|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$775.62
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$341.27 |
| Max. Negotiated Rate |
$698.06 |
| Rate for Payer: Aetna American Axle |
$504.15
|
| Rate for Payer: Aetna Commercial |
$659.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.15
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cofinity Commercial |
$542.93
|
| Rate for Payer: Cofinity Commercial |
$667.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.50
|
| Rate for Payer: Healthscope Commercial |
$698.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.28
|
| Rate for Payer: PHP Commercial |
$659.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.15
|
| Rate for Payer: Priority Health SBD |
$488.64
|
| Rate for Payer: UMR Bronson Commercial |
$341.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.72
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$775.62
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.19 |
| Max. Negotiated Rate |
$698.06 |
| Rate for Payer: Aetna American Axle |
$504.15
|
| Rate for Payer: Aetna Commercial |
$659.28
|
| Rate for Payer: Aetna Medicare |
$387.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.15
|
| Rate for Payer: BCBS Complete |
$310.25
|
| Rate for Payer: BCBS Trust/PPO |
$67.19
|
| Rate for Payer: BCN Commercial |
$67.19
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cofinity Commercial |
$542.93
|
| Rate for Payer: Cofinity Commercial |
$667.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.50
|
| Rate for Payer: Healthscope Commercial |
$698.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.28
|
| Rate for Payer: PHP Commercial |
$659.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.15
|
| Rate for Payer: Priority Health SBD |
$488.64
|
| Rate for Payer: UMR Bronson Commercial |
$286.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.72
|
|
|
ILEOSCOPY, THROUGH STOMA; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,887.15
|
|
|
Service Code
|
CPT 44380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$54.49 |
| Max. Negotiated Rate |
$2,887.15 |
| Rate for Payer: Aetna Medicare |
$955.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$687.15
|
| Rate for Payer: BCN Commercial |
$687.15
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Nomi Health Commercial |
$1,929.06
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,887.15
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.72
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.94
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$54.49
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: VA VA |
$918.60
|
|
|
ILEOSCOPY, THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,887.15
|
|
|
Service Code
|
CPT 44382
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$2,887.15 |
| Rate for Payer: Aetna Medicare |
$955.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,659.33
|
| Rate for Payer: BCN Commercial |
$1,659.33
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Nomi Health Commercial |
$1,929.06
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,887.15
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.72
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.35
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$70.32
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: VA VA |
$918.60
|
|
|
ILEOSTOMY OR JEJUNOSTOMY, NON-TUBE
|
Facility
|
OP
|
$3,823.25
|
|
|
Service Code
|
CPT 44310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,011.66 |
| Max. Negotiated Rate |
$3,823.25 |
| Rate for Payer: BCBS Trust/PPO |
$3,823.25
|
| Rate for Payer: BCN Commercial |
$3,823.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,112.83
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$1,011.66
|
|
|
IMATINIB 100 MG TABLET
|
Facility
|
OP
|
$30,401.91
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
32979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,248.71 |
| Max. Negotiated Rate |
$27,361.72 |
| Rate for Payer: Aetna American Axle |
$19,761.24
|
| Rate for Payer: Aetna American Axle |
$659.74
|
| Rate for Payer: Aetna American Axle |
$196.56
|
| Rate for Payer: Aetna Commercial |
$25,841.62
|
| Rate for Payer: Aetna Commercial |
$257.04
|
| Rate for Payer: Aetna Commercial |
$862.74
|
| Rate for Payer: Aetna Medicare |
$15,200.96
|
| Rate for Payer: Aetna Medicare |
$151.20
|
| Rate for Payer: Aetna Medicare |
$507.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,761.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.74
|
| Rate for Payer: BCBS Complete |
$406.00
|
| Rate for Payer: BCBS Complete |
$120.96
|
| Rate for Payer: BCBS Complete |
$12,160.76
|
| Rate for Payer: Cash Price |
$24,321.53
|
| Rate for Payer: Cash Price |
$241.92
|
| Rate for Payer: Cash Price |
$811.99
|
| Rate for Payer: Cofinity Commercial |
$260.06
|
| Rate for Payer: Cofinity Commercial |
$710.49
|
| Rate for Payer: Cofinity Commercial |
$872.89
|
| Rate for Payer: Cofinity Commercial |
$26,145.64
|
| Rate for Payer: Cofinity Commercial |
$21,281.34
|
| Rate for Payer: Cofinity Commercial |
$211.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$710.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,281.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,321.53
|
| Rate for Payer: Healthscope Commercial |
$913.49
|
| Rate for Payer: Healthscope Commercial |
$272.16
|
| Rate for Payer: Healthscope Commercial |
$27,361.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$710.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,281.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$761.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,801.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$862.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,841.62
|
| Rate for Payer: PHP Commercial |
$862.74
|
| Rate for Payer: PHP Commercial |
$257.04
|
| Rate for Payer: PHP Commercial |
$25,841.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,761.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.74
|
| Rate for Payer: Priority Health SBD |
$190.51
|
| Rate for Payer: Priority Health SBD |
$639.44
|
| Rate for Payer: Priority Health SBD |
$19,153.20
|
| Rate for Payer: UMR Bronson Commercial |
$11,248.71
|
| Rate for Payer: UMR Bronson Commercial |
$375.55
|
| Rate for Payer: UMR Bronson Commercial |
$111.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$761.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,801.43
|
|
|
IMATINIB 100 MG TABLET
|
Facility
|
IP
|
$1,014.99
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
32979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$446.60 |
| Max. Negotiated Rate |
$913.49 |
| Rate for Payer: Aetna American Axle |
$659.74
|
| Rate for Payer: Aetna American Axle |
$196.56
|
| Rate for Payer: Aetna American Axle |
$19,761.24
|
| Rate for Payer: Aetna Commercial |
$257.04
|
| Rate for Payer: Aetna Commercial |
$862.74
|
| Rate for Payer: Aetna Commercial |
$25,841.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,761.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.56
|
| Rate for Payer: Cash Price |
$24,321.53
|
| Rate for Payer: Cash Price |
$241.92
|
| Rate for Payer: Cash Price |
$811.99
|
| Rate for Payer: Cofinity Commercial |
$872.89
|
| Rate for Payer: Cofinity Commercial |
$260.06
|
| Rate for Payer: Cofinity Commercial |
$211.68
|
| Rate for Payer: Cofinity Commercial |
$26,145.64
|
| Rate for Payer: Cofinity Commercial |
$21,281.34
|
| Rate for Payer: Cofinity Commercial |
$710.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$710.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,281.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,321.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.92
|
| Rate for Payer: Healthscope Commercial |
$272.16
|
| Rate for Payer: Healthscope Commercial |
$913.49
|
| Rate for Payer: Healthscope Commercial |
$27,361.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$710.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,281.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$761.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,801.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$862.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,841.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.04
|
| Rate for Payer: PHP Commercial |
$25,841.62
|
| Rate for Payer: PHP Commercial |
$257.04
|
| Rate for Payer: PHP Commercial |
$862.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,761.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.74
|
| Rate for Payer: Priority Health SBD |
$19,153.20
|
| Rate for Payer: Priority Health SBD |
$190.51
|
| Rate for Payer: Priority Health SBD |
$639.44
|
| Rate for Payer: UMR Bronson Commercial |
$446.60
|
| Rate for Payer: UMR Bronson Commercial |
$13,376.84
|
| Rate for Payer: UMR Bronson Commercial |
$133.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,801.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$761.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.80
|
|
|
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 |
$18.74 |
| 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 |
$37.54
|
| Rate for Payer: Aetna Commercial |
$114.86
|
| Rate for Payer: Aetna Medicare |
$67.56
|
| Rate for Payer: Aetna Medicare |
$22.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.70
|
| Rate for Payer: BCBS Complete |
$17.66
|
| Rate for Payer: BCBS Complete |
$54.05
|
| Rate for Payer: BCBS Trust/PPO |
$18.74
|
| Rate for Payer: BCBS Trust/PPO |
$18.74
|
| Rate for Payer: BCN Commercial |
$18.74
|
| Rate for Payer: BCN Commercial |
$18.74
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cash Price |
$108.10
|
| Rate for Payer: Cash Price |
$108.10
|
| Rate for Payer: Cofinity Commercial |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$30.91
|
| Rate for Payer: Cofinity Commercial |
$94.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.10
|
| Rate for Payer: Healthscope Commercial |
$39.74
|
| Rate for Payer: Healthscope Commercial |
$121.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$114.86
|
| Rate for Payer: PHP Commercial |
$37.54
|
| 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 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$135.13
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
9603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.46 |
| Max. Negotiated Rate |
$121.62 |
| Rate for Payer: Aetna American Axle |
$87.83
|
| Rate for Payer: Aetna American Axle |
$28.70
|
| Rate for Payer: Aetna Commercial |
$114.86
|
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.70
|
| Rate for Payer: Cash Price |
$108.10
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cofinity Commercial |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$30.91
|
| Rate for Payer: Cofinity Commercial |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$94.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$121.62
|
| Rate for Payer: Healthscope Commercial |
$39.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.86
|
| 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 |
$85.13
|
| Rate for Payer: Priority Health SBD |
$27.82
|
| Rate for Payer: UMR Bronson Commercial |
$59.46
|
| Rate for Payer: UMR Bronson Commercial |
$19.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.12
|
|
|
IMIPENEM-CILASTATIN-RELEBACTAM 1.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
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
|
|
|
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 |
$1.34 |
| 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 |
$2.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.12
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: BCBS MAPPO |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$6.75
|
| Rate for Payer: BCN Commercial |
$6.75
|
| Rate for Payer: BCN Medicare Advantage |
$2.50
|
| 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 |
$2.50
|
| 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 |
$1.34
|
| Rate for Payer: Mclaren Medicare |
$2.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.62
|
| Rate for Payer: Meridian Medicaid |
$1.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.84
|
| Rate for Payer: Nomi Health Commercial |
$7.50
|
| Rate for Payer: PACE Medicare |
$2.38
|
| Rate for Payer: PACE SWMI |
$2.50
|
| Rate for Payer: PHP Commercial |
$834.84
|
| Rate for Payer: PHP Medicare Advantage |
$2.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.24
|
| Rate for Payer: Priority Health Medicare |
$2.50
|
| Rate for Payer: Priority Health Narrow Network |
$5.79
|
| Rate for Payer: Priority Health SBD |
$618.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.50
|
| Rate for Payer: UHC Exchange |
$4.78
|
| Rate for Payer: UHC Medicare Advantage |
$2.50
|
| Rate for Payer: UHCCP Medicaid |
$1.34
|
| Rate for Payer: UMR Bronson Commercial |
$363.40
|
| Rate for Payer: VA VA |
$2.50
|
| 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 |
$274.72
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS 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 |
$274.72
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS 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
|
$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 |
$155.80
|
| 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 |
$137.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.80
|
| Rate for Payer: PHP Commercial |
$155.80
|
| 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 |
$137.48
|
|
|
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 |
$148.30
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS 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
|
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 |
$155.80
|
| 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 |
$137.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.80
|
| Rate for Payer: PHP Commercial |
$155.80
|
| 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 |
$137.48
|
|
|
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 |
$148.30
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS 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
|
|
|
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 |
$26.27 |
| 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 |
$50.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,595.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.26
|
| Rate for Payer: BCBS Complete |
$27.58
|
| Rate for Payer: BCBS MAPPO |
$49.01
|
| Rate for Payer: BCBS Trust/PPO |
$131.58
|
| Rate for Payer: BCN Commercial |
$131.58
|
| Rate for Payer: BCN Medicare Advantage |
$49.01
|
| 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 |
$49.01
|
| 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 |
$26.27
|
| Rate for Payer: Mclaren Medicare |
$49.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.46
|
| Rate for Payer: Meridian Medicaid |
$27.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,317.72
|
| Rate for Payer: Nomi Health Commercial |
$147.03
|
| Rate for Payer: PACE Medicare |
$46.56
|
| Rate for Payer: PACE SWMI |
$49.01
|
| Rate for Payer: PHP Commercial |
$7,317.72
|
| Rate for Payer: PHP Medicare Advantage |
$49.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,595.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.45
|
| Rate for Payer: Priority Health Medicare |
$49.01
|
| Rate for Payer: Priority Health Narrow Network |
$112.36
|
| Rate for Payer: Priority Health SBD |
$5,423.72
|
| Rate for Payer: Railroad Medicare Medicare |
$49.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.01
|
| Rate for Payer: UHC Exchange |
$93.66
|
| Rate for Payer: UHC Medicare Advantage |
$49.01
|
| Rate for Payer: UHCCP Medicaid |
$26.27
|
| Rate for Payer: UMR Bronson Commercial |
$3,185.36
|
| Rate for Payer: VA VA |
$49.01
|
| 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 |
$26.27 |
| Max. Negotiated Rate |
$15,496.34 |
| Rate for Payer: Aetna American Axle |
$11,191.80
|
| Rate for Payer: Aetna Commercial |
$14,635.43
|
| Rate for Payer: Aetna Medicare |
$50.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,191.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.26
|
| Rate for Payer: BCBS Complete |
$27.58
|
| Rate for Payer: BCBS MAPPO |
$49.01
|
| Rate for Payer: BCBS Trust/PPO |
$131.58
|
| Rate for Payer: BCN Commercial |
$131.58
|
| Rate for Payer: BCN Medicare Advantage |
$49.01
|
| Rate for Payer: Cash Price |
$13,774.52
|
| Rate for Payer: Cash Price |
$13,774.52
|
| Rate for Payer: Cofinity Commercial |
$14,807.61
|
| Rate for Payer: Cofinity Commercial |
$12,052.70
|
| 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 |
$49.01
|
| Rate for Payer: Healthscope Commercial |
$15,496.34
|
| 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 |
$26.27
|
| Rate for Payer: Mclaren Medicare |
$49.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.46
|
| Rate for Payer: Meridian Medicaid |
$27.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,635.43
|
| Rate for Payer: Nomi Health Commercial |
$147.03
|
| Rate for Payer: PACE Medicare |
$46.56
|
| Rate for Payer: PACE SWMI |
$49.01
|
| Rate for Payer: PHP Commercial |
$14,635.43
|
| Rate for Payer: PHP Medicare Advantage |
$49.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,191.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.45
|
| Rate for Payer: Priority Health Medicare |
$49.01
|
| Rate for Payer: Priority Health Narrow Network |
$112.36
|
| Rate for Payer: Priority Health SBD |
$10,847.43
|
| Rate for Payer: Railroad Medicare Medicare |
$49.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.01
|
| Rate for Payer: UHC Exchange |
$93.66
|
| Rate for Payer: UHC Medicare Advantage |
$49.01
|
| Rate for Payer: UHCCP Medicaid |
$26.27
|
| Rate for Payer: UMR Bronson Commercial |
$6,370.72
|
| Rate for Payer: VA VA |
$49.01
|
| 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
|
$718.13
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$646.32 |
| Rate for Payer: Aetna American Axle |
$466.78
|
| Rate for Payer: Aetna American Axle |
$5,601.38
|
| Rate for Payer: Aetna American Axle |
$1,867.12
|
| Rate for Payer: Aetna American Axle |
$933.56
|
| Rate for Payer: Aetna American Axle |
$3,734.25
|
| Rate for Payer: Aetna Commercial |
$2,441.62
|
| Rate for Payer: Aetna Commercial |
$7,324.88
|
| Rate for Payer: Aetna Commercial |
$1,220.81
|
| Rate for Payer: Aetna Commercial |
$4,883.25
|
| Rate for Payer: Aetna Commercial |
$610.41
|
| Rate for Payer: Aetna Medicare |
$48.32
|
| Rate for Payer: Aetna Medicare |
$48.32
|
| Rate for Payer: Aetna Medicare |
$48.32
|
| Rate for Payer: Aetna Medicare |
$48.32
|
| Rate for Payer: Aetna Medicare |
$48.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,601.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$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: Allen County Amish Medical Aid Commercial |
$58.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.08
|
| Rate for Payer: BCBS Complete |
$26.15
|
| Rate for Payer: BCBS Complete |
$26.15
|
| Rate for Payer: BCBS Complete |
$26.15
|
| Rate for Payer: BCBS Complete |
$26.15
|
| Rate for Payer: BCBS Complete |
$26.15
|
| Rate for Payer: BCBS MAPPO |
$46.46
|
| Rate for Payer: BCBS MAPPO |
$46.46
|
| Rate for Payer: BCBS MAPPO |
$46.46
|
| Rate for Payer: BCBS MAPPO |
$46.46
|
| Rate for Payer: BCBS MAPPO |
$46.46
|
| Rate for Payer: BCBS Trust/PPO |
$133.96
|
| Rate for Payer: BCBS Trust/PPO |
$133.96
|
| Rate for Payer: BCBS Trust/PPO |
$133.96
|
| Rate for Payer: BCBS Trust/PPO |
$133.96
|
| Rate for Payer: BCBS Trust/PPO |
$133.96
|
| Rate for Payer: BCN Commercial |
$133.96
|
| Rate for Payer: BCN Commercial |
$133.96
|
| Rate for Payer: BCN Commercial |
$133.96
|
| Rate for Payer: BCN Commercial |
$133.96
|
| Rate for Payer: BCN Commercial |
$133.96
|
| Rate for Payer: BCN Medicare Advantage |
$46.46
|
| Rate for Payer: BCN Medicare Advantage |
$46.46
|
| Rate for Payer: BCN Medicare Advantage |
$46.46
|
| Rate for Payer: BCN Medicare Advantage |
$46.46
|
| Rate for Payer: BCN Medicare Advantage |
$46.46
|
| Rate for Payer: Cash Price |
$6,894.00
|
| Rate for Payer: Cash Price |
$2,298.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cash Price |
$6,894.00
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$2,298.00
|
| Rate for Payer: Cash Price |
$4,596.00
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$4,596.00
|
| Rate for Payer: Cofinity Commercial |
$1,235.18
|
| Rate for Payer: Cofinity Commercial |
$7,411.05
|
| Rate for Payer: Cofinity Commercial |
$2,470.35
|
| Rate for Payer: Cofinity Commercial |
$6,032.25
|
| Rate for Payer: Cofinity Commercial |
$4,940.70
|
| Rate for Payer: Cofinity Commercial |
$4,021.50
|
| Rate for Payer: Cofinity Commercial |
$1,005.38
|
| Rate for Payer: Cofinity Commercial |
$2,010.75
|
| Rate for Payer: Cofinity Commercial |
$617.59
|
| Rate for Payer: Cofinity Commercial |
$502.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$502.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,010.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,021.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,005.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,032.25
|
| 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 |
$6,894.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,596.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,298.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.46
|
| Rate for Payer: Healthscope Commercial |
$2,585.25
|
| Rate for Payer: Healthscope Commercial |
$646.32
|
| Rate for Payer: Healthscope Commercial |
$7,755.75
|
| Rate for Payer: Healthscope Commercial |
$5,170.50
|
| Rate for Payer: Healthscope Commercial |
$1,292.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,021.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,032.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,005.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,010.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$502.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,077.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,463.12
|
| 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 |
$538.60
|
| Rate for Payer: Mclaren Medicaid |
$24.90
|
| Rate for Payer: Mclaren Medicaid |
$24.90
|
| Rate for Payer: Mclaren Medicaid |
$24.90
|
| Rate for Payer: Mclaren Medicaid |
$24.90
|
| Rate for Payer: Mclaren Medicaid |
$24.90
|
| Rate for Payer: Mclaren Medicare |
$46.46
|
| Rate for Payer: Mclaren Medicare |
$46.46
|
| Rate for Payer: Mclaren Medicare |
$46.46
|
| Rate for Payer: Mclaren Medicare |
$46.46
|
| Rate for Payer: Mclaren Medicare |
$46.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.78
|
| Rate for Payer: Meridian Medicaid |
$26.15
|
| Rate for Payer: Meridian Medicaid |
$26.15
|
| Rate for Payer: Meridian Medicaid |
$26.15
|
| Rate for Payer: Meridian Medicaid |
$26.15
|
| Rate for Payer: Meridian Medicaid |
$26.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,441.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,883.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,324.88
|
| Rate for Payer: Nomi Health Commercial |
$139.38
|
| Rate for Payer: Nomi Health Commercial |
$139.38
|
| Rate for Payer: Nomi Health Commercial |
$139.38
|
| Rate for Payer: Nomi Health Commercial |
$139.38
|
| Rate for Payer: Nomi Health Commercial |
$139.38
|
| Rate for Payer: PACE Medicare |
$44.14
|
| Rate for Payer: PACE Medicare |
$44.14
|
| Rate for Payer: PACE Medicare |
$44.14
|
| Rate for Payer: PACE Medicare |
$44.14
|
| Rate for Payer: PACE Medicare |
$44.14
|
| Rate for Payer: PACE SWMI |
$46.46
|
| Rate for Payer: PACE SWMI |
$46.46
|
| Rate for Payer: PACE SWMI |
$46.46
|
| Rate for Payer: PACE SWMI |
$46.46
|
| Rate for Payer: PACE SWMI |
$46.46
|
| Rate for Payer: PHP Commercial |
$4,883.25
|
| Rate for Payer: PHP Commercial |
$610.41
|
| Rate for Payer: PHP Commercial |
$7,324.88
|
| Rate for Payer: PHP Commercial |
$1,220.81
|
| Rate for Payer: PHP Commercial |
$2,441.62
|
| Rate for Payer: PHP Medicare Advantage |
$46.46
|
| Rate for Payer: PHP Medicare Advantage |
$46.46
|
| Rate for Payer: PHP Medicare Advantage |
$46.46
|
| Rate for Payer: PHP Medicare Advantage |
$46.46
|
| Rate for Payer: PHP Medicare Advantage |
$46.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,867.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.56
|
| 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 HMO/PPO/Tiered Network |
$143.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.02
|
| Rate for Payer: Priority Health Medicare |
$46.46
|
| Rate for Payer: Priority Health Medicare |
$46.46
|
| Rate for Payer: Priority Health Medicare |
$46.46
|
| Rate for Payer: Priority Health Medicare |
$46.46
|
| Rate for Payer: Priority Health Medicare |
$46.46
|
| Rate for Payer: Priority Health Narrow Network |
$114.42
|
| Rate for Payer: Priority Health Narrow Network |
$114.42
|
| Rate for Payer: Priority Health Narrow Network |
$114.42
|
| Rate for Payer: Priority Health Narrow Network |
$114.42
|
| Rate for Payer: Priority Health Narrow Network |
$114.42
|
| Rate for Payer: Priority Health SBD |
$452.42
|
| Rate for Payer: Priority Health SBD |
$904.84
|
| Rate for Payer: Priority Health SBD |
$5,429.02
|
| Rate for Payer: Priority Health SBD |
$1,809.68
|
| Rate for Payer: Priority Health SBD |
$3,619.35
|
| Rate for Payer: Railroad Medicare Medicare |
$46.46
|
| Rate for Payer: Railroad Medicare Medicare |
$46.46
|
| Rate for Payer: Railroad Medicare Medicare |
$46.46
|
| Rate for Payer: Railroad Medicare Medicare |
$46.46
|
| Rate for Payer: Railroad Medicare Medicare |
$46.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.46
|
| Rate for Payer: UHC Exchange |
$88.79
|
| Rate for Payer: UHC Exchange |
$88.79
|
| Rate for Payer: UHC Exchange |
$88.79
|
| Rate for Payer: UHC Exchange |
$88.79
|
| Rate for Payer: UHC Exchange |
$88.79
|
| Rate for Payer: UHC Medicare Advantage |
$46.46
|
| Rate for Payer: UHC Medicare Advantage |
$46.46
|
| Rate for Payer: UHC Medicare Advantage |
$46.46
|
| Rate for Payer: UHC Medicare Advantage |
$46.46
|
| Rate for Payer: UHC Medicare Advantage |
$46.46
|
| Rate for Payer: UHCCP Medicaid |
$24.90
|
| Rate for Payer: UHCCP Medicaid |
$24.90
|
| Rate for Payer: UHCCP Medicaid |
$24.90
|
| Rate for Payer: UHCCP Medicaid |
$24.90
|
| Rate for Payer: UHCCP Medicaid |
$24.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,062.82
|
| Rate for Payer: UMR Bronson Commercial |
$265.71
|
| Rate for Payer: UMR Bronson Commercial |
$2,125.65
|
| Rate for Payer: UMR Bronson Commercial |
$3,188.48
|
| Rate for Payer: UMR Bronson Commercial |
$531.41
|
| Rate for Payer: VA VA |
$46.46
|
| Rate for Payer: VA VA |
$46.46
|
| Rate for Payer: VA VA |
$46.46
|
| Rate for Payer: VA VA |
$46.46
|
| Rate for Payer: VA VA |
$46.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$538.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,077.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,154.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,308.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,463.12
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
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 |
$1,235.18
|
| 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 |
$1,809.68
|
| 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
|
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 |
$4,317.34
|
| 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 |
$4,317.34
|
|
|
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 |
$43.65 |
| 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 |
$84.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,741.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.79
|
| Rate for Payer: BCBS Complete |
$45.83
|
| Rate for Payer: BCBS MAPPO |
$81.43
|
| Rate for Payer: BCBS Trust/PPO |
$221.61
|
| Rate for Payer: BCN Commercial |
$221.61
|
| Rate for Payer: BCN Medicare Advantage |
$81.43
|
| 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 |
$81.43
|
| 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 |
$4,317.34
|
| Rate for Payer: Mclaren Medicaid |
$43.65
|
| Rate for Payer: Mclaren Medicare |
$81.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.50
|
| Rate for Payer: Meridian Medicaid |
$45.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,892.99
|
| Rate for Payer: Nomi Health Commercial |
$244.29
|
| Rate for Payer: PACE Medicare |
$77.36
|
| Rate for Payer: PACE SWMI |
$81.43
|
| Rate for Payer: PHP Commercial |
$4,892.99
|
| Rate for Payer: PHP Medicare Advantage |
$81.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,741.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.56
|
| Rate for Payer: Priority Health Medicare |
$81.43
|
| Rate for Payer: Priority Health Narrow Network |
$189.25
|
| Rate for Payer: Priority Health SBD |
$3,626.57
|
| Rate for Payer: Railroad Medicare Medicare |
$81.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.43
|
| Rate for Payer: UHC Exchange |
$155.62
|
| Rate for Payer: UHC Medicare Advantage |
$81.43
|
| Rate for Payer: UHCCP Medicaid |
$43.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,129.89
|
| Rate for Payer: VA VA |
$81.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,317.34
|
|
|
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
|
|
