|
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 |
$43.65 |
| 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 |
$84.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,870.84
|
| 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 |
$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 |
$81.43
|
| 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 |
$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 |
$2,446.48
|
| 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 |
$2,446.48
|
| 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 |
$1,870.84
|
| 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 |
$1,813.27
|
| 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 |
$1,064.94
|
| Rate for Payer: VA VA |
$81.43
|
| 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
|
$1,805.47
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
172293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$1,624.92 |
| Rate for Payer: Aetna American Axle |
$1,173.56
|
| Rate for Payer: Aetna American Axle |
$2,347.10
|
| Rate for Payer: Aetna American Axle |
$4,694.20
|
| 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 |
$51.27
|
| Rate for Payer: Aetna Medicare |
$51.27
|
| Rate for Payer: Aetna Medicare |
$51.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,173.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,694.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.62
|
| Rate for Payer: BCBS Complete |
$27.75
|
| Rate for Payer: BCBS Complete |
$27.75
|
| Rate for Payer: BCBS Complete |
$27.75
|
| Rate for Payer: BCBS MAPPO |
$49.30
|
| Rate for Payer: BCBS MAPPO |
$49.30
|
| Rate for Payer: BCBS MAPPO |
$49.30
|
| Rate for Payer: BCBS Trust/PPO |
$132.90
|
| Rate for Payer: BCBS Trust/PPO |
$132.90
|
| Rate for Payer: BCBS Trust/PPO |
$132.90
|
| Rate for Payer: BCN Commercial |
$132.90
|
| Rate for Payer: BCN Commercial |
$132.90
|
| Rate for Payer: BCN Commercial |
$132.90
|
| Rate for Payer: BCN Medicare Advantage |
$49.30
|
| Rate for Payer: BCN Medicare Advantage |
$49.30
|
| Rate for Payer: BCN Medicare Advantage |
$49.30
|
| Rate for Payer: Cash Price |
$5,777.48
|
| 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 |
$2,888.74
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cofinity Commercial |
$6,210.79
|
| Rate for Payer: Cofinity Commercial |
$1,552.70
|
| Rate for Payer: Cofinity Commercial |
$1,263.83
|
| Rate for Payer: Cofinity Commercial |
$3,105.40
|
| Rate for Payer: Cofinity Commercial |
$2,527.65
|
| Rate for Payer: Cofinity Commercial |
$5,055.30
|
| 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 |
$1,444.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,888.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,777.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.30
|
| 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 |
$5,055.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,527.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,263.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,416.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,708.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,354.10
|
| Rate for Payer: Mclaren Medicaid |
$26.42
|
| Rate for Payer: Mclaren Medicaid |
$26.42
|
| Rate for Payer: Mclaren Medicaid |
$26.42
|
| Rate for Payer: Mclaren Medicare |
$49.30
|
| Rate for Payer: Mclaren Medicare |
$49.30
|
| Rate for Payer: Mclaren Medicare |
$49.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.76
|
| Rate for Payer: Meridian Medicaid |
$27.75
|
| Rate for Payer: Meridian Medicaid |
$27.75
|
| Rate for Payer: Meridian Medicaid |
$27.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.70
|
| 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: Multiplan/Beech St/PHCS Commercial |
$3,069.29
|
| Rate for Payer: Nomi Health Commercial |
$147.90
|
| Rate for Payer: Nomi Health Commercial |
$147.90
|
| Rate for Payer: Nomi Health Commercial |
$147.90
|
| Rate for Payer: PACE Medicare |
$46.84
|
| Rate for Payer: PACE Medicare |
$46.84
|
| Rate for Payer: PACE Medicare |
$46.84
|
| Rate for Payer: PACE SWMI |
$49.30
|
| Rate for Payer: PACE SWMI |
$49.30
|
| Rate for Payer: PACE SWMI |
$49.30
|
| Rate for Payer: PHP Commercial |
$3,069.29
|
| Rate for Payer: PHP Commercial |
$1,534.65
|
| Rate for Payer: PHP Commercial |
$6,138.57
|
| Rate for Payer: PHP Medicare Advantage |
$49.30
|
| Rate for Payer: PHP Medicare Advantage |
$49.30
|
| Rate for Payer: PHP Medicare Advantage |
$49.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,694.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,347.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,173.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.02
|
| Rate for Payer: Priority Health Medicare |
$49.30
|
| Rate for Payer: Priority Health Medicare |
$49.30
|
| Rate for Payer: Priority Health Medicare |
$49.30
|
| Rate for Payer: Priority Health Narrow Network |
$112.82
|
| Rate for Payer: Priority Health Narrow Network |
$112.82
|
| Rate for Payer: Priority Health Narrow Network |
$112.82
|
| 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 |
$49.30
|
| Rate for Payer: Railroad Medicare Medicare |
$49.30
|
| Rate for Payer: Railroad Medicare Medicare |
$49.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.30
|
| Rate for Payer: UHC Exchange |
$94.22
|
| Rate for Payer: UHC Exchange |
$94.22
|
| Rate for Payer: UHC Exchange |
$94.22
|
| Rate for Payer: UHC Medicare Advantage |
$49.30
|
| Rate for Payer: UHC Medicare Advantage |
$49.30
|
| Rate for Payer: UHC Medicare Advantage |
$49.30
|
| Rate for Payer: UHCCP Medicaid |
$26.42
|
| Rate for Payer: UHCCP Medicaid |
$26.42
|
| Rate for Payer: UHCCP Medicaid |
$26.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,336.04
|
| Rate for Payer: UMR Bronson Commercial |
$668.02
|
| Rate for Payer: UMR Bronson Commercial |
$2,672.08
|
| Rate for Payer: VA VA |
$49.30
|
| Rate for Payer: VA VA |
$49.30
|
| Rate for Payer: VA VA |
$49.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,354.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,416.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,708.20
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,131.59
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
171063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.41 |
| 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 |
$51.25
|
| Rate for Payer: Aetna Medicare |
$51.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,385.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,771.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.60
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$49.28
|
| Rate for Payer: BCBS MAPPO |
$49.28
|
| Rate for Payer: BCBS Trust/PPO |
$132.88
|
| Rate for Payer: BCBS Trust/PPO |
$132.88
|
| Rate for Payer: BCN Commercial |
$132.88
|
| Rate for Payer: BCN Commercial |
$132.88
|
| Rate for Payer: BCN Medicare Advantage |
$49.28
|
| Rate for Payer: BCN Medicare Advantage |
$49.28
|
| Rate for Payer: Cash Price |
$3,410.54
|
| Rate for Payer: Cash Price |
$1,705.27
|
| Rate for Payer: Cash Price |
$3,410.54
|
| Rate for Payer: Cash Price |
$1,705.27
|
| Rate for Payer: Cofinity Commercial |
$3,666.33
|
| Rate for Payer: Cofinity Commercial |
$2,984.23
|
| Rate for Payer: Cofinity Commercial |
$1,492.11
|
| Rate for Payer: Cofinity Commercial |
$1,833.17
|
| 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 |
$49.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.28
|
| 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 |
$1,598.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,197.38
|
| Rate for Payer: Mclaren Medicaid |
$26.41
|
| Rate for Payer: Mclaren Medicaid |
$26.41
|
| Rate for Payer: Mclaren Medicare |
$49.28
|
| Rate for Payer: Mclaren Medicare |
$49.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.74
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,811.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,623.70
|
| Rate for Payer: Nomi Health Commercial |
$147.84
|
| Rate for Payer: Nomi Health Commercial |
$147.84
|
| Rate for Payer: PACE Medicare |
$46.82
|
| Rate for Payer: PACE Medicare |
$46.82
|
| Rate for Payer: PACE SWMI |
$49.28
|
| Rate for Payer: PACE SWMI |
$49.28
|
| Rate for Payer: PHP Commercial |
$3,623.70
|
| Rate for Payer: PHP Commercial |
$1,811.85
|
| Rate for Payer: PHP Medicare Advantage |
$49.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,771.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.81
|
| Rate for Payer: Priority Health Medicare |
$49.28
|
| Rate for Payer: Priority Health Medicare |
$49.28
|
| Rate for Payer: Priority Health Narrow Network |
$111.85
|
| Rate for Payer: Priority Health Narrow Network |
$111.85
|
| Rate for Payer: Priority Health SBD |
$1,342.90
|
| Rate for Payer: Priority Health SBD |
$2,685.80
|
| Rate for Payer: Railroad Medicare Medicare |
$49.28
|
| Rate for Payer: Railroad Medicare Medicare |
$49.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.28
|
| Rate for Payer: UHC Exchange |
$94.18
|
| Rate for Payer: UHC Exchange |
$94.18
|
| Rate for Payer: UHC Medicare Advantage |
$49.28
|
| Rate for Payer: UHC Medicare Advantage |
$49.28
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
| Rate for Payer: UMR Bronson Commercial |
$788.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,577.38
|
| Rate for Payer: VA VA |
$49.28
|
| Rate for Payer: VA VA |
$49.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,598.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,197.38
|
|
|
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 |
$3,197.38
|
| 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 |
$3,197.38
|
|
|
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 |
$26.42 |
| 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 |
$51.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.62
|
| Rate for Payer: BCBS Complete |
$27.75
|
| Rate for Payer: BCBS MAPPO |
$49.30
|
| Rate for Payer: BCBS Trust/PPO |
$132.90
|
| Rate for Payer: BCN Commercial |
$132.90
|
| Rate for Payer: BCN Medicare Advantage |
$49.30
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cofinity Commercial |
$3,105.40
|
| Rate for Payer: Cofinity Commercial |
$2,527.65
|
| 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 |
$49.30
|
| 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 |
$26.42
|
| Rate for Payer: Mclaren Medicare |
$49.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.76
|
| Rate for Payer: Meridian Medicaid |
$27.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,069.29
|
| Rate for Payer: Nomi Health Commercial |
$147.90
|
| Rate for Payer: PACE Medicare |
$46.84
|
| Rate for Payer: PACE SWMI |
$49.30
|
| Rate for Payer: PHP Commercial |
$3,069.29
|
| Rate for Payer: PHP Medicare Advantage |
$49.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,347.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.02
|
| Rate for Payer: Priority Health Medicare |
$49.30
|
| Rate for Payer: Priority Health Narrow Network |
$112.82
|
| Rate for Payer: Priority Health SBD |
$2,274.89
|
| Rate for Payer: Railroad Medicare Medicare |
$49.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.30
|
| Rate for Payer: UHC Exchange |
$94.22
|
| Rate for Payer: UHC Medicare Advantage |
$49.30
|
| Rate for Payer: UHCCP Medicaid |
$26.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,336.04
|
| Rate for Payer: VA VA |
$49.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,708.20
|
|
|
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 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 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 |
$7.86
|
| 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
|
|
|
IMPACT PEPTIDE/VITAL 1.5 BOLUS FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
150765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity 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 |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$59.20
|
|
|
Service Code
|
NDC 70074062720
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$53.28 |
| Rate for Payer: Aetna American Axle |
$38.48
|
| Rate for Payer: Aetna Commercial |
$50.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.48
|
| Rate for Payer: Cash Price |
$47.36
|
| Rate for Payer: Cofinity Commercial |
$41.44
|
| Rate for Payer: Cofinity Commercial |
$50.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.36
|
| Rate for Payer: Healthscope Commercial |
$53.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.32
|
| Rate for Payer: PHP Commercial |
$50.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.48
|
| Rate for Payer: Priority Health SBD |
$37.30
|
| Rate for Payer: UMR Bronson Commercial |
$26.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.40
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity 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 CONTINUOUS FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity 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 |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$59.20
|
|
|
Service Code
|
NDC 70074062720
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$53.28 |
| Rate for Payer: Aetna American Axle |
$38.48
|
| Rate for Payer: Aetna Commercial |
$50.32
|
| Rate for Payer: Aetna Medicare |
$29.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.48
|
| Rate for Payer: BCBS Complete |
$23.68
|
| Rate for Payer: Cash Price |
$47.36
|
| Rate for Payer: Cofinity Commercial |
$41.44
|
| Rate for Payer: Cofinity Commercial |
$50.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.36
|
| Rate for Payer: Healthscope Commercial |
$53.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.32
|
| Rate for Payer: PHP Commercial |
$50.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.48
|
| Rate for Payer: Priority Health SBD |
$37.30
|
| Rate for Payer: UMR Bronson Commercial |
$21.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.40
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$7.86
|
| 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
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity 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 PEPTIDE/VITAL 1.5 CYCLIC FEED
|
Facility
|
OP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$7.86
|
| 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
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CYCLIC FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity 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 CYCLIC FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity 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 |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CYCLIC FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity 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 PEPTIDE/VITAL 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.62
|
| 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: 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 INTERMITTENT FEED
|
Facility
|
OP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200090
|
|
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 |
$7.86
|
| 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
|
|
|
IMPACT PEPTIDE/VITAL 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: 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 |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE/VITAL 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200090
|
|
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
|
|
|
IMPLANTATION OF BIOLOGIC IMPLANT (EG, ACELLULAR DERMAL MATRIX) FOR SOFT TISSUE REINFORCEMENT (IE, BREAST, TRUNK) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$6,179.57
|
|
|
Service Code
|
CPT 15777
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$6,179.57 |
| Rate for Payer: BCBS Trust/PPO |
$6,179.57
|
| Rate for Payer: BCN Commercial |
$6,179.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.41
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$206.74
|
|
|
IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY IN ADDITION TO NEUROMA EXCISION)
|
Facility
|
OP
|
$888.23
|
|
|
Service Code
|
CPT 64787
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$225.87 |
| Max. Negotiated Rate |
$888.23 |
| Rate for Payer: BCBS Trust/PPO |
$888.23
|
| Rate for Payer: BCN Commercial |
$888.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.46
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$225.87
|
|
