19
|
| Rate for Payer: UHC Exchange |
$78.19
|
| Rate for Payer: UHC Medicaid |
$24.60
|
| Rate for Payer: UHC Medicaid |
$24.60
|
| Rate for Payer: UHC Medicaid |
$24.60
|
| Rate for Payer: UHCCP Medicaid |
$24.60
|
| Rate for Payer: UHCCP Medicaid |
$24.60
|
| Rate for Payer: UHCCP Medicaid |
$24.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,336.04
|
| Rate for Payer: UMR Bronson Commercial |
$668.02
|
| Rate for Payer: UMR Bronson Commercial |
$2,672.08
|
| Rate for Payer: VA VA |
$47.04
|
| Rate for Payer: VA VA |
$47.04
|
| Rate for Payer: VA VA |
$47.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,354.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,416.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,708.20
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,237.49
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
171063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$2,013.74 |
| Rate for Payer: Aetna American Axle |
$1,454.37
|
| Rate for Payer: Aetna American Axle |
$2,908.74
|
| Rate for Payer: Aetna Commercial |
$1,901.87
|
| Rate for Payer: Aetna Commercial |
$3,803.73
|
| Rate for Payer: Aetna Medicare |
$51.51
|
| Rate for Payer: Aetna Medicare |
$51.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,454.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,908.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.91
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS MAPPO |
$49.53
|
| Rate for Payer: BCBS MAPPO |
$49.53
|
| Rate for Payer: BCBS Trust/PPO |
$163.01
|
| Rate for Payer: BCBS Trust/PPO |
$163.01
|
| Rate for Payer: BCN Commercial |
$163.01
|
| Rate for Payer: BCN Commercial |
$163.01
|
| Rate for Payer: BCN Medicare Advantage |
$49.53
|
| Rate for Payer: BCN Medicare Advantage |
$49.53
|
| Rate for Payer: Cash Price |
$3,579.98
|
| Rate for Payer: Cash Price |
$1,789.99
|
| Rate for Payer: Cash Price |
$1,789.99
|
| Rate for Payer: Cash Price |
$3,579.98
|
| Rate for Payer: Cofinity Advantage |
$3,132.49
|
| Rate for Payer: Cofinity Advantage |
$1,566.24
|
| Rate for Payer: Cofinity Commercial |
$1,924.24
|
| Rate for Payer: Cofinity Commercial |
$3,848.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,579.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,789.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.53
|
| Rate for Payer: Healthscope Commercial |
$2,013.74
|
| Rate for Payer: Healthscope Commercial |
$4,027.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,566.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,132.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,356.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,678.12
|
| Rate for Payer: Mclaren Medicaid |
$49.53
|
| Rate for Payer: Mclaren Medicaid |
$49.53
|
| Rate for Payer: Mclaren Medicare |
$49.53
|
| Rate for Payer: Mclaren Medicare |
$49.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.01
|
| Rate for Payer: Meridian Medicaid |
$52.01
|
| Rate for Payer: Meridian Medicaid |
$52.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,803.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,901.87
|
| Rate for Payer: Nomi Health Commercial |
$148.59
|
| Rate for Payer: Nomi Health Commercial |
$148.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,678.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,356.24
|
| Rate for Payer: PACE Medicare |
$47.05
|
| Rate for Payer: PACE Medicare |
$47.05
|
| Rate for Payer: PACE SWMI |
$49.53
|
| Rate for Payer: PACE SWMI |
$49.53
|
| Rate for Payer: PHP Commercial |
$1,901.87
|
| Rate for Payer: PHP Commercial |
$3,803.73
|
| Rate for Payer: PHP Medicare Advantage |
$49.53
|
| Rate for Payer: PHP Medicare Advantage |
$49.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$160.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$160.02
|
| Rate for Payer: Priority Health Medicare |
$49.53
|
| Rate for Payer: Priority Health Medicare |
$49.53
|
| Rate for Payer: Priority Health SBD |
$2,819.24
|
| Rate for Payer: Priority Health SBD |
$1,409.62
|
| Rate for Payer: Priority Health Tiered Network |
$128.02
|
| Rate for Payer: Priority Health Tiered Network |
$128.02
|
| Rate for Payer: Railroad Medicare Medicare |
$49.53
|
| Rate for Payer: Railroad Medicare Medicare |
$49.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.96
|
| Rate for Payer: UHC Core |
$82.96
|
| Rate for Payer: UHC Core |
$82.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.53
|
| Rate for Payer: UHC Exchange |
$82.96
|
| Rate for Payer: UHC Exchange |
$82.96
|
| Rate for Payer: UHC Medicaid |
$25.90
|
| Rate for Payer: UHC Medicaid |
$25.90
|
| Rate for Payer: UHCCP Medicaid |
$25.90
|
| Rate for Payer: UHCCP Medicaid |
$25.90
|
| Rate for Payer: UMR Bronson Commercial |
$827.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,655.74
|
| Rate for Payer: VA VA |
$49.53
|
| Rate for Payer: VA VA |
$49.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,678.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,356.24
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$4,474.98
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
171063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,968.99 |
| Max. Negotiated Rate |
$4,027.48 |
| Rate for Payer: Aetna American Axle |
$2,908.74
|
| Rate for Payer: Aetna Commercial |
$3,803.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,908.74
|
| Rate for Payer: Cash Price |
$3,579.98
|
| Rate for Payer: Cofinity Advantage |
$3,132.49
|
| Rate for Payer: Cofinity Commercial |
$3,848.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,579.98
|
| Rate for Payer: Healthscope Commercial |
$4,027.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,132.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,356.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,803.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,356.24
|
| Rate for Payer: PHP Commercial |
$3,803.73
|
| Rate for Payer: Priority Health SBD |
$2,819.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,968.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,356.24
|
|
|
IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,610.93
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
171059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$3,249.84 |
| Rate for Payer: Aetna American Axle |
$2,347.10
|
| Rate for Payer: Aetna Commercial |
$3,069.29
|
| Rate for Payer: Aetna Medicare |
$48.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.80
|
| Rate for Payer: BCBS Complete |
$25.83
|
| Rate for Payer: BCBS MAPPO |
$47.04
|
| Rate for Payer: BCBS Trust/PPO |
$153.62
|
| Rate for Payer: BCN Commercial |
$153.62
|
| Rate for Payer: BCN Medicare Advantage |
$47.04
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cofinity Advantage |
$2,527.65
|
| Rate for Payer: Cofinity Commercial |
$3,105.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,888.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.04
|
| Rate for Payer: Healthscope Commercial |
$3,249.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,527.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,708.20
|
| Rate for Payer: Mclaren Medicaid |
$47.04
|
| Rate for Payer: Mclaren Medicare |
$47.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.39
|
| Rate for Payer: Meridian Medicaid |
$49.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,069.29
|
| Rate for Payer: Nomi Health Commercial |
$141.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,708.20
|
| Rate for Payer: PACE Medicare |
$44.69
|
| Rate for Payer: PACE SWMI |
$47.04
|
| Rate for Payer: PHP Commercial |
$3,069.29
|
| Rate for Payer: PHP Medicare Advantage |
$47.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$149.90
|
| Rate for Payer: Priority Health Medicare |
$47.04
|
| Rate for Payer: Priority Health SBD |
$2,274.89
|
| Rate for Payer: Priority Health Tiered Network |
$119.92
|
| Rate for Payer: Railroad Medicare Medicare |
$47.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.19
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.04
|
| Rate for Payer: UHC Exchange |
$78.19
|
| Rate for Payer: UHC Medicaid |
$24.60
|
| Rate for Payer: UHCCP Medicaid |
$24.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,336.04
|
| Rate for Payer: VA VA |
$47.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,708.20
|
|
|
IMMUNE GLOBULIN,GAMMA (IGG)-IFAS-GLYCINE 10 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,310.73
|
|
|
Service Code
|
HCPCS J1576
|
| Hospital Charge Code |
188667
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.61 |
| Max. Negotiated Rate |
$1,179.66 |
| Rate for Payer: Aetna American Axle |
$851.97
|
| Rate for Payer: Aetna American Axle |
$6,815.76
|
| Rate for Payer: Aetna Commercial |
$8,912.91
|
| Rate for Payer: Aetna Commercial |
$1,114.12
|
| Rate for Payer: Aetna Medicare |
$76.78
|
| Rate for Payer: Aetna Medicare |
$76.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,815.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.29
|
| Rate for Payer: BCBS Complete |
$40.55
|
| Rate for Payer: BCBS Complete |
$40.55
|
| Rate for Payer: BCBS MAPPO |
$73.83
|
| Rate for Payer: BCBS MAPPO |
$73.83
|
| Rate for Payer: BCBS Trust/PPO |
$230.93
|
| Rate for Payer: BCBS Trust/PPO |
$230.93
|
| Rate for Payer: BCN Commercial |
$230.93
|
| Rate for Payer: BCN Commercial |
$230.93
|
| Rate for Payer: BCN Medicare Advantage |
$73.83
|
| Rate for Payer: BCN Medicare Advantage |
$73.83
|
| Rate for Payer: Cash Price |
$8,388.62
|
| Rate for Payer: Cash Price |
$1,048.58
|
| Rate for Payer: Cash Price |
$1,048.58
|
| Rate for Payer: Cash Price |
$8,388.62
|
| Rate for Payer: Cofinity Advantage |
$917.51
|
| Rate for Payer: Cofinity Advantage |
$7,340.05
|
| Rate for Payer: Cofinity Commercial |
$9,017.77
|
| Rate for Payer: Cofinity Commercial |
$1,127.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,388.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.83
|
| Rate for Payer: Healthscope Commercial |
$9,437.20
|
| Rate for Payer: Healthscope Commercial |
$1,179.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$917.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,340.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,864.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$983.05
|
| Rate for Payer: Mclaren Medicaid |
$73.83
|
| Rate for Payer: Mclaren Medicaid |
$73.83
|
| Rate for Payer: Mclaren Medicare |
$73.83
|
| Rate for Payer: Mclaren Medicare |
$73.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.52
|
| Rate for Payer: Meridian Medicaid |
$77.52
|
| Rate for Payer: Meridian Medicaid |
$77.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,912.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,114.12
|
| Rate for Payer: Nomi Health Commercial |
$221.49
|
| Rate for Payer: Nomi Health Commercial |
$221.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$983.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,864.34
|
| Rate for Payer: PACE Medicare |
$70.14
|
| Rate for Payer: PACE Medicare |
$70.14
|
| Rate for Payer: PACE SWMI |
$73.83
|
| Rate for Payer: PACE SWMI |
$73.83
|
| Rate for Payer: PHP Commercial |
$8,912.91
|
| Rate for Payer: PHP Commercial |
$1,114.12
|
| Rate for Payer: PHP Medicare Advantage |
$73.83
|
| Rate for Payer: PHP Medicare Advantage |
$73.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$230.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$230.22
|
| Rate for Payer: Priority Health Medicare |
$73.83
|
| Rate for Payer: Priority Health Medicare |
$73.83
|
| Rate for Payer: Priority Health SBD |
$6,606.04
|
| Rate for Payer: Priority Health SBD |
$825.76
|
| Rate for Payer: Priority Health Tiered Network |
$184.18
|
| Rate for Payer: Priority Health Tiered Network |
$184.18
|
| Rate for Payer: Railroad Medicare Medicare |
$73.83
|
| Rate for Payer: Railroad Medicare Medicare |
$73.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.51
|
| Rate for Payer: UHC Core |
$117.51
|
| Rate for Payer: UHC Core |
$117.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.83
|
| Rate for Payer: UHC Exchange |
$117.51
|
| Rate for Payer: UHC Exchange |
$117.51
|
| Rate for Payer: UHC Medicaid |
$38.61
|
| Rate for Payer: UHC Medicaid |
$38.61
|
| Rate for Payer: UHCCP Medicaid |
$38.61
|
| Rate for Payer: UHCCP Medicaid |
$38.61
|
| Rate for Payer: UMR Bronson Commercial |
$3,879.74
|
| Rate for Payer: UMR Bronson Commercial |
$484.97
|
| Rate for Payer: VA VA |
$73.83
|
| Rate for Payer: VA VA |
$73.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$983.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,864.34
|
|
|
IMPACT ORAL LIQUID CUSTOM
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900035818
|
| 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 Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: 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 Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$29.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT ORAL LIQUID CUSTOM
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900035818
|
| Hospital Charge Code |
150859
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.29
|
| Rate for Payer: UHC Core |
$34.70
|
| Rate for Payer: UHC Exchange |
$26.17
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE 1.5 BOLUS FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| 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 Advantage |
$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 Commercial |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.80
|
| Rate for Payer: PHP Commercial |
$13.37
|
| 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 BOLUS FEED
|
Facility
|
OP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
150765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$7.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$12.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.80
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.22
|
| Rate for Payer: UHC Core |
$8.20
|
| Rate for Payer: UHC Exchange |
$6.18
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$7.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$12.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.80
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.22
|
| Rate for Payer: UHC Core |
$8.20
|
| Rate for Payer: UHC Exchange |
$6.18
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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 Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: 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 Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$29.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.29
|
| Rate for Payer: UHC Core |
$34.70
|
| Rate for Payer: UHC Exchange |
$26.17
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| 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 Advantage |
$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 Commercial |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.80
|
| Rate for Payer: PHP Commercial |
$13.37
|
| 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
|
$62.90
|
|
|
Service Code
|
NDC 70074062720
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.17
|
|
|
IMPACT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 70074062720
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna American Axle |
$40.88
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.88
|
| Rate for Payer: UHC Core |
$32.77
|
| Rate for Payer: UHC Exchange |
$24.72
|
| Rate for Payer: UMR Bronson Commercial |
$23.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.17
|
|
|
IMPACT PEPTIDE 1.5 CYCLIC FEED
|
Facility
|
OP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$7.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$12.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.80
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.22
|
| Rate for Payer: UHC Core |
$8.20
|
| Rate for Payer: UHC Exchange |
$6.18
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE 1.5 CYCLIC FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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 Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: 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 Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$29.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE 1.5 CYCLIC FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Advantage |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.29
|
| Rate for Payer: UHC Core |
$34.70
|
| Rate for Payer: UHC Exchange |
$26.17
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE 1.5 CYCLIC FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| 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 Advantage |
$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 Commercial |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.80
|
| Rate for Payer: PHP Commercial |
$13.37
|
| 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
|
|
