|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
NDC 49483060301
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.09 |
| Max. Negotiated Rate |
$157.45 |
| Rate for Payer: Aetna Commercial |
$141.71
|
| Rate for Payer: ASR ASR |
$152.73
|
| Rate for Payer: BCBS Trust/PPO |
$129.30
|
| Rate for Payer: BCN Commercial |
$129.30
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Commercial |
$148.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$152.73
|
| Rate for Payer: Healthscope Whirlpool |
$157.45
|
| Rate for Payer: Mclaren Commercial |
$141.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.83
|
| Rate for Payer: Nomi Health Commercial |
$129.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.56
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 904585461
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Aetna Medicare |
$68.69
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS Trust/PPO |
$153.07
|
| Rate for Payer: BCN Commercial |
$153.07
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$174.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$180.08
|
| Rate for Payer: Healthscope Whirlpool |
$185.65
|
| Rate for Payer: Mclaren Commercial |
$167.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.67
|
| Rate for Payer: Priority Health Narrow Network |
$130.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.37
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$406.55
|
|
|
Service Code
|
NDC 60687045701
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.91 |
| Max. Negotiated Rate |
$406.55 |
| Rate for Payer: Aetna Commercial |
$365.89
|
| Rate for Payer: ASR ASR |
$394.35
|
| Rate for Payer: BCBS Trust/PPO |
$333.86
|
| Rate for Payer: BCN Commercial |
$333.86
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Commercial |
$382.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$394.35
|
| Rate for Payer: Healthscope Whirlpool |
$406.55
|
| Rate for Payer: Mclaren Commercial |
$365.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.57
|
| Rate for Payer: Nomi Health Commercial |
$333.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.76
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$166.85
|
|
|
Service Code
|
NDC 67877032001
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$166.85 |
| Rate for Payer: Aetna Commercial |
$150.16
|
| Rate for Payer: Aetna Medicare |
$61.73
|
| Rate for Payer: ASR ASR |
$161.84
|
| Rate for Payer: BCBS Complete |
$66.74
|
| Rate for Payer: BCBS Trust/PPO |
$137.57
|
| Rate for Payer: BCN Commercial |
$137.57
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$156.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$161.84
|
| Rate for Payer: Healthscope Whirlpool |
$166.85
|
| Rate for Payer: Mclaren Commercial |
$150.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Nomi Health Commercial |
$136.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$146.19
|
| Rate for Payer: Priority Health Narrow Network |
$116.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.83
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$157.45
|
|
|
Service Code
|
NDC 49483060301
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.26 |
| Max. Negotiated Rate |
$157.45 |
| Rate for Payer: Aetna Commercial |
$141.71
|
| Rate for Payer: Aetna Medicare |
$58.26
|
| Rate for Payer: ASR ASR |
$152.73
|
| Rate for Payer: BCBS Complete |
$62.98
|
| Rate for Payer: BCBS Trust/PPO |
$129.82
|
| Rate for Payer: BCN Commercial |
$129.82
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Commercial |
$148.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$152.73
|
| Rate for Payer: Healthscope Whirlpool |
$157.45
|
| Rate for Payer: Mclaren Commercial |
$141.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.83
|
| Rate for Payer: Nomi Health Commercial |
$129.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$137.96
|
| Rate for Payer: Priority Health Narrow Network |
$110.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.56
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 67877032001
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$166.85 |
| Rate for Payer: Aetna Commercial |
$150.16
|
| Rate for Payer: ASR ASR |
$161.84
|
| Rate for Payer: BCBS Trust/PPO |
$137.02
|
| Rate for Payer: BCN Commercial |
$137.02
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$156.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$161.84
|
| Rate for Payer: Healthscope Whirlpool |
$166.85
|
| Rate for Payer: Mclaren Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Nomi Health Commercial |
$136.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.83
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 60687045711
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: ASR ASR |
$3.94
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.35
|
| Rate for Payer: BCN Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Healthscope Whirlpool |
$4.07
|
| Rate for Payer: Mclaren Commercial |
$3.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.46
|
| Rate for Payer: Nomi Health Commercial |
$3.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.56
|
| Rate for Payer: Priority Health Narrow Network |
$2.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.58
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$4.07
|
|
|
Service Code
|
NDC 60687045711
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: ASR ASR |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCN Commercial |
$3.34
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Healthscope Whirlpool |
$4.07
|
| Rate for Payer: Mclaren Commercial |
$3.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.46
|
| Rate for Payer: Nomi Health Commercial |
$3.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.58
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$18.80
|
|
|
Service Code
|
NDC 904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: ASR ASR |
$18.24
|
| Rate for Payer: BCBS Trust/PPO |
$15.44
|
| Rate for Payer: BCN Commercial |
$15.44
|
| Rate for Payer: Cash Price |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$17.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.04
|
| Rate for Payer: Healthscope Commercial |
$18.24
|
| Rate for Payer: Healthscope Whirlpool |
$18.80
|
| Rate for Payer: Mclaren Commercial |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.98
|
| Rate for Payer: Nomi Health Commercial |
$15.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.54
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$18.80
|
|
|
Service Code
|
NDC 904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Aetna Medicare |
$6.96
|
| Rate for Payer: ASR ASR |
$18.24
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$15.50
|
| Rate for Payer: BCN Commercial |
$15.50
|
| Rate for Payer: Cash Price |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$17.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.04
|
| Rate for Payer: Healthscope Commercial |
$18.24
|
| Rate for Payer: Healthscope Whirlpool |
$18.80
|
| Rate for Payer: Mclaren Commercial |
$16.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.98
|
| Rate for Payer: Nomi Health Commercial |
$15.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.47
|
| Rate for Payer: Priority Health Narrow Network |
$13.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.54
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$157.45
|
|
|
Service Code
|
NDC 67877032101
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.26 |
| Max. Negotiated Rate |
$157.45 |
| Rate for Payer: Aetna Commercial |
$141.71
|
| Rate for Payer: Aetna Medicare |
$58.26
|
| Rate for Payer: ASR ASR |
$152.73
|
| Rate for Payer: BCBS Complete |
$62.98
|
| Rate for Payer: BCBS Trust/PPO |
$129.82
|
| Rate for Payer: BCN Commercial |
$129.82
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Commercial |
$148.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$152.73
|
| Rate for Payer: Healthscope Whirlpool |
$157.45
|
| Rate for Payer: Mclaren Commercial |
$141.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.83
|
| Rate for Payer: Nomi Health Commercial |
$129.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$137.96
|
| Rate for Payer: Priority Health Narrow Network |
$110.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.56
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
NDC 67877032101
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.09 |
| Max. Negotiated Rate |
$157.45 |
| Rate for Payer: Aetna Commercial |
$141.71
|
| Rate for Payer: ASR ASR |
$152.73
|
| Rate for Payer: BCBS Trust/PPO |
$129.30
|
| Rate for Payer: BCN Commercial |
$129.30
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Commercial |
$148.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$152.73
|
| Rate for Payer: Healthscope Whirlpool |
$157.45
|
| Rate for Payer: Mclaren Commercial |
$141.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.83
|
| Rate for Payer: Nomi Health Commercial |
$129.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.56
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
IP
|
$18,177.18
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
172845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,632.89 |
| Max. Negotiated Rate |
$18,177.18 |
| Rate for Payer: Aetna Commercial |
$16,359.46
|
| Rate for Payer: ASR ASR |
$17,631.86
|
| Rate for Payer: BCBS Trust/PPO |
$14,927.10
|
| Rate for Payer: BCN Commercial |
$14,927.10
|
| Rate for Payer: Cash Price |
$14,541.74
|
| Rate for Payer: Cofinity Commercial |
$17,086.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,541.74
|
| Rate for Payer: Healthscope Commercial |
$17,631.86
|
| Rate for Payer: Healthscope Whirlpool |
$18,177.18
|
| Rate for Payer: Mclaren Commercial |
$16,359.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,450.60
|
| Rate for Payer: Nomi Health Commercial |
$14,905.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,632.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,995.92
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
OP
|
$18,177.18
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
172845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$18,177.18 |
| Rate for Payer: Aetna Commercial |
$16,359.46
|
| Rate for Payer: Aetna Medicare |
$49.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.16
|
| Rate for Payer: ASR ASR |
$17,631.86
|
| Rate for Payer: BCBS Complete |
$27.31
|
| Rate for Payer: BCBS MAPPO |
$49.73
|
| Rate for Payer: BCBS Trust/PPO |
$14,987.08
|
| Rate for Payer: BCN Commercial |
$14,987.08
|
| Rate for Payer: BCN Medicare Advantage |
$49.73
|
| Rate for Payer: Cash Price |
$14,541.74
|
| Rate for Payer: Cash Price |
$14,541.74
|
| Rate for Payer: Cofinity Commercial |
$17,086.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,541.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.73
|
| Rate for Payer: Healthscope Commercial |
$17,631.86
|
| Rate for Payer: Healthscope Whirlpool |
$18,177.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.73
|
| Rate for Payer: Mclaren Commercial |
$16,359.46
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$49.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.22
|
| Rate for Payer: Meridian Medicaid |
$27.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,450.60
|
| Rate for Payer: Nomi Health Commercial |
$14,905.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,632.89
|
| Rate for Payer: PACE Medicare |
$47.24
|
| Rate for Payer: PACE SWMI |
$49.73
|
| Rate for Payer: PHP Commercial |
$54.70
|
| Rate for Payer: PHP Medicaid |
$26.66
|
| Rate for Payer: PHP Medicare Advantage |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$50.93
|
| Rate for Payer: Priority Health Medicare |
$49.73
|
| Rate for Payer: Priority Health Narrow Network |
$40.74
|
| Rate for Payer: Railroad Medicare Medicare |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,995.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.73
|
| Rate for Payer: UHC Exchange |
$77.08
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHCCP DNSP |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: VA VA |
$49.73
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$2,294.50
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,720.88 |
| Max. Negotiated Rate |
$2,294.50 |
| Rate for Payer: Aetna Commercial |
$2,065.05
|
| Rate for Payer: Aetna Commercial |
$413.01
|
| Rate for Payer: Aetna Commercial |
$4,129.74
|
| Rate for Payer: ASR ASR |
$445.13
|
| Rate for Payer: ASR ASR |
$2,225.66
|
| Rate for Payer: ASR ASR |
$4,450.94
|
| Rate for Payer: BCBS Trust/PPO |
$376.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,884.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,768.16
|
| Rate for Payer: BCN Commercial |
$3,768.16
|
| Rate for Payer: BCN Commercial |
$1,884.24
|
| Rate for Payer: BCN Commercial |
$376.85
|
| Rate for Payer: Cash Price |
$367.12
|
| Rate for Payer: Cash Price |
$1,835.60
|
| Rate for Payer: Cash Price |
$3,670.88
|
| Rate for Payer: Cofinity Commercial |
$2,156.83
|
| Rate for Payer: Cofinity Commercial |
$4,313.28
|
| Rate for Payer: Cofinity Commercial |
$431.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,835.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,670.88
|
| Rate for Payer: Healthscope Commercial |
$4,450.94
|
| Rate for Payer: Healthscope Commercial |
$2,225.66
|
| Rate for Payer: Healthscope Commercial |
$445.13
|
| Rate for Payer: Healthscope Whirlpool |
$4,588.60
|
| Rate for Payer: Healthscope Whirlpool |
$458.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,294.50
|
| Rate for Payer: Mclaren Commercial |
$4,129.74
|
| Rate for Payer: Mclaren Commercial |
$2,065.05
|
| Rate for Payer: Mclaren Commercial |
$413.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,900.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,950.33
|
| Rate for Payer: Nomi Health Commercial |
$3,762.65
|
| Rate for Payer: Nomi Health Commercial |
$1,881.49
|
| Rate for Payer: Nomi Health Commercial |
$376.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,720.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$344.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,441.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,037.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,019.16
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$458.90
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$458.90 |
| Rate for Payer: Aetna Commercial |
$413.01
|
| Rate for Payer: Aetna Commercial |
$2,065.05
|
| Rate for Payer: Aetna Commercial |
$4,129.74
|
| Rate for Payer: Aetna Medicare |
$49.08
|
| Rate for Payer: Aetna Medicare |
$49.08
|
| Rate for Payer: Aetna Medicare |
$49.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.35
|
| Rate for Payer: ASR ASR |
$4,450.94
|
| Rate for Payer: ASR ASR |
$2,225.66
|
| Rate for Payer: ASR ASR |
$445.13
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS MAPPO |
$49.08
|
| Rate for Payer: BCBS Trust/PPO |
$378.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,783.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,891.82
|
| Rate for Payer: BCN Commercial |
$3,783.30
|
| Rate for Payer: BCN Commercial |
$1,891.82
|
| Rate for Payer: BCN Commercial |
$378.36
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: BCN Medicare Advantage |
$49.08
|
| Rate for Payer: Cash Price |
$1,835.60
|
| Rate for Payer: Cash Price |
$367.12
|
| Rate for Payer: Cash Price |
$3,670.88
|
| Rate for Payer: Cash Price |
$3,670.88
|
| Rate for Payer: Cash Price |
$1,835.60
|
| Rate for Payer: Cash Price |
$367.12
|
| Rate for Payer: Cofinity Commercial |
$2,156.83
|
| Rate for Payer: Cofinity Commercial |
$431.37
|
| Rate for Payer: Cofinity Commercial |
$4,313.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,835.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,670.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.08
|
| Rate for Payer: Healthscope Commercial |
$4,450.94
|
| Rate for Payer: Healthscope Commercial |
$2,225.66
|
| Rate for Payer: Healthscope Commercial |
$445.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,294.50
|
| Rate for Payer: Healthscope Whirlpool |
$458.90
|
| Rate for Payer: Healthscope Whirlpool |
$4,588.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.08
|
| Rate for Payer: Mclaren Commercial |
$4,129.74
|
| Rate for Payer: Mclaren Commercial |
$413.01
|
| Rate for Payer: Mclaren Commercial |
$2,065.05
|
| Rate for Payer: Mclaren Medicaid |
$49.08
|
| Rate for Payer: Mclaren Medicaid |
$49.08
|
| Rate for Payer: Mclaren Medicaid |
$49.08
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Mclaren Medicare |
$49.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.53
|
| Rate for Payer: Meridian Medicaid |
$26.95
|
| Rate for Payer: Meridian Medicaid |
$26.95
|
| Rate for Payer: Meridian Medicaid |
$26.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,900.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,950.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.06
|
| Rate for Payer: Nomi Health Commercial |
$376.30
|
| Rate for Payer: Nomi Health Commercial |
$1,881.49
|
| Rate for Payer: Nomi Health Commercial |
$3,762.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,441.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,720.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$344.18
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE Medicare |
$46.63
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PACE SWMI |
$49.08
|
| Rate for Payer: PHP Commercial |
$53.99
|
| Rate for Payer: PHP Commercial |
$53.99
|
| Rate for Payer: PHP Commercial |
$53.99
|
| Rate for Payer: PHP Medicaid |
$26.31
|
| Rate for Payer: PHP Medicaid |
$26.31
|
| Rate for Payer: PHP Medicaid |
$26.31
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: PHP Medicare Advantage |
$49.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.07
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Narrow Network |
$39.26
|
| Rate for Payer: Priority Health Narrow Network |
$39.26
|
| Rate for Payer: Priority Health Narrow Network |
$39.26
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: Railroad Medicare Medicare |
$49.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,019.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,037.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.08
|
| Rate for Payer: UHC Exchange |
$76.07
|
| Rate for Payer: UHC Exchange |
$76.07
|
| Rate for Payer: UHC Exchange |
$76.07
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHCCP DNSP |
$49.08
|
| Rate for Payer: UHCCP DNSP |
$49.08
|
| Rate for Payer: UHCCP DNSP |
$49.08
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: VA VA |
$49.08
|
| Rate for Payer: VA VA |
$49.08
|
| Rate for Payer: VA VA |
$49.08
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,221.85
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
172293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$7,221.85 |
| Rate for Payer: Aetna Commercial |
$6,499.66
|
| Rate for Payer: Aetna Medicare |
$47.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.80
|
| Rate for Payer: ASR ASR |
$7,005.19
|
| Rate for Payer: BCBS Complete |
$25.83
|
| Rate for Payer: BCBS MAPPO |
$47.04
|
| Rate for Payer: BCBS Trust/PPO |
$5,954.41
|
| Rate for Payer: BCN Commercial |
$5,954.41
|
| Rate for Payer: BCN Medicare Advantage |
$47.04
|
| Rate for Payer: Cash Price |
$5,777.48
|
| Rate for Payer: Cash Price |
$5,777.48
|
| Rate for Payer: Cofinity Commercial |
$6,788.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,777.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.04
|
| Rate for Payer: Healthscope Commercial |
$7,005.19
|
| Rate for Payer: Healthscope Whirlpool |
$7,221.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$47.04
|
| Rate for Payer: Mclaren Commercial |
$6,499.66
|
| Rate for Payer: Mclaren Medicaid |
$47.04
|
| Rate for Payer: Mclaren Medicare |
$47.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.39
|
| Rate for Payer: Meridian Medicaid |
$25.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,138.57
|
| Rate for Payer: Nomi Health Commercial |
$5,921.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,416.39
|
| Rate for Payer: PACE Medicare |
$44.69
|
| Rate for Payer: PACE SWMI |
$47.04
|
| Rate for Payer: PHP Commercial |
$51.74
|
| Rate for Payer: PHP Medicaid |
$25.21
|
| Rate for Payer: PHP Medicare Advantage |
$47.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.17
|
| Rate for Payer: Priority Health Medicare |
$47.04
|
| Rate for Payer: Priority Health Narrow Network |
$39.34
|
| Rate for Payer: Railroad Medicare Medicare |
$47.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,355.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.04
|
| Rate for Payer: UHC Exchange |
$72.91
|
| Rate for Payer: UHC Medicaid |
$24.60
|
| Rate for Payer: UHCCP DNSP |
$47.04
|
| Rate for Payer: UHCCP Medicaid |
$24.60
|
| Rate for Payer: VA VA |
$47.04
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,221.85
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
172293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,416.39 |
| Max. Negotiated Rate |
$7,221.85 |
| Rate for Payer: Aetna Commercial |
$6,499.66
|
| Rate for Payer: ASR ASR |
$7,005.19
|
| Rate for Payer: BCBS Trust/PPO |
$5,930.58
|
| Rate for Payer: BCN Commercial |
$5,930.58
|
| Rate for Payer: Cash Price |
$5,777.48
|
| Rate for Payer: Cofinity Commercial |
$6,788.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,777.48
|
| Rate for Payer: Healthscope Commercial |
$7,005.19
|
| Rate for Payer: Healthscope Whirlpool |
$7,221.85
|
| Rate for Payer: Mclaren Commercial |
$6,499.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,138.57
|
| Rate for Payer: Nomi Health Commercial |
$5,921.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,416.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,355.23
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$8,949.94
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
171063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$8,949.94 |
| Rate for Payer: Aetna Commercial |
$8,054.95
|
| Rate for Payer: Aetna Commercial |
$2,013.74
|
| Rate for Payer: Aetna Commercial |
$4,027.47
|
| Rate for Payer: Aetna Medicare |
$49.53
|
| Rate for Payer: Aetna Medicare |
$49.53
|
| Rate for Payer: Aetna Medicare |
$49.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.91
|
| Rate for Payer: ASR ASR |
$4,340.72
|
| Rate for Payer: ASR ASR |
$2,170.36
|
| Rate for Payer: ASR ASR |
$8,681.45
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS MAPPO |
$49.53
|
| Rate for Payer: BCBS MAPPO |
$49.53
|
| Rate for Payer: BCBS MAPPO |
$49.53
|
| Rate for Payer: BCBS Trust/PPO |
$7,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,689.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,844.81
|
| Rate for Payer: BCN Commercial |
$3,689.61
|
| Rate for Payer: BCN Commercial |
$1,844.81
|
| Rate for Payer: BCN Commercial |
$7,379.23
|
| Rate for Payer: BCN Medicare Advantage |
$49.53
|
| Rate for Payer: BCN Medicare Advantage |
$49.53
|
| Rate for Payer: BCN Medicare Advantage |
$49.53
|
| Rate for Payer: Cash Price |
$1,789.99
|
| Rate for Payer: Cash Price |
$7,159.96
|
| Rate for Payer: Cash Price |
$3,579.98
|
| Rate for Payer: Cash Price |
$3,579.98
|
| Rate for Payer: Cash Price |
$1,789.99
|
| Rate for Payer: Cash Price |
$7,159.96
|
| Rate for Payer: Cofinity Commercial |
$2,103.24
|
| Rate for Payer: Cofinity Commercial |
$8,412.95
|
| Rate for Payer: Cofinity Commercial |
$4,206.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,159.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,789.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,579.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.53
|
| Rate for Payer: Healthscope Commercial |
$4,340.72
|
| Rate for Payer: Healthscope Commercial |
$2,170.36
|
| Rate for Payer: Healthscope Commercial |
$8,681.45
|
| Rate for Payer: Healthscope Whirlpool |
$2,237.49
|
| Rate for Payer: Healthscope Whirlpool |
$8,949.94
|
| Rate for Payer: Healthscope Whirlpool |
$4,474.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.53
|
| Rate for Payer: Mclaren Commercial |
$4,027.47
|
| Rate for Payer: Mclaren Commercial |
$8,054.95
|
| Rate for Payer: Mclaren Commercial |
$2,013.74
|
| Rate for Payer: Mclaren Medicaid |
$49.53
|
| Rate for Payer: Mclaren Medicaid |
$49.53
|
| Rate for Payer: Mclaren Medicaid |
$49.53
|
| Rate for Payer: Mclaren Medicare |
$49.53
|
| Rate for Payer: Mclaren Medicare |
$49.53
|
| Rate for Payer: Mclaren Medicare |
$49.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.01
|
| Rate for Payer: Meridian Medicaid |
$27.20
|
| Rate for Payer: Meridian Medicaid |
$27.20
|
| Rate for Payer: Meridian Medicaid |
$27.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,803.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,901.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,607.45
|
| Rate for Payer: Nomi Health Commercial |
$7,338.95
|
| Rate for Payer: Nomi Health Commercial |
$1,834.74
|
| Rate for Payer: Nomi Health Commercial |
$3,669.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,356.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,678.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,712.46
|
| Rate for Payer: PACE Medicare |
$47.05
|
| Rate for Payer: PACE Medicare |
$47.05
|
| Rate for Payer: PACE Medicare |
$47.05
|
| Rate for Payer: PACE SWMI |
$49.53
|
| Rate for Payer: PACE SWMI |
$49.53
|
| Rate for Payer: PACE SWMI |
$49.53
|
| Rate for Payer: PHP Commercial |
$54.48
|
| Rate for Payer: PHP Commercial |
$54.48
|
| Rate for Payer: PHP Commercial |
$54.48
|
| Rate for Payer: PHP Medicaid |
$26.55
|
| Rate for Payer: PHP Medicaid |
$26.55
|
| Rate for Payer: PHP Medicaid |
$26.55
|
| Rate for Payer: PHP Medicare Advantage |
$49.53
|
| Rate for Payer: PHP Medicare Advantage |
$49.53
|
| Rate for Payer: PHP Medicare Advantage |
$49.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$52.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$52.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$52.18
|
| Rate for Payer: Priority Health Medicare |
$49.53
|
| Rate for Payer: Priority Health Medicare |
$49.53
|
| Rate for Payer: Priority Health Medicare |
$49.53
|
| Rate for Payer: Priority Health Narrow Network |
$41.74
|
| Rate for Payer: Priority Health Narrow Network |
$41.74
|
| Rate for Payer: Priority Health Narrow Network |
$41.74
|
| Rate for Payer: Railroad Medicare Medicare |
$49.53
|
| Rate for Payer: Railroad Medicare Medicare |
$49.53
|
| Rate for Payer: Railroad Medicare Medicare |
$49.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,968.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,937.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,875.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.53
|
| Rate for Payer: UHC Exchange |
$76.77
|
| Rate for Payer: UHC Exchange |
$76.77
|
| Rate for Payer: UHC Exchange |
$76.77
|
| Rate for Payer: UHC Medicaid |
$25.90
|
| Rate for Payer: UHC Medicaid |
$25.90
|
| Rate for Payer: UHC Medicaid |
$25.90
|
| Rate for Payer: UHCCP DNSP |
$49.53
|
| Rate for Payer: UHCCP DNSP |
$49.53
|
| Rate for Payer: UHCCP DNSP |
$49.53
|
| Rate for Payer: UHCCP Medicaid |
$25.90
|
| Rate for Payer: UHCCP Medicaid |
$25.90
|
| Rate for Payer: UHCCP Medicaid |
$25.90
|
| Rate for Payer: VA VA |
$49.53
|
| Rate for Payer: VA VA |
$49.53
|
| Rate for Payer: VA VA |
$49.53
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,237.49
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
171063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,678.11 |
| Max. Negotiated Rate |
$2,237.49 |
| Rate for Payer: Aetna Commercial |
$2,013.74
|
| Rate for Payer: Aetna Commercial |
$8,054.95
|
| Rate for Payer: Aetna Commercial |
$4,027.47
|
| Rate for Payer: ASR ASR |
$8,681.45
|
| Rate for Payer: ASR ASR |
$2,170.36
|
| Rate for Payer: ASR ASR |
$4,340.72
|
| Rate for Payer: BCBS Trust/PPO |
$7,349.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,837.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,674.85
|
| Rate for Payer: BCN Commercial |
$3,674.85
|
| Rate for Payer: BCN Commercial |
$1,837.42
|
| Rate for Payer: BCN Commercial |
$7,349.69
|
| Rate for Payer: Cash Price |
$7,159.96
|
| Rate for Payer: Cash Price |
$1,789.99
|
| Rate for Payer: Cash Price |
$3,579.98
|
| Rate for Payer: Cofinity Commercial |
$2,103.24
|
| Rate for Payer: Cofinity Commercial |
$4,206.47
|
| Rate for Payer: Cofinity Commercial |
$8,412.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,159.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,789.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,579.98
|
| Rate for Payer: Healthscope Commercial |
$4,340.72
|
| Rate for Payer: Healthscope Commercial |
$2,170.36
|
| Rate for Payer: Healthscope Commercial |
$8,681.45
|
| Rate for Payer: Healthscope Whirlpool |
$4,474.97
|
| Rate for Payer: Healthscope Whirlpool |
$8,949.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,237.49
|
| Rate for Payer: Mclaren Commercial |
$4,027.47
|
| Rate for Payer: Mclaren Commercial |
$2,013.74
|
| Rate for Payer: Mclaren Commercial |
$8,054.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,803.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,607.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,901.86
|
| Rate for Payer: Nomi Health Commercial |
$3,669.48
|
| Rate for Payer: Nomi Health Commercial |
$1,834.74
|
| Rate for Payer: Nomi Health Commercial |
$7,338.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,678.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,712.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,356.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,875.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,937.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,968.99
|
|
|
IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$902.73
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
171059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$902.73 |
| Rate for Payer: Aetna Commercial |
$812.46
|
| Rate for Payer: Aetna Commercial |
$3,249.83
|
| Rate for Payer: Aetna Medicare |
$47.04
|
| Rate for Payer: Aetna Medicare |
$47.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.80
|
| Rate for Payer: ASR ASR |
$875.65
|
| Rate for Payer: ASR ASR |
$3,502.60
|
| Rate for Payer: BCBS Complete |
$25.83
|
| Rate for Payer: BCBS Complete |
$25.83
|
| Rate for Payer: BCBS MAPPO |
$47.04
|
| Rate for Payer: BCBS MAPPO |
$47.04
|
| Rate for Payer: BCBS Trust/PPO |
$744.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,977.21
|
| Rate for Payer: BCN Commercial |
$2,977.21
|
| Rate for Payer: BCN Commercial |
$744.30
|
| Rate for Payer: BCN Medicare Advantage |
$47.04
|
| Rate for Payer: BCN Medicare Advantage |
$47.04
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cash Price |
$722.18
|
| Rate for Payer: Cash Price |
$722.18
|
| Rate for Payer: Cofinity Commercial |
$848.57
|
| Rate for Payer: Cofinity Commercial |
$3,394.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,888.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.04
|
| Rate for Payer: Healthscope Commercial |
$3,502.60
|
| Rate for Payer: Healthscope Commercial |
$875.65
|
| Rate for Payer: Healthscope Whirlpool |
$902.73
|
| Rate for Payer: Healthscope Whirlpool |
$3,610.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$47.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$47.04
|
| Rate for Payer: Mclaren Commercial |
$812.46
|
| Rate for Payer: Mclaren Commercial |
$3,249.83
|
| Rate for Payer: Mclaren Medicaid |
$47.04
|
| Rate for Payer: Mclaren Medicaid |
$47.04
|
| Rate for Payer: Mclaren Medicare |
$47.04
|
| Rate for Payer: Mclaren Medicare |
$47.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.39
|
| Rate for Payer: Meridian Medicaid |
$25.83
|
| Rate for Payer: Meridian Medicaid |
$25.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$767.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,069.29
|
| Rate for Payer: Nomi Health Commercial |
$2,960.96
|
| Rate for Payer: Nomi Health Commercial |
$740.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$677.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,708.19
|
| Rate for Payer: PACE Medicare |
$44.69
|
| Rate for Payer: PACE Medicare |
$44.69
|
| Rate for Payer: PACE SWMI |
$47.04
|
| Rate for Payer: PACE SWMI |
$47.04
|
| Rate for Payer: PHP Commercial |
$51.74
|
| Rate for Payer: PHP Commercial |
$51.74
|
| Rate for Payer: PHP Medicaid |
$25.21
|
| Rate for Payer: PHP Medicaid |
$25.21
|
| Rate for Payer: PHP Medicare Advantage |
$47.04
|
| Rate for Payer: PHP Medicare Advantage |
$47.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.17
|
| Rate for Payer: Priority Health Medicare |
$47.04
|
| Rate for Payer: Priority Health Medicare |
$47.04
|
| Rate for Payer: Priority Health Narrow Network |
$39.34
|
| Rate for Payer: Priority Health Narrow Network |
$39.34
|
| Rate for Payer: Railroad Medicare Medicare |
$47.04
|
| Rate for Payer: Railroad Medicare Medicare |
$47.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$794.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,177.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.04
|
| Rate for Payer: UHC Exchange |
$72.91
|
| Rate for Payer: UHC Exchange |
$72.91
|
| Rate for Payer: UHC Medicaid |
$24.60
|
| Rate for Payer: UHC Medicaid |
$24.60
|
| Rate for Payer: UHCCP DNSP |
$47.04
|
| Rate for Payer: UHCCP DNSP |
$47.04
|
| Rate for Payer: UHCCP Medicaid |
$24.60
|
| Rate for Payer: UHCCP Medicaid |
$24.60
|
| Rate for Payer: VA VA |
$47.04
|
| Rate for Payer: VA VA |
$47.04
|
|
|
IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$902.73
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
171059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$677.05 |
| Max. Negotiated Rate |
$902.73 |
| Rate for Payer: Aetna Commercial |
$812.46
|
| Rate for Payer: Aetna Commercial |
$3,249.83
|
| Rate for Payer: ASR ASR |
$3,502.60
|
| Rate for Payer: ASR ASR |
$875.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,965.29
|
| Rate for Payer: BCBS Trust/PPO |
$741.32
|
| Rate for Payer: BCN Commercial |
$741.32
|
| Rate for Payer: BCN Commercial |
$2,965.29
|
| Rate for Payer: Cash Price |
$722.18
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cofinity Commercial |
$3,394.27
|
| Rate for Payer: Cofinity Commercial |
$848.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,888.74
|
| Rate for Payer: Healthscope Commercial |
$3,502.60
|
| Rate for Payer: Healthscope Commercial |
$875.65
|
| Rate for Payer: Healthscope Whirlpool |
$3,610.92
|
| Rate for Payer: Healthscope Whirlpool |
$902.73
|
| Rate for Payer: Mclaren Commercial |
$812.46
|
| Rate for Payer: Mclaren Commercial |
$3,249.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,069.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$767.32
|
| Rate for Payer: Nomi Health Commercial |
$740.24
|
| Rate for Payer: Nomi Health Commercial |
$2,960.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,708.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$677.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,177.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$794.40
|
|
|
IMPACT PEPTIDE 1.5 BOLUS FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
150765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: ASR ASR |
$15.25
|
| Rate for Payer: BCBS Trust/PPO |
$12.91
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$14.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Whirlpool |
$15.72
|
| Rate for Payer: Mclaren Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: Nomi Health Commercial |
$12.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.84
|
|
|
IMPACT PEPTIDE 1.5 BOLUS FEED
|
Facility
|
OP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
150765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: ASR ASR |
$15.25
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: BCBS Trust/PPO |
$12.97
|
| Rate for Payer: BCN Commercial |
$12.97
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$14.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Whirlpool |
$15.72
|
| Rate for Payer: Mclaren Commercial |
$14.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: Nomi Health Commercial |
$12.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.78
|
| Rate for Payer: Priority Health Narrow Network |
$11.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.84
|
|
|
IMPACT PEPTIDE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: ASR ASR |
$15.25
|
| Rate for Payer: BCBS Trust/PPO |
$12.91
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$14.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Whirlpool |
$15.72
|
| Rate for Payer: Mclaren Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: Nomi Health Commercial |
$12.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.84
|
|
