|
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 |
$50.00 |
| 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: Cash Price |
$108.10
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cofinity Commercial |
$94.59
|
| Rate for Payer: Cofinity Commercial |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$30.91
|
| Rate for Payer: Cofinity Commercial |
$37.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.59
|
| 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 |
$39.74
|
| Rate for Payer: Healthscope Commercial |
$121.62
|
| 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: Multiplan/Beech St/PHCS Commercial |
$114.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$114.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.70
|
| Rate for Payer: Priority Health SBD |
$27.82
|
| Rate for Payer: Priority Health SBD |
$85.13
|
| 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 |
$33.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.35
|
|
|
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 |
$1.40 |
| 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 |
$2.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.26
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: BCBS MAPPO |
$2.61
|
| Rate for Payer: BCN Medicare Advantage |
$2.61
|
| Rate for Payer: Cash Price |
$785.74
|
| Rate for Payer: Cash Price |
$785.74
|
| Rate for Payer: Cofinity Commercial |
$844.67
|
| Rate for Payer: Cofinity Commercial |
$687.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.61
|
| 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: Mclaren Medicaid |
$1.40
|
| Rate for Payer: Mclaren Medicare |
$2.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.74
|
| Rate for Payer: Meridian Medicaid |
$1.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.84
|
| Rate for Payer: PACE Medicare |
$2.48
|
| Rate for Payer: PACE SWMI |
$2.61
|
| Rate for Payer: PHP Commercial |
$834.84
|
| Rate for Payer: PHP Medicare Advantage |
$2.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.41
|
| Rate for Payer: Priority Health Medicare |
$2.61
|
| Rate for Payer: Priority Health SBD |
$618.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.61
|
| Rate for Payer: UHC Exchange |
$4.99
|
| Rate for Payer: UHC Medicare Advantage |
$2.61
|
| Rate for Payer: UHCCP Medicaid |
$1.40
|
| Rate for Payer: UMR Bronson Commercial |
$363.40
|
| Rate for Payer: VA VA |
$2.61
|
| 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 Commercial |
$687.52
|
| Rate for Payer: Cofinity Commercial |
$844.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.52
|
| 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: PHP Commercial |
$834.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.41
|
| 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
|
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 Commercial |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.71
|
| 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: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$145.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
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 Commercial |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.71
|
| 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: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
IMIPRAMINE 25 MG TABLET
|
Facility
|
IP
|
$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 Commercial |
$148.29
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.29
|
| 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: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.70
|
| 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
|
$183.30
|
|
|
Service Code
|
NDC 64380017001
|
| Hospital Charge Code |
3861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.65 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna American Axle |
$119.14
|
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.14
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UMR Bronson Commercial |
$80.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
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 Commercial |
$148.29
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.29
|
| 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: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.70
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| 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
|
$183.30
|
|
|
Service Code
|
NDC 64380017001
|
| Hospital Charge Code |
3861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.82 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna American Axle |
$119.14
|
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$91.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: BCBS Complete |
$73.32
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.14
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UMR Bronson Commercial |
$67.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
OP
|
$8,609.08
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$7,748.17 |
| Rate for Payer: Aetna American Axle |
$5,595.90
|
| Rate for Payer: Aetna Commercial |
$7,317.72
|
| Rate for Payer: Aetna Medicare |
$50.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,595.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.20
|
| Rate for Payer: BCBS Complete |
$27.55
|
| Rate for Payer: BCBS MAPPO |
$48.96
|
| Rate for Payer: BCN Medicare Advantage |
$48.96
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cofinity Commercial |
$7,403.81
|
| Rate for Payer: Cofinity Commercial |
$6,026.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,026.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,887.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$7,748.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,026.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,456.81
|
| Rate for Payer: Mclaren Medicaid |
$26.24
|
| Rate for Payer: Mclaren Medicare |
$48.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.41
|
| Rate for Payer: Meridian Medicaid |
$27.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,317.72
|
| Rate for Payer: PACE Medicare |
$46.51
|
| Rate for Payer: PACE SWMI |
$48.96
|
| Rate for Payer: PHP Commercial |
$7,317.72
|
| Rate for Payer: PHP Medicare Advantage |
$48.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,595.90
|
| Rate for Payer: Priority Health Medicare |
$48.96
|
| Rate for Payer: Priority Health SBD |
$5,423.72
|
| Rate for Payer: Railroad Medicare Medicare |
$48.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.96
|
| Rate for Payer: UHC Exchange |
$93.57
|
| Rate for Payer: UHC Medicare Advantage |
$48.96
|
| Rate for Payer: UHCCP Medicaid |
$26.24
|
| Rate for Payer: UMR Bronson Commercial |
$3,185.36
|
| Rate for Payer: VA VA |
$48.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,456.81
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
IP
|
$8,609.08
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,788.00 |
| Max. Negotiated Rate |
$7,748.17 |
| Rate for Payer: Aetna American Axle |
$5,595.90
|
| Rate for Payer: Aetna Commercial |
$7,317.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,595.90
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cofinity Commercial |
$6,026.36
|
| Rate for Payer: Cofinity Commercial |
$7,403.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,026.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,887.26
|
| Rate for Payer: Healthscope Commercial |
$7,748.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,026.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,456.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,317.72
|
| Rate for Payer: PHP Commercial |
$7,317.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,595.90
|
| Rate for Payer: Priority Health SBD |
$5,423.72
|
| Rate for Payer: UMR Bronson Commercial |
$3,788.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,456.81
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
OP
|
$17,218.15
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
172845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$15,496.33 |
| Rate for Payer: Aetna American Axle |
$11,191.80
|
| Rate for Payer: Aetna Commercial |
$14,635.43
|
| Rate for Payer: Aetna Medicare |
$50.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,191.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.20
|
| Rate for Payer: BCBS Complete |
$27.55
|
| Rate for Payer: BCBS MAPPO |
$48.96
|
| Rate for Payer: BCN Medicare Advantage |
$48.96
|
| Rate for Payer: Cash Price |
$13,774.52
|
| Rate for Payer: Cash Price |
$13,774.52
|
| Rate for Payer: Cofinity Commercial |
$12,052.70
|
| Rate for Payer: Cofinity Commercial |
$14,807.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,052.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,774.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$15,496.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,052.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,913.61
|
| Rate for Payer: Mclaren Medicaid |
$26.24
|
| Rate for Payer: Mclaren Medicare |
$48.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.41
|
| Rate for Payer: Meridian Medicaid |
$27.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,635.43
|
| Rate for Payer: PACE Medicare |
$46.51
|
| Rate for Payer: PACE SWMI |
$48.96
|
| Rate for Payer: PHP Commercial |
$14,635.43
|
| Rate for Payer: PHP Medicare Advantage |
$48.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,191.80
|
| Rate for Payer: Priority Health Medicare |
$48.96
|
| Rate for Payer: Priority Health SBD |
$10,847.43
|
| Rate for Payer: Railroad Medicare Medicare |
$48.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.96
|
| Rate for Payer: UHC Exchange |
$93.57
|
| Rate for Payer: UHC Medicare Advantage |
$48.96
|
| Rate for Payer: UHCCP Medicaid |
$26.24
|
| Rate for Payer: UMR Bronson Commercial |
$6,370.72
|
| Rate for Payer: VA VA |
$48.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,913.61
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,436.25
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.29 |
| Max. Negotiated Rate |
$1,292.62 |
| Rate for Payer: Aetna American Axle |
$933.56
|
| Rate for Payer: Aetna American Axle |
$466.78
|
| Rate for Payer: Aetna American Axle |
$1,867.12
|
| Rate for Payer: Aetna American Axle |
$3,734.25
|
| Rate for Payer: Aetna American Axle |
$5,601.38
|
| Rate for Payer: Aetna Commercial |
$4,883.25
|
| Rate for Payer: Aetna Commercial |
$610.41
|
| Rate for Payer: Aetna Commercial |
$1,220.81
|
| Rate for Payer: Aetna Commercial |
$7,324.88
|
| Rate for Payer: Aetna Commercial |
$2,441.62
|
| Rate for Payer: Aetna Medicare |
$47.12
|
| Rate for Payer: Aetna Medicare |
$47.12
|
| Rate for Payer: Aetna Medicare |
$47.12
|
| Rate for Payer: Aetna Medicare |
$47.12
|
| Rate for Payer: Aetna Medicare |
$47.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,867.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,734.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,601.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$6,894.00
|
| Rate for Payer: Cash Price |
$6,894.00
|
| Rate for Payer: Cash Price |
$4,596.00
|
| Rate for Payer: Cash Price |
$2,298.00
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$2,298.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cash Price |
$4,596.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cofinity Commercial |
$1,235.17
|
| Rate for Payer: Cofinity Commercial |
$2,010.75
|
| Rate for Payer: Cofinity Commercial |
$1,005.38
|
| Rate for Payer: Cofinity Commercial |
$4,940.70
|
| Rate for Payer: Cofinity Commercial |
$7,411.05
|
| Rate for Payer: Cofinity Commercial |
$6,032.25
|
| Rate for Payer: Cofinity Commercial |
$502.69
|
| Rate for Payer: Cofinity Commercial |
$617.59
|
| Rate for Payer: Cofinity Commercial |
$4,021.50
|
| Rate for Payer: Cofinity Commercial |
$2,470.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,005.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,021.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,032.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$502.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,010.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,149.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,596.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,894.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,298.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Healthscope Commercial |
$7,755.75
|
| Rate for Payer: Healthscope Commercial |
$2,585.25
|
| Rate for Payer: Healthscope Commercial |
$646.32
|
| Rate for Payer: Healthscope Commercial |
$1,292.62
|
| Rate for Payer: Healthscope Commercial |
$5,170.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,021.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,005.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,032.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,010.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$502.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$538.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,308.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,154.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,463.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,077.19
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,324.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,883.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,441.62
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PHP Commercial |
$2,441.62
|
| Rate for Payer: PHP Commercial |
$1,220.81
|
| Rate for Payer: PHP Commercial |
$4,883.25
|
| Rate for Payer: PHP Commercial |
$610.41
|
| Rate for Payer: PHP Commercial |
$7,324.88
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,867.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,601.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,734.25
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health SBD |
$452.42
|
| Rate for Payer: Priority Health SBD |
$3,619.35
|
| Rate for Payer: Priority Health SBD |
$904.84
|
| Rate for Payer: Priority Health SBD |
$1,809.67
|
| Rate for Payer: Priority Health SBD |
$5,429.02
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Exchange |
$86.59
|
| Rate for Payer: UHC Exchange |
$86.59
|
| Rate for Payer: UHC Exchange |
$86.59
|
| Rate for Payer: UHC Exchange |
$86.59
|
| Rate for Payer: UHC Exchange |
$86.59
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHCCP Medicaid |
$24.29
|
| Rate for Payer: UHCCP Medicaid |
$24.29
|
| Rate for Payer: UHCCP Medicaid |
$24.29
|
| Rate for Payer: UHCCP Medicaid |
$24.29
|
| Rate for Payer: UHCCP Medicaid |
$24.29
|
| Rate for Payer: UMR Bronson Commercial |
$531.41
|
| Rate for Payer: UMR Bronson Commercial |
$2,125.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,062.83
|
| Rate for Payer: UMR Bronson Commercial |
$265.71
|
| Rate for Payer: UMR Bronson Commercial |
$3,188.47
|
| Rate for Payer: VA VA |
$45.31
|
| Rate for Payer: VA VA |
$45.31
|
| Rate for Payer: VA VA |
$45.31
|
| Rate for Payer: VA VA |
$45.31
|
| Rate for Payer: VA VA |
$45.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,463.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$538.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,154.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,308.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,077.19
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$718.13
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$315.98 |
| Max. Negotiated Rate |
$646.32 |
| Rate for Payer: Aetna American Axle |
$466.78
|
| Rate for Payer: Aetna American Axle |
$933.56
|
| Rate for Payer: Aetna American Axle |
$1,867.12
|
| Rate for Payer: Aetna American Axle |
$5,601.38
|
| Rate for Payer: Aetna American Axle |
$3,734.25
|
| Rate for Payer: Aetna Commercial |
$610.41
|
| Rate for Payer: Aetna Commercial |
$2,441.62
|
| Rate for Payer: Aetna Commercial |
$1,220.81
|
| Rate for Payer: Aetna Commercial |
$7,324.88
|
| Rate for Payer: Aetna Commercial |
$4,883.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,734.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,601.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,867.12
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$6,894.00
|
| Rate for Payer: Cash Price |
$2,298.00
|
| Rate for Payer: Cash Price |
$4,596.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cofinity Commercial |
$6,032.25
|
| Rate for Payer: Cofinity Commercial |
$1,005.38
|
| Rate for Payer: Cofinity Commercial |
$617.59
|
| Rate for Payer: Cofinity Commercial |
$502.69
|
| Rate for Payer: Cofinity Commercial |
$4,021.50
|
| Rate for Payer: Cofinity Commercial |
$2,010.75
|
| Rate for Payer: Cofinity Commercial |
$2,470.35
|
| Rate for Payer: Cofinity Commercial |
$4,940.70
|
| Rate for Payer: Cofinity Commercial |
$1,235.17
|
| Rate for Payer: Cofinity Commercial |
$7,411.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$502.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,005.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,010.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,032.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,021.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,298.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,149.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,894.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,596.00
|
| Rate for Payer: Healthscope Commercial |
$2,585.25
|
| Rate for Payer: Healthscope Commercial |
$646.32
|
| Rate for Payer: Healthscope Commercial |
$5,170.50
|
| Rate for Payer: Healthscope Commercial |
$7,755.75
|
| Rate for Payer: Healthscope Commercial |
$1,292.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$502.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,005.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,021.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,010.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,032.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,308.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,154.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,077.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$538.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,463.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,441.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,883.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,324.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.81
|
| Rate for Payer: PHP Commercial |
$1,220.81
|
| Rate for Payer: PHP Commercial |
$7,324.88
|
| Rate for Payer: PHP Commercial |
$4,883.25
|
| Rate for Payer: PHP Commercial |
$610.41
|
| Rate for Payer: PHP Commercial |
$2,441.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,867.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,734.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,601.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.56
|
| Rate for Payer: Priority Health SBD |
$5,429.02
|
| Rate for Payer: Priority Health SBD |
$3,619.35
|
| Rate for Payer: Priority Health SBD |
$1,809.67
|
| Rate for Payer: Priority Health SBD |
$904.84
|
| Rate for Payer: Priority Health SBD |
$452.42
|
| Rate for Payer: UMR Bronson Commercial |
$631.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,263.90
|
| Rate for Payer: UMR Bronson Commercial |
$315.98
|
| Rate for Payer: UMR Bronson Commercial |
$3,791.70
|
| Rate for Payer: UMR Bronson Commercial |
$2,527.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,077.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,308.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,154.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,463.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$538.60
|
|
|
IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$5,756.46
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$5,180.81 |
| Rate for Payer: Aetna American Axle |
$3,741.70
|
| Rate for Payer: Aetna Commercial |
$4,892.99
|
| Rate for Payer: Aetna Medicare |
$81.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,741.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.50
|
| Rate for Payer: BCBS Complete |
$44.35
|
| Rate for Payer: BCBS MAPPO |
$78.80
|
| Rate for Payer: BCN Medicare Advantage |
$78.80
|
| Rate for Payer: Cash Price |
$4,605.17
|
| Rate for Payer: Cash Price |
$4,605.17
|
| Rate for Payer: Cofinity Commercial |
$4,950.56
|
| Rate for Payer: Cofinity Commercial |
$4,029.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,029.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,605.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.80
|
| Rate for Payer: Healthscope Commercial |
$5,180.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,029.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,317.35
|
| Rate for Payer: Mclaren Medicaid |
$42.24
|
| Rate for Payer: Mclaren Medicare |
$78.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.74
|
| Rate for Payer: Meridian Medicaid |
$44.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,892.99
|
| Rate for Payer: PACE Medicare |
$74.86
|
| Rate for Payer: PACE SWMI |
$78.80
|
| Rate for Payer: PHP Commercial |
$4,892.99
|
| Rate for Payer: PHP Medicare Advantage |
$78.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,741.70
|
| Rate for Payer: Priority Health Medicare |
$78.80
|
| Rate for Payer: Priority Health SBD |
$3,626.57
|
| Rate for Payer: Railroad Medicare Medicare |
$78.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.80
|
| Rate for Payer: UHC Exchange |
$150.59
|
| Rate for Payer: UHC Medicare Advantage |
$78.80
|
| Rate for Payer: UHCCP Medicaid |
$42.24
|
| Rate for Payer: UMR Bronson Commercial |
$2,129.89
|
| Rate for Payer: VA VA |
$78.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,317.35
|
|
|
IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$5,756.46
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,532.84 |
| Max. Negotiated Rate |
$5,180.81 |
| Rate for Payer: Aetna American Axle |
$3,741.70
|
| Rate for Payer: Aetna Commercial |
$4,892.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,741.70
|
| Rate for Payer: Cash Price |
$4,605.17
|
| Rate for Payer: Cofinity Commercial |
$4,029.52
|
| Rate for Payer: Cofinity Commercial |
$4,950.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,029.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,605.17
|
| Rate for Payer: Healthscope Commercial |
$5,180.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,029.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,317.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,892.99
|
| Rate for Payer: PHP Commercial |
$4,892.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,741.70
|
| Rate for Payer: Priority Health SBD |
$3,626.57
|
| Rate for Payer: UMR Bronson Commercial |
$2,532.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,317.35
|
|
|
IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$2,878.21
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$2,590.39 |
| Rate for Payer: Aetna American Axle |
$1,870.84
|
| Rate for Payer: Aetna Commercial |
$2,446.48
|
| Rate for Payer: Aetna Medicare |
$81.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,870.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.50
|
| Rate for Payer: BCBS Complete |
$44.35
|
| Rate for Payer: BCBS MAPPO |
$78.80
|
| Rate for Payer: BCN Medicare Advantage |
$78.80
|
| Rate for Payer: Cash Price |
$2,302.57
|
| Rate for Payer: Cash Price |
$2,302.57
|
| Rate for Payer: Cofinity Commercial |
$2,475.26
|
| Rate for Payer: Cofinity Commercial |
$2,014.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,014.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,302.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.80
|
| Rate for Payer: Healthscope Commercial |
$2,590.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,014.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,158.66
|
| Rate for Payer: Mclaren Medicaid |
$42.24
|
| Rate for Payer: Mclaren Medicare |
$78.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.74
|
| Rate for Payer: Meridian Medicaid |
$44.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,446.48
|
| Rate for Payer: PACE Medicare |
$74.86
|
| Rate for Payer: PACE SWMI |
$78.80
|
| Rate for Payer: PHP Commercial |
$2,446.48
|
| Rate for Payer: PHP Medicare Advantage |
$78.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,870.84
|
| Rate for Payer: Priority Health Medicare |
$78.80
|
| Rate for Payer: Priority Health SBD |
$1,813.27
|
| Rate for Payer: Railroad Medicare Medicare |
$78.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.80
|
| Rate for Payer: UHC Exchange |
$150.59
|
| Rate for Payer: UHC Medicare Advantage |
$78.80
|
| Rate for Payer: UHCCP Medicaid |
$42.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,064.94
|
| Rate for Payer: VA VA |
$78.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,158.66
|
|
|
IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$2,878.21
|
|
|
Service Code
|
HCPCS J1566
|
| Hospital Charge Code |
171071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,266.41 |
| Max. Negotiated Rate |
$2,590.39 |
| Rate for Payer: Aetna American Axle |
$1,870.84
|
| Rate for Payer: Aetna Commercial |
$2,446.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,870.84
|
| Rate for Payer: Cash Price |
$2,302.57
|
| Rate for Payer: Cofinity Commercial |
$2,014.75
|
| Rate for Payer: Cofinity Commercial |
$2,475.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,014.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,302.57
|
| Rate for Payer: Healthscope Commercial |
$2,590.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,014.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,158.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,446.48
|
| Rate for Payer: PHP Commercial |
$2,446.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,870.84
|
| Rate for Payer: Priority Health SBD |
$1,813.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,266.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,158.66
|
|
|
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 |
$25.48 |
| Max. Negotiated Rate |
$6,499.66 |
| Rate for Payer: Aetna American Axle |
$4,694.20
|
| Rate for Payer: Aetna American Axle |
$2,347.10
|
| Rate for Payer: Aetna American Axle |
$1,173.56
|
| Rate for Payer: Aetna Commercial |
$6,138.57
|
| Rate for Payer: Aetna Commercial |
$1,534.65
|
| Rate for Payer: Aetna Commercial |
$3,069.29
|
| Rate for Payer: Aetna Medicare |
$49.43
|
| Rate for Payer: Aetna Medicare |
$49.43
|
| Rate for Payer: Aetna Medicare |
$49.43
|
| 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: Aetna New Business (MI Preferred) |
$4,694.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.41
|
| Rate for Payer: BCBS Complete |
$26.75
|
| Rate for Payer: BCBS Complete |
$26.75
|
| Rate for Payer: BCBS Complete |
$26.75
|
| Rate for Payer: BCBS MAPPO |
$47.53
|
| Rate for Payer: BCBS MAPPO |
$47.53
|
| Rate for Payer: BCBS MAPPO |
$47.53
|
| Rate for Payer: BCN Medicare Advantage |
$47.53
|
| Rate for Payer: BCN Medicare Advantage |
$47.53
|
| Rate for Payer: BCN Medicare Advantage |
$47.53
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cash Price |
$1,444.38
|
| Rate for Payer: Cash Price |
$1,444.38
|
| Rate for Payer: Cash Price |
$5,777.48
|
| Rate for Payer: Cash Price |
$5,777.48
|
| Rate for Payer: Cofinity Commercial |
$1,263.83
|
| Rate for Payer: Cofinity Commercial |
$6,210.79
|
| Rate for Payer: Cofinity Commercial |
$5,055.30
|
| Rate for Payer: Cofinity Commercial |
$2,527.65
|
| Rate for Payer: Cofinity Commercial |
$1,552.70
|
| Rate for Payer: Cofinity Commercial |
$3,105.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,055.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,527.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,263.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,777.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,888.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,444.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.53
|
| Rate for Payer: Healthscope Commercial |
$1,624.92
|
| Rate for Payer: Healthscope Commercial |
$6,499.66
|
| Rate for Payer: Healthscope Commercial |
$3,249.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,527.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,055.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,263.83
|
| 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: Lakeland Regional Health Systems Commercial |
$2,708.20
|
| Rate for Payer: Mclaren Medicaid |
$25.48
|
| Rate for Payer: Mclaren Medicaid |
$25.48
|
| Rate for Payer: Mclaren Medicaid |
$25.48
|
| Rate for Payer: Mclaren Medicare |
$47.53
|
| Rate for Payer: Mclaren Medicare |
$47.53
|
| Rate for Payer: Mclaren Medicare |
$47.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.91
|
| Rate for Payer: Meridian Medicaid |
$26.75
|
| Rate for Payer: Meridian Medicaid |
$26.75
|
| Rate for Payer: Meridian Medicaid |
$26.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.66
|
| 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: Multiplan/Beech St/PHCS Commercial |
$1,534.65
|
| Rate for Payer: PACE Medicare |
$45.15
|
| Rate for Payer: PACE Medicare |
$45.15
|
| Rate for Payer: PACE Medicare |
$45.15
|
| Rate for Payer: PACE SWMI |
$47.53
|
| Rate for Payer: PACE SWMI |
$47.53
|
| Rate for Payer: PACE SWMI |
$47.53
|
| 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 |
$47.53
|
| Rate for Payer: PHP Medicare Advantage |
$47.53
|
| Rate for Payer: PHP Medicare Advantage |
$47.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,347.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,694.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,173.56
|
| Rate for Payer: Priority Health Medicare |
$47.53
|
| Rate for Payer: Priority Health Medicare |
$47.53
|
| Rate for Payer: Priority Health Medicare |
$47.53
|
| Rate for Payer: Priority Health SBD |
$1,137.45
|
| Rate for Payer: Priority Health SBD |
$2,274.89
|
| Rate for Payer: Priority Health SBD |
$4,549.77
|
| Rate for Payer: Railroad Medicare Medicare |
$47.53
|
| Rate for Payer: Railroad Medicare Medicare |
$47.53
|
| Rate for Payer: Railroad Medicare Medicare |
$47.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.53
|
| Rate for Payer: UHC Exchange |
$90.83
|
| Rate for Payer: UHC Exchange |
$90.83
|
| Rate for Payer: UHC Exchange |
$90.83
|
| Rate for Payer: UHC Medicare Advantage |
$47.53
|
| Rate for Payer: UHC Medicare Advantage |
$47.53
|
| Rate for Payer: UHC Medicare Advantage |
$47.53
|
| Rate for Payer: UHCCP Medicaid |
$25.48
|
| Rate for Payer: UHCCP Medicaid |
$25.48
|
| Rate for Payer: UHCCP Medicaid |
$25.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,336.04
|
| Rate for Payer: UMR Bronson Commercial |
$2,672.08
|
| Rate for Payer: UMR Bronson Commercial |
$668.02
|
| Rate for Payer: VA VA |
$47.53
|
| Rate for Payer: VA VA |
$47.53
|
| Rate for Payer: VA VA |
$47.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,708.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,416.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,354.10
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$4,263.18
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
171063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,875.80 |
| Max. Negotiated Rate |
$3,836.86 |
| Rate for Payer: Aetna American Axle |
$2,771.07
|
| Rate for Payer: Aetna Commercial |
$3,623.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,771.07
|
| Rate for Payer: Cash Price |
$3,410.54
|
| Rate for Payer: Cofinity Commercial |
$2,984.23
|
| Rate for Payer: Cofinity Commercial |
$3,666.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,984.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,410.54
|
| Rate for Payer: Healthscope Commercial |
$3,836.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,984.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,197.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,623.70
|
| Rate for Payer: PHP Commercial |
$3,623.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,771.07
|
| Rate for Payer: Priority Health SBD |
$2,685.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,875.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,197.39
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,131.59
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
171063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$1,918.43 |
| Rate for Payer: Aetna American Axle |
$1,385.53
|
| Rate for Payer: Aetna American Axle |
$2,771.07
|
| Rate for Payer: Aetna Commercial |
$1,811.85
|
| Rate for Payer: Aetna Commercial |
$3,623.70
|
| Rate for Payer: Aetna Medicare |
$52.77
|
| Rate for Payer: Aetna Medicare |
$52.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,771.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,385.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.42
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS MAPPO |
$50.74
|
| Rate for Payer: BCBS MAPPO |
$50.74
|
| Rate for Payer: BCN Medicare Advantage |
$50.74
|
| Rate for Payer: BCN Medicare Advantage |
$50.74
|
| Rate for Payer: Cash Price |
$1,705.27
|
| Rate for Payer: Cash Price |
$1,705.27
|
| Rate for Payer: Cash Price |
$3,410.54
|
| Rate for Payer: Cash Price |
$3,410.54
|
| Rate for Payer: Cofinity Commercial |
$1,492.11
|
| Rate for Payer: Cofinity Commercial |
$1,833.17
|
| Rate for Payer: Cofinity Commercial |
$2,984.23
|
| Rate for Payer: Cofinity Commercial |
$3,666.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,492.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,984.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,705.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,410.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.74
|
| Rate for Payer: Healthscope Commercial |
$3,836.86
|
| Rate for Payer: Healthscope Commercial |
$1,918.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,492.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,984.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,197.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,598.69
|
| Rate for Payer: Mclaren Medicaid |
$27.20
|
| Rate for Payer: Mclaren Medicaid |
$27.20
|
| Rate for Payer: Mclaren Medicare |
$50.74
|
| Rate for Payer: Mclaren Medicare |
$50.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.28
|
| Rate for Payer: Meridian Medicaid |
$28.56
|
| Rate for Payer: Meridian Medicaid |
$28.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,623.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,811.85
|
| Rate for Payer: PACE Medicare |
$48.20
|
| Rate for Payer: PACE Medicare |
$48.20
|
| Rate for Payer: PACE SWMI |
$50.74
|
| Rate for Payer: PACE SWMI |
$50.74
|
| Rate for Payer: PHP Commercial |
$3,623.70
|
| Rate for Payer: PHP Commercial |
$1,811.85
|
| Rate for Payer: PHP Medicare Advantage |
$50.74
|
| Rate for Payer: PHP Medicare Advantage |
$50.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,771.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.53
|
| Rate for Payer: Priority Health Medicare |
$50.74
|
| Rate for Payer: Priority Health Medicare |
$50.74
|
| Rate for Payer: Priority Health SBD |
$2,685.80
|
| Rate for Payer: Priority Health SBD |
$1,342.90
|
| Rate for Payer: Railroad Medicare Medicare |
$50.74
|
| Rate for Payer: Railroad Medicare Medicare |
$50.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.74
|
| Rate for Payer: UHC Exchange |
$96.97
|
| Rate for Payer: UHC Exchange |
$96.97
|
| Rate for Payer: UHC Medicare Advantage |
$50.74
|
| Rate for Payer: UHC Medicare Advantage |
$50.74
|
| Rate for Payer: UHCCP Medicaid |
$27.20
|
| Rate for Payer: UHCCP Medicaid |
$27.20
|
| Rate for Payer: UMR Bronson Commercial |
$788.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,577.38
|
| Rate for Payer: VA VA |
$50.74
|
| Rate for Payer: VA VA |
$50.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,197.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,598.69
|
|
|
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 |
$25.48 |
| 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 |
$49.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.41
|
| Rate for Payer: BCBS Complete |
$26.75
|
| Rate for Payer: BCBS MAPPO |
$47.53
|
| Rate for Payer: BCN Medicare Advantage |
$47.53
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cofinity Commercial |
$2,527.65
|
| Rate for Payer: Cofinity Commercial |
$3,105.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,527.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,888.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.53
|
| 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 |
$25.48
|
| Rate for Payer: Mclaren Medicare |
$47.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.91
|
| Rate for Payer: Meridian Medicaid |
$26.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,069.29
|
| Rate for Payer: PACE Medicare |
$45.15
|
| Rate for Payer: PACE SWMI |
$47.53
|
| Rate for Payer: PHP Commercial |
$3,069.29
|
| Rate for Payer: PHP Medicare Advantage |
$47.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,347.10
|
| Rate for Payer: Priority Health Medicare |
$47.53
|
| Rate for Payer: Priority Health SBD |
$2,274.89
|
| Rate for Payer: Railroad Medicare Medicare |
$47.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.53
|
| Rate for Payer: UHC Exchange |
$90.83
|
| Rate for Payer: UHC Medicare Advantage |
$47.53
|
| Rate for Payer: UHCCP Medicaid |
$25.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,336.04
|
| Rate for Payer: VA VA |
$47.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,708.20
|
|
|
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 Commercial |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: 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: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.29
|
| 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 Commercial |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: 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: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.29
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE/VITAL 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 Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.01
|
| 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: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.22
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
