|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 60687045701
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.68 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna Commercial |
$363.78
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: ASR ASR |
$392.07
|
| Rate for Payer: ASR Commercial |
$392.07
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: BCBS Trust/PPO |
$331.00
|
| Rate for Payer: BCN Commercial |
$313.38
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$404.20
|
| Rate for Payer: Healthscope Whirlpool |
$392.07
|
| Rate for Payer: Mclaren Commercial |
$363.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.16
|
| Rate for Payer: Priority Health Narrow Network |
$283.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.70
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 00904585461
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: ASR Commercial |
$180.08
|
| Rate for Payer: BCBS Trust/PPO |
$151.29
|
| Rate for Payer: BCN Commercial |
$143.93
|
| 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 |
$185.65
|
| Rate for Payer: Healthscope Whirlpool |
$180.08
|
| Rate for Payer: Mclaren Commercial |
$167.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.37
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$4.04
|
|
|
Service Code
|
NDC 60687045711
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.64
|
| Rate for Payer: ASR ASR |
$3.92
|
| Rate for Payer: ASR Commercial |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.29
|
| Rate for Payer: BCN Commercial |
$3.13
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.23
|
| Rate for Payer: Healthscope Commercial |
$4.04
|
| Rate for Payer: Healthscope Whirlpool |
$3.92
|
| Rate for Payer: Mclaren Commercial |
$3.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.43
|
| Rate for Payer: Nomi Health Commercial |
$3.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.56
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 60687045701
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.73 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna Commercial |
$363.78
|
| Rate for Payer: ASR ASR |
$392.07
|
| Rate for Payer: ASR Commercial |
$392.07
|
| Rate for Payer: BCBS Trust/PPO |
$329.38
|
| Rate for Payer: BCN Commercial |
$313.38
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$404.20
|
| Rate for Payer: Healthscope Whirlpool |
$392.07
|
| Rate for Payer: Mclaren Commercial |
$363.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.70
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$157.45
|
|
|
Service Code
|
NDC 49483060301
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.98 |
| Max. Negotiated Rate |
$157.45 |
| Rate for Payer: Aetna Commercial |
$141.71
|
| Rate for Payer: Aetna Medicare |
$78.72
|
| Rate for Payer: ASR ASR |
$152.73
|
| Rate for Payer: ASR Commercial |
$152.73
|
| Rate for Payer: BCBS Complete |
$62.98
|
| Rate for Payer: BCBS Trust/PPO |
$128.94
|
| Rate for Payer: BCN Commercial |
$122.07
|
| 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 |
$157.45
|
| Rate for Payer: Healthscope Whirlpool |
$152.73
|
| 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: Priority Health Cigna Priority Health |
$102.34
|
| Rate for Payer: 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
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 00904585461
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Aetna Medicare |
$92.83
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: ASR Commercial |
$180.08
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS Trust/PPO |
$152.03
|
| Rate for Payer: BCN Commercial |
$143.93
|
| 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 |
$185.65
|
| Rate for Payer: Healthscope Whirlpool |
$180.08
|
| Rate for Payer: Mclaren Commercial |
$167.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: 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
|
$164.50
|
|
|
Service Code
|
NDC 67877032001
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.92 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$148.05
|
| Rate for Payer: ASR ASR |
$159.56
|
| Rate for Payer: ASR Commercial |
$159.56
|
| Rate for Payer: BCBS Trust/PPO |
$134.05
|
| Rate for Payer: BCN Commercial |
$127.54
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Whirlpool |
$159.56
|
| Rate for Payer: Mclaren Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.82
|
| Rate for Payer: Nomi Health Commercial |
$134.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.76
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$4.04
|
|
|
Service Code
|
NDC 60687045711
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.64
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: ASR ASR |
$3.92
|
| Rate for Payer: ASR Commercial |
$3.92
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.13
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.23
|
| Rate for Payer: Healthscope Commercial |
$4.04
|
| Rate for Payer: Healthscope Whirlpool |
$3.92
|
| Rate for Payer: Mclaren Commercial |
$3.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.43
|
| Rate for Payer: Nomi Health Commercial |
$3.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.54
|
| Rate for Payer: Priority Health Narrow Network |
$2.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.56
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$164.50
|
|
|
Service Code
|
NDC 67877032001
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$148.05
|
| Rate for Payer: Aetna Medicare |
$82.25
|
| Rate for Payer: ASR ASR |
$159.56
|
| Rate for Payer: ASR Commercial |
$159.56
|
| Rate for Payer: BCBS Complete |
$65.80
|
| Rate for Payer: BCBS Trust/PPO |
$134.71
|
| Rate for Payer: BCN Commercial |
$127.54
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Whirlpool |
$159.56
|
| Rate for Payer: Mclaren Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.82
|
| Rate for Payer: Nomi Health Commercial |
$134.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.13
|
| Rate for Payer: Priority Health Narrow Network |
$115.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.76
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
NDC 49483060301
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.34 |
| Max. Negotiated Rate |
$157.45 |
| Rate for Payer: Aetna Commercial |
$141.71
|
| Rate for Payer: ASR ASR |
$152.73
|
| Rate for Payer: ASR Commercial |
$152.73
|
| Rate for Payer: BCBS Trust/PPO |
$128.31
|
| Rate for Payer: BCN Commercial |
$122.07
|
| 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 |
$157.45
|
| Rate for Payer: Healthscope Whirlpool |
$152.73
|
| 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: Priority Health Cigna Priority Health |
$102.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.56
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$16.22
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna Commercial |
$14.60
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: ASR ASR |
$15.73
|
| Rate for Payer: ASR Commercial |
$15.73
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS Trust/PPO |
$13.28
|
| Rate for Payer: BCN Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cofinity Commercial |
$15.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.98
|
| Rate for Payer: Healthscope Commercial |
$16.22
|
| Rate for Payer: Healthscope Whirlpool |
$15.73
|
| Rate for Payer: Mclaren Commercial |
$14.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.79
|
| Rate for Payer: Nomi Health Commercial |
$13.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.21
|
| Rate for Payer: Priority Health Narrow Network |
$11.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.27
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 67877032101
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.81 |
| Max. Negotiated Rate |
$155.10 |
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: ASR ASR |
$150.45
|
| Rate for Payer: ASR Commercial |
$150.45
|
| Rate for Payer: BCBS Trust/PPO |
$126.39
|
| Rate for Payer: BCN Commercial |
$120.25
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$145.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$155.10
|
| Rate for Payer: Healthscope Whirlpool |
$150.45
|
| Rate for Payer: Mclaren Commercial |
$139.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Nomi Health Commercial |
$127.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.49
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 67877032101
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$155.10 |
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: ASR ASR |
$150.45
|
| Rate for Payer: ASR Commercial |
$150.45
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: BCBS Trust/PPO |
$127.01
|
| Rate for Payer: BCN Commercial |
$120.25
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$145.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$155.10
|
| Rate for Payer: Healthscope Whirlpool |
$150.45
|
| Rate for Payer: Mclaren Commercial |
$139.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Nomi Health Commercial |
$127.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.90
|
| Rate for Payer: Priority Health Narrow Network |
$108.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.49
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$16.22
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna Commercial |
$14.60
|
| Rate for Payer: ASR ASR |
$15.73
|
| Rate for Payer: ASR Commercial |
$15.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.22
|
| Rate for Payer: BCN Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cofinity Commercial |
$15.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.98
|
| Rate for Payer: Healthscope Commercial |
$16.22
|
| Rate for Payer: Healthscope Whirlpool |
$15.73
|
| Rate for Payer: Mclaren Commercial |
$14.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.79
|
| Rate for Payer: Nomi Health Commercial |
$13.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.27
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
OP
|
$17,218.15
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
172845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$17,218.15 |
| Rate for Payer: Aetna Commercial |
$15,496.33
|
| Rate for Payer: Aetna Medicare |
$48.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.20
|
| Rate for Payer: ASR ASR |
$16,701.61
|
| Rate for Payer: ASR Commercial |
$16,701.61
|
| Rate for Payer: BCBS Complete |
$27.55
|
| Rate for Payer: BCBS MAPPO |
$48.96
|
| Rate for Payer: BCBS Trust/PPO |
$14,099.94
|
| Rate for Payer: BCN Commercial |
$13,349.23
|
| Rate for Payer: BCN Medicare Advantage |
$48.96
|
| Rate for Payer: Cash Price |
$13,774.52
|
| Rate for Payer: Cash Price |
$13,774.52
|
| Rate for Payer: Cofinity Commercial |
$16,185.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,774.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$17,218.15
|
| Rate for Payer: Healthscope Whirlpool |
$16,701.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$48.96
|
| Rate for Payer: Mclaren Commercial |
$15,496.33
|
| Rate for Payer: Mclaren Medicaid |
$26.24
|
| Rate for Payer: Mclaren Medicare |
$48.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.41
|
| Rate for Payer: Meridian Medicaid |
$27.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,635.43
|
| Rate for Payer: Nomi Health Commercial |
$14,118.88
|
| Rate for Payer: PACE Medicare |
$46.51
|
| Rate for Payer: PACE SWMI |
$48.96
|
| Rate for Payer: PHP Commercial |
$53.86
|
| Rate for Payer: PHP Medicaid |
$26.24
|
| Rate for Payer: PHP Medicare Advantage |
$48.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,191.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,086.54
|
| Rate for Payer: Priority Health Medicare |
$48.96
|
| Rate for Payer: Priority Health Narrow Network |
$12,069.92
|
| Rate for Payer: Railroad Medicare Medicare |
$48.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,151.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.96
|
| Rate for Payer: UHC Exchange |
$75.89
|
| Rate for Payer: UHC Medicare Advantage |
$48.96
|
| Rate for Payer: UHCCP DNSP |
$48.96
|
| Rate for Payer: UHCCP Medicaid |
$26.24
|
| Rate for Payer: VA VA |
$48.96
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
IP
|
$17,218.15
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
172845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,191.80 |
| Max. Negotiated Rate |
$17,218.15 |
| Rate for Payer: Aetna Commercial |
$15,496.33
|
| Rate for Payer: ASR ASR |
$16,701.61
|
| Rate for Payer: ASR Commercial |
$16,701.61
|
| Rate for Payer: BCBS Trust/PPO |
$14,031.07
|
| Rate for Payer: BCN Commercial |
$13,349.23
|
| Rate for Payer: Cash Price |
$13,774.52
|
| Rate for Payer: Cofinity Commercial |
$16,185.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,774.52
|
| Rate for Payer: Healthscope Commercial |
$17,218.15
|
| Rate for Payer: Healthscope Whirlpool |
$16,701.61
|
| Rate for Payer: Mclaren Commercial |
$15,496.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,635.43
|
| Rate for Payer: Nomi Health Commercial |
$14,118.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,191.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,151.97
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Commercial |
$1,350.00
|
| Rate for Payer: Aetna Commercial |
$2,700.00
|
| Rate for Payer: ASR ASR |
$1,455.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: ASR ASR |
$2,910.00
|
| Rate for Payer: ASR Commercial |
$291.00
|
| Rate for Payer: ASR Commercial |
$1,455.00
|
| Rate for Payer: ASR Commercial |
$2,910.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,444.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,222.35
|
| Rate for Payer: BCBS Trust/PPO |
$244.47
|
| Rate for Payer: BCN Commercial |
$1,162.95
|
| Rate for Payer: BCN Commercial |
$2,325.90
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cofinity Commercial |
$2,820.00
|
| Rate for Payer: Cofinity Commercial |
$1,410.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,400.00
|
| Rate for Payer: Healthscope Commercial |
$1,500.00
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$3,000.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,455.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,910.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Mclaren Commercial |
$1,350.00
|
| Rate for Payer: Mclaren Commercial |
$2,700.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,550.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,275.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Nomi Health Commercial |
$1,230.00
|
| Rate for Payer: Nomi Health Commercial |
$2,460.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$975.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,950.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,640.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,320.00
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.29 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,700.00
|
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Commercial |
$1,350.00
|
| Rate for Payer: Aetna Medicare |
$45.31
|
| Rate for Payer: Aetna Medicare |
$45.31
|
| Rate for Payer: Aetna Medicare |
$45.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.64
|
| Rate for Payer: ASR ASR |
$1,455.00
|
| Rate for Payer: ASR ASR |
$2,910.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: ASR Commercial |
$2,910.00
|
| Rate for Payer: ASR Commercial |
$1,455.00
|
| Rate for Payer: ASR Commercial |
$291.00
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS Complete |
$25.50
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCBS MAPPO |
$45.31
|
| Rate for Payer: BCBS Trust/PPO |
$245.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,456.70
|
| Rate for Payer: BCN Commercial |
$2,325.90
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: BCN Commercial |
$1,162.95
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$45.31
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$1,410.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$2,820.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,400.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.31
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$1,500.00
|
| Rate for Payer: Healthscope Commercial |
$3,000.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,910.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,455.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.31
|
| Rate for Payer: Mclaren Commercial |
$1,350.00
|
| Rate for Payer: Mclaren Commercial |
$2,700.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$24.29
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Mclaren Medicare |
$45.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.58
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: Meridian Medicaid |
$25.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,275.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,550.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Nomi Health Commercial |
$1,230.00
|
| Rate for Payer: Nomi Health Commercial |
$2,460.00
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE Medicare |
$43.04
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PACE SWMI |
$45.31
|
| Rate for Payer: PHP Commercial |
$49.84
|
| Rate for Payer: PHP Commercial |
$49.84
|
| Rate for Payer: PHP Commercial |
$49.84
|
| Rate for Payer: PHP Medicaid |
$24.29
|
| Rate for Payer: PHP Medicaid |
$24.29
|
| Rate for Payer: PHP Medicaid |
$24.29
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: PHP Medicare Advantage |
$45.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,950.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$975.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,314.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$262.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,628.60
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health Medicare |
$45.31
|
| Rate for Payer: Priority Health Narrow Network |
$210.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,051.50
|
| Rate for Payer: Priority Health Narrow Network |
$2,103.00
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$45.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,320.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,640.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.31
|
| Rate for Payer: UHC Exchange |
$70.23
|
| Rate for Payer: UHC Exchange |
$70.23
|
| Rate for Payer: UHC Exchange |
$70.23
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHC Medicare Advantage |
$45.31
|
| Rate for Payer: UHCCP DNSP |
$45.31
|
| Rate for Payer: UHCCP DNSP |
$45.31
|
| Rate for Payer: UHCCP DNSP |
$45.31
|
| Rate for Payer: UHCCP Medicaid |
$24.29
|
| Rate for Payer: UHCCP Medicaid |
$24.29
|
| Rate for Payer: UHCCP Medicaid |
$24.29
|
| Rate for Payer: VA VA |
$45.31
|
| Rate for Payer: VA VA |
$45.31
|
| Rate for Payer: VA VA |
$45.31
|
|
|
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 |
$4,694.20 |
| 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: ASR Commercial |
$7,005.19
|
| Rate for Payer: BCBS Trust/PPO |
$5,885.09
|
| Rate for Payer: BCN Commercial |
$5,599.10
|
| 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 |
$7,221.85
|
| Rate for Payer: Healthscope Whirlpool |
$7,005.19
|
| 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: Priority Health Cigna Priority Health |
$4,694.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,355.23
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,221.85
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
172293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$7,221.85 |
| Rate for Payer: Aetna Commercial |
$6,499.66
|
| Rate for Payer: Aetna Medicare |
$47.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.41
|
| Rate for Payer: ASR ASR |
$7,005.19
|
| Rate for Payer: ASR Commercial |
$7,005.19
|
| Rate for Payer: BCBS Complete |
$26.75
|
| Rate for Payer: BCBS MAPPO |
$47.53
|
| Rate for Payer: BCBS Trust/PPO |
$5,913.97
|
| Rate for Payer: BCN Commercial |
$5,599.10
|
| Rate for Payer: BCN Medicare Advantage |
$47.53
|
| 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 |
$47.53
|
| Rate for Payer: Healthscope Commercial |
$7,221.85
|
| Rate for Payer: Healthscope Whirlpool |
$7,005.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$47.53
|
| Rate for Payer: Mclaren Commercial |
$6,499.66
|
| Rate for Payer: Mclaren Medicaid |
$25.48
|
| Rate for Payer: Mclaren Medicare |
$47.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.91
|
| Rate for Payer: Meridian Medicaid |
$26.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,138.57
|
| Rate for Payer: Nomi Health Commercial |
$5,921.92
|
| Rate for Payer: PACE Medicare |
$45.15
|
| Rate for Payer: PACE SWMI |
$47.53
|
| Rate for Payer: PHP Commercial |
$52.28
|
| Rate for Payer: PHP Medicaid |
$25.48
|
| Rate for Payer: PHP Medicare Advantage |
$47.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,694.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,327.78
|
| Rate for Payer: Priority Health Medicare |
$47.53
|
| Rate for Payer: Priority Health Narrow Network |
$5,062.52
|
| Rate for Payer: Railroad Medicare Medicare |
$47.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,355.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.53
|
| Rate for Payer: UHC Exchange |
$73.67
|
| Rate for Payer: UHC Medicare Advantage |
$47.53
|
| Rate for Payer: UHCCP DNSP |
$47.53
|
| Rate for Payer: UHCCP Medicaid |
$25.48
|
| Rate for Payer: VA VA |
$47.53
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$8,526.35
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
171063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$8,526.35 |
| Rate for Payer: Aetna Commercial |
$7,673.72
|
| Rate for Payer: Aetna Commercial |
$3,836.85
|
| Rate for Payer: Aetna Commercial |
$1,918.43
|
| Rate for Payer: Aetna Medicare |
$50.74
|
| Rate for Payer: Aetna Medicare |
$50.74
|
| Rate for Payer: Aetna Medicare |
$50.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.42
|
| Rate for Payer: ASR ASR |
$2,067.64
|
| Rate for Payer: ASR ASR |
$8,270.56
|
| Rate for Payer: ASR ASR |
$4,135.27
|
| Rate for Payer: ASR Commercial |
$8,270.56
|
| Rate for Payer: ASR Commercial |
$2,067.64
|
| Rate for Payer: ASR Commercial |
$4,135.27
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS MAPPO |
$50.74
|
| Rate for Payer: BCBS MAPPO |
$50.74
|
| Rate for Payer: BCBS MAPPO |
$50.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,491.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,745.56
|
| Rate for Payer: BCBS Trust/PPO |
$6,982.23
|
| Rate for Payer: BCN Commercial |
$6,610.48
|
| Rate for Payer: BCN Commercial |
$3,305.24
|
| Rate for Payer: BCN Commercial |
$1,652.62
|
| Rate for Payer: BCN Medicare Advantage |
$50.74
|
| Rate for Payer: BCN Medicare Advantage |
$50.74
|
| Rate for Payer: BCN Medicare Advantage |
$50.74
|
| Rate for Payer: Cash Price |
$3,410.54
|
| Rate for Payer: Cash Price |
$1,705.27
|
| Rate for Payer: Cash Price |
$1,705.27
|
| Rate for Payer: Cash Price |
$6,821.08
|
| Rate for Payer: Cash Price |
$6,821.08
|
| Rate for Payer: Cash Price |
$3,410.54
|
| Rate for Payer: Cofinity Commercial |
$2,003.69
|
| Rate for Payer: Cofinity Commercial |
$4,007.38
|
| Rate for Payer: Cofinity Commercial |
$8,014.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,821.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,410.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,705.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.74
|
| Rate for Payer: Healthscope Commercial |
$4,263.17
|
| Rate for Payer: Healthscope Commercial |
$2,131.59
|
| Rate for Payer: Healthscope Commercial |
$8,526.35
|
| Rate for Payer: Healthscope Whirlpool |
$4,135.27
|
| Rate for Payer: Healthscope Whirlpool |
$8,270.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,067.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$50.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$50.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$50.74
|
| Rate for Payer: Mclaren Commercial |
$1,918.43
|
| Rate for Payer: Mclaren Commercial |
$7,673.72
|
| Rate for Payer: Mclaren Commercial |
$3,836.85
|
| Rate for Payer: Mclaren Medicaid |
$27.20
|
| Rate for Payer: Mclaren Medicaid |
$27.20
|
| Rate for Payer: Mclaren Medicaid |
$27.20
|
| Rate for Payer: Mclaren Medicare |
$50.74
|
| Rate for Payer: Mclaren Medicare |
$50.74
|
| Rate for Payer: Mclaren Medicare |
$50.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.28
|
| Rate for Payer: Meridian Medicaid |
$28.56
|
| Rate for Payer: Meridian Medicaid |
$28.56
|
| Rate for Payer: Meridian Medicaid |
$28.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,811.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,247.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,623.69
|
| Rate for Payer: Nomi Health Commercial |
$3,495.80
|
| Rate for Payer: Nomi Health Commercial |
$1,747.90
|
| Rate for Payer: Nomi Health Commercial |
$6,991.61
|
| Rate for Payer: PACE Medicare |
$48.20
|
| Rate for Payer: PACE Medicare |
$48.20
|
| Rate for Payer: PACE Medicare |
$48.20
|
| Rate for Payer: PACE SWMI |
$50.74
|
| Rate for Payer: PACE SWMI |
$50.74
|
| Rate for Payer: PACE SWMI |
$50.74
|
| Rate for Payer: PHP Commercial |
$55.81
|
| Rate for Payer: PHP Commercial |
$55.81
|
| Rate for Payer: PHP Commercial |
$55.81
|
| Rate for Payer: PHP Medicaid |
$27.20
|
| Rate for Payer: PHP Medicaid |
$27.20
|
| Rate for Payer: PHP Medicaid |
$27.20
|
| Rate for Payer: PHP Medicare Advantage |
$50.74
|
| Rate for Payer: PHP Medicare Advantage |
$50.74
|
| Rate for Payer: PHP Medicare Advantage |
$50.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,542.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,771.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,867.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,735.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,470.79
|
| Rate for Payer: Priority Health Medicare |
$50.74
|
| Rate for Payer: Priority Health Medicare |
$50.74
|
| Rate for Payer: Priority Health Medicare |
$50.74
|
| Rate for Payer: Priority Health Narrow Network |
$2,988.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,494.24
|
| Rate for Payer: Priority Health Narrow Network |
$5,976.97
|
| Rate for Payer: Railroad Medicare Medicare |
$50.74
|
| Rate for Payer: Railroad Medicare Medicare |
$50.74
|
| Rate for Payer: Railroad Medicare Medicare |
$50.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,875.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,751.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,503.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.74
|
| Rate for Payer: UHC Exchange |
$78.65
|
| Rate for Payer: UHC Exchange |
$78.65
|
| Rate for Payer: UHC Exchange |
$78.65
|
| Rate for Payer: UHC Medicare Advantage |
$50.74
|
| Rate for Payer: UHC Medicare Advantage |
$50.74
|
| Rate for Payer: UHC Medicare Advantage |
$50.74
|
| Rate for Payer: UHCCP DNSP |
$50.74
|
| Rate for Payer: UHCCP DNSP |
$50.74
|
| Rate for Payer: UHCCP DNSP |
$50.74
|
| Rate for Payer: UHCCP Medicaid |
$27.20
|
| Rate for Payer: UHCCP Medicaid |
$27.20
|
| Rate for Payer: UHCCP Medicaid |
$27.20
|
| Rate for Payer: VA VA |
$50.74
|
| Rate for Payer: VA VA |
$50.74
|
| Rate for Payer: VA VA |
$50.74
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$4,263.17
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
171063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,771.06 |
| Max. Negotiated Rate |
$4,263.17 |
| Rate for Payer: Aetna Commercial |
$3,836.85
|
| Rate for Payer: Aetna Commercial |
$1,918.43
|
| Rate for Payer: Aetna Commercial |
$7,673.72
|
| Rate for Payer: ASR ASR |
$2,067.64
|
| Rate for Payer: ASR ASR |
$4,135.27
|
| Rate for Payer: ASR ASR |
$8,270.56
|
| Rate for Payer: ASR Commercial |
$4,135.27
|
| Rate for Payer: ASR Commercial |
$2,067.64
|
| Rate for Payer: ASR Commercial |
$8,270.56
|
| Rate for Payer: BCBS Trust/PPO |
$6,948.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,737.03
|
| Rate for Payer: BCBS Trust/PPO |
$3,474.06
|
| Rate for Payer: BCN Commercial |
$1,652.62
|
| Rate for Payer: BCN Commercial |
$6,610.48
|
| Rate for Payer: BCN Commercial |
$3,305.24
|
| Rate for Payer: Cash Price |
$3,410.54
|
| Rate for Payer: Cash Price |
$1,705.27
|
| Rate for Payer: Cash Price |
$6,821.08
|
| Rate for Payer: Cofinity Commercial |
$8,014.77
|
| Rate for Payer: Cofinity Commercial |
$2,003.69
|
| Rate for Payer: Cofinity Commercial |
$4,007.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,410.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,705.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,821.08
|
| Rate for Payer: Healthscope Commercial |
$2,131.59
|
| Rate for Payer: Healthscope Commercial |
$4,263.17
|
| Rate for Payer: Healthscope Commercial |
$8,526.35
|
| Rate for Payer: Healthscope Whirlpool |
$4,135.27
|
| Rate for Payer: Healthscope Whirlpool |
$2,067.64
|
| Rate for Payer: Healthscope Whirlpool |
$8,270.56
|
| Rate for Payer: Mclaren Commercial |
$3,836.85
|
| Rate for Payer: Mclaren Commercial |
$1,918.43
|
| Rate for Payer: Mclaren Commercial |
$7,673.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,247.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,623.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,811.85
|
| Rate for Payer: Nomi Health Commercial |
$3,495.80
|
| Rate for Payer: Nomi Health Commercial |
$1,747.90
|
| Rate for Payer: Nomi Health Commercial |
$6,991.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,542.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,771.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,751.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,503.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,875.80
|
|
|
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 |
$586.77 |
| 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 |
$3,502.59
|
| Rate for Payer: ASR ASR |
$875.65
|
| Rate for Payer: ASR Commercial |
$3,502.59
|
| Rate for Payer: ASR Commercial |
$875.65
|
| Rate for Payer: BCBS Trust/PPO |
$735.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,942.54
|
| Rate for Payer: BCN Commercial |
$699.89
|
| Rate for Payer: BCN Commercial |
$2,799.55
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cash Price |
$722.18
|
| Rate for Payer: Cofinity Commercial |
$848.57
|
| Rate for Payer: Cofinity Commercial |
$3,394.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,888.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.18
|
| Rate for Payer: Healthscope Commercial |
$3,610.92
|
| Rate for Payer: Healthscope Commercial |
$902.73
|
| Rate for Payer: Healthscope Whirlpool |
$3,502.59
|
| Rate for Payer: Healthscope Whirlpool |
$875.65
|
| Rate for Payer: Mclaren Commercial |
$812.46
|
| Rate for Payer: Mclaren Commercial |
$3,249.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,069.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$767.32
|
| Rate for Payer: Nomi Health Commercial |
$740.24
|
| Rate for Payer: Nomi Health Commercial |
$2,960.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,347.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,177.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$794.40
|
|
|
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 |
$25.48 |
| 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 |
$47.53
|
| Rate for Payer: Aetna Medicare |
$47.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.41
|
| Rate for Payer: ASR ASR |
$875.65
|
| Rate for Payer: ASR ASR |
$3,502.59
|
| Rate for Payer: ASR Commercial |
$875.65
|
| Rate for Payer: ASR Commercial |
$3,502.59
|
| Rate for Payer: BCBS Complete |
$26.75
|
| Rate for Payer: BCBS Complete |
$26.75
|
| Rate for Payer: BCBS MAPPO |
$47.53
|
| Rate for Payer: BCBS MAPPO |
$47.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,956.98
|
| Rate for Payer: BCBS Trust/PPO |
$739.25
|
| Rate for Payer: BCN Commercial |
$2,799.55
|
| Rate for Payer: BCN Commercial |
$699.89
|
| Rate for Payer: BCN Medicare Advantage |
$47.53
|
| Rate for Payer: BCN Medicare Advantage |
$47.53
|
| Rate for Payer: Cash Price |
$722.18
|
| 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: Cofinity Commercial |
$848.57
|
| Rate for Payer: Cofinity Commercial |
$3,394.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,888.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.53
|
| Rate for Payer: Healthscope Commercial |
$3,610.92
|
| Rate for Payer: Healthscope Commercial |
$902.73
|
| Rate for Payer: Healthscope Whirlpool |
$875.65
|
| Rate for Payer: Healthscope Whirlpool |
$3,502.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$47.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$47.53
|
| Rate for Payer: Mclaren Commercial |
$812.46
|
| Rate for Payer: Mclaren Commercial |
$3,249.83
|
| Rate for Payer: Mclaren Medicaid |
$25.48
|
| Rate for Payer: Mclaren Medicaid |
$25.48
|
| Rate for Payer: Mclaren Medicare |
$47.53
|
| Rate for Payer: Mclaren Medicare |
$47.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.91
|
| Rate for Payer: Meridian Medicaid |
$26.75
|
| Rate for Payer: Meridian Medicaid |
$26.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$767.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,069.28
|
| Rate for Payer: Nomi Health Commercial |
$2,960.95
|
| Rate for Payer: Nomi Health Commercial |
$740.24
|
| Rate for Payer: PACE Medicare |
$45.15
|
| Rate for Payer: PACE Medicare |
$45.15
|
| Rate for Payer: PACE SWMI |
$47.53
|
| Rate for Payer: PACE SWMI |
$47.53
|
| Rate for Payer: PHP Commercial |
$52.28
|
| Rate for Payer: PHP Commercial |
$52.28
|
| Rate for Payer: PHP Medicaid |
$25.48
|
| Rate for Payer: PHP Medicaid |
$25.48
|
| Rate for Payer: PHP Medicare Advantage |
$47.53
|
| Rate for Payer: PHP Medicare Advantage |
$47.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,347.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,163.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$790.97
|
| Rate for Payer: Priority Health Medicare |
$47.53
|
| Rate for Payer: Priority Health Medicare |
$47.53
|
| Rate for Payer: Priority Health Narrow Network |
$2,531.25
|
| Rate for Payer: Priority Health Narrow Network |
$632.81
|
| Rate for Payer: Railroad Medicare Medicare |
$47.53
|
| Rate for Payer: Railroad Medicare Medicare |
$47.53
|
| 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 |
$47.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.53
|
| Rate for Payer: UHC Exchange |
$73.67
|
| Rate for Payer: UHC Exchange |
$73.67
|
| Rate for Payer: UHC Medicare Advantage |
$47.53
|
| Rate for Payer: UHC Medicare Advantage |
$47.53
|
| Rate for Payer: UHCCP DNSP |
$47.53
|
| Rate for Payer: UHCCP DNSP |
$47.53
|
| Rate for Payer: UHCCP Medicaid |
$25.48
|
| Rate for Payer: UHCCP Medicaid |
$25.48
|
| Rate for Payer: VA VA |
$47.53
|
| Rate for Payer: VA VA |
$47.53
|
|
|
IMPACT PEPTIDE/VITAL 1.5 BOLUS FEED
|
Facility
|
IP
|
$15.72
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
150765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: ASR ASR |
$15.25
|
| Rate for Payer: ASR Commercial |
$15.25
|
| Rate for Payer: BCBS Trust/PPO |
$12.81
|
| Rate for Payer: BCN Commercial |
$12.19
|
| 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 |
$15.72
|
| Rate for Payer: Healthscope Whirlpool |
$15.25
|
| Rate for Payer: Mclaren Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.36
|
| Rate for Payer: Nomi Health Commercial |
$12.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.83
|
|
