|
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 |
$15,496.34
|
| 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 |
$15,496.34
|
| 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
|
$300.00
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
171062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.90 |
| 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: Aetna Medicare |
$46.46
|
| Rate for Payer: Aetna Medicare |
$46.46
|
| Rate for Payer: Aetna Medicare |
$46.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.08
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: ASR ASR |
$1,455.00
|
| 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 Complete |
$26.15
|
| Rate for Payer: BCBS Complete |
$26.15
|
| Rate for Payer: BCBS Complete |
$26.15
|
| Rate for Payer: BCBS MAPPO |
$46.46
|
| Rate for Payer: BCBS MAPPO |
$46.46
|
| Rate for Payer: BCBS MAPPO |
$46.46
|
| Rate for Payer: BCBS Trust/PPO |
$245.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,456.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.35
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: BCN Commercial |
$1,162.95
|
| Rate for Payer: BCN Commercial |
$2,325.90
|
| Rate for Payer: BCN Medicare Advantage |
$46.46
|
| Rate for Payer: BCN Medicare Advantage |
$46.46
|
| Rate for Payer: BCN Medicare Advantage |
$46.46
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cofinity Commercial |
$1,410.00
|
| Rate for Payer: Cofinity Commercial |
$2,820.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| 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 |
$46.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.46
|
| Rate for Payer: Healthscope Commercial |
$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 |
$46.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.46
|
| 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 |
$24.90
|
| Rate for Payer: Mclaren Medicaid |
$24.90
|
| Rate for Payer: Mclaren Medicaid |
$24.90
|
| Rate for Payer: Mclaren Medicare |
$46.46
|
| Rate for Payer: Mclaren Medicare |
$46.46
|
| Rate for Payer: Mclaren Medicare |
$46.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.78
|
| Rate for Payer: Meridian Medicaid |
$26.15
|
| Rate for Payer: Meridian Medicaid |
$26.15
|
| Rate for Payer: Meridian Medicaid |
$26.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| 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: Nomi Health Commercial |
$1,230.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Nomi Health Commercial |
$2,460.00
|
| Rate for Payer: PACE Medicare |
$44.14
|
| Rate for Payer: PACE Medicare |
$44.14
|
| Rate for Payer: PACE Medicare |
$44.14
|
| Rate for Payer: PACE SWMI |
$46.46
|
| Rate for Payer: PACE SWMI |
$46.46
|
| Rate for Payer: PACE SWMI |
$46.46
|
| Rate for Payer: PHP Commercial |
$51.11
|
| Rate for Payer: PHP Commercial |
$51.11
|
| Rate for Payer: PHP Commercial |
$51.11
|
| Rate for Payer: PHP Medicaid |
$24.90
|
| Rate for Payer: PHP Medicaid |
$24.90
|
| Rate for Payer: PHP Medicaid |
$24.90
|
| Rate for Payer: PHP Medicare Advantage |
$46.46
|
| Rate for Payer: PHP Medicare Advantage |
$46.46
|
| Rate for Payer: PHP Medicare Advantage |
$46.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| 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 HMO/PPO/Tiered Network |
$46.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.83
|
| Rate for Payer: Priority Health Medicare |
$46.46
|
| Rate for Payer: Priority Health Medicare |
$46.46
|
| Rate for Payer: Priority Health Medicare |
$46.46
|
| Rate for Payer: Priority Health Narrow Network |
$37.46
|
| Rate for Payer: Priority Health Narrow Network |
$37.46
|
| Rate for Payer: Priority Health Narrow Network |
$37.46
|
| Rate for Payer: Railroad Medicare Medicare |
$46.46
|
| Rate for Payer: Railroad Medicare Medicare |
$46.46
|
| Rate for Payer: Railroad Medicare Medicare |
$46.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + 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
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.46
|
| Rate for Payer: UHC Exchange |
$72.01
|
| Rate for Payer: UHC Exchange |
$72.01
|
| Rate for Payer: UHC Exchange |
$72.01
|
| Rate for Payer: UHC Medicare Advantage |
$46.46
|
| Rate for Payer: UHC Medicare Advantage |
$46.46
|
| Rate for Payer: UHC Medicare Advantage |
$46.46
|
| Rate for Payer: UHCCP DNSP |
$46.46
|
| Rate for Payer: UHCCP DNSP |
$46.46
|
| Rate for Payer: UHCCP DNSP |
$46.46
|
| Rate for Payer: UHCCP Medicaid |
$24.90
|
| Rate for Payer: UHCCP Medicaid |
$24.90
|
| Rate for Payer: UHCCP Medicaid |
$24.90
|
| Rate for Payer: VA VA |
$46.46
|
| Rate for Payer: VA VA |
$46.46
|
| Rate for Payer: VA VA |
$46.46
|
|
|
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 |
$26.42 |
| Max. Negotiated Rate |
$7,221.85 |
| Rate for Payer: Aetna Commercial |
$6,499.66
|
| Rate for Payer: Aetna Medicare |
$49.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.62
|
| Rate for Payer: ASR ASR |
$7,005.19
|
| Rate for Payer: ASR Commercial |
$7,005.19
|
| Rate for Payer: BCBS Complete |
$27.75
|
| Rate for Payer: BCBS MAPPO |
$49.30
|
| Rate for Payer: BCBS Trust/PPO |
$5,913.97
|
| Rate for Payer: BCN Commercial |
$5,599.10
|
| Rate for Payer: BCN Medicare Advantage |
$49.30
|
| 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 |
$49.30
|
| Rate for Payer: Healthscope Commercial |
$7,221.85
|
| Rate for Payer: Healthscope Whirlpool |
$7,005.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.30
|
| Rate for Payer: Mclaren Commercial |
$6,499.66
|
| Rate for Payer: Mclaren Medicaid |
$26.42
|
| Rate for Payer: Mclaren Medicare |
$49.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.76
|
| Rate for Payer: Meridian Medicaid |
$27.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,138.57
|
| Rate for Payer: Nomi Health Commercial |
$5,921.92
|
| Rate for Payer: PACE Medicare |
$46.84
|
| Rate for Payer: PACE SWMI |
$49.30
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Medicaid |
$26.42
|
| Rate for Payer: PHP Medicare Advantage |
$49.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,694.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.87
|
| Rate for Payer: Priority Health Medicare |
$49.30
|
| Rate for Payer: Priority Health Narrow Network |
$39.90
|
| Rate for Payer: Railroad Medicare Medicare |
$49.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,355.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.30
|
| Rate for Payer: UHC Exchange |
$76.42
|
| Rate for Payer: UHC Medicare Advantage |
$49.30
|
| Rate for Payer: UHCCP DNSP |
$49.30
|
| Rate for Payer: UHCCP Medicaid |
$26.42
|
| Rate for Payer: VA VA |
$49.30
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,263.17
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
171063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.41 |
| 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: Aetna Medicare |
$49.28
|
| Rate for Payer: Aetna Medicare |
$49.28
|
| Rate for Payer: Aetna Medicare |
$49.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.60
|
| Rate for Payer: ASR ASR |
$4,135.27
|
| Rate for Payer: ASR ASR |
$2,067.64
|
| 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 Complete |
$27.73
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$49.28
|
| Rate for Payer: BCBS MAPPO |
$49.28
|
| Rate for Payer: BCBS MAPPO |
$49.28
|
| Rate for Payer: BCBS Trust/PPO |
$3,491.11
|
| Rate for Payer: BCBS Trust/PPO |
$6,982.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,745.56
|
| Rate for Payer: BCN Commercial |
$3,305.24
|
| Rate for Payer: BCN Commercial |
$1,652.62
|
| Rate for Payer: BCN Commercial |
$6,610.48
|
| Rate for Payer: BCN Medicare Advantage |
$49.28
|
| Rate for Payer: BCN Medicare Advantage |
$49.28
|
| Rate for Payer: BCN Medicare Advantage |
$49.28
|
| Rate for Payer: Cash Price |
$1,705.27
|
| Rate for Payer: Cash Price |
$6,821.08
|
| Rate for Payer: Cash Price |
$3,410.54
|
| Rate for Payer: Cash Price |
$1,705.27
|
| Rate for Payer: Cash Price |
$3,410.54
|
| Rate for Payer: Cash Price |
$6,821.08
|
| Rate for Payer: Cofinity Commercial |
$2,003.69
|
| Rate for Payer: Cofinity Commercial |
$8,014.77
|
| Rate for Payer: Cofinity Commercial |
$4,007.38
|
| 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 |
$49.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.28
|
| Rate for Payer: Healthscope Commercial |
$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 |
$49.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.28
|
| 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 |
$26.41
|
| Rate for Payer: Mclaren Medicaid |
$26.41
|
| Rate for Payer: Mclaren Medicaid |
$26.41
|
| Rate for Payer: Mclaren Medicare |
$49.28
|
| Rate for Payer: Mclaren Medicare |
$49.28
|
| Rate for Payer: Mclaren Medicare |
$49.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.74
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.67
|
| 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: Multiplan/Beech St/PHCS Commercial |
$7,247.40
|
| Rate for Payer: Nomi Health Commercial |
$1,747.90
|
| Rate for Payer: Nomi Health Commercial |
$3,495.80
|
| Rate for Payer: Nomi Health Commercial |
$6,991.61
|
| Rate for Payer: PACE Medicare |
$46.82
|
| Rate for Payer: PACE Medicare |
$46.82
|
| Rate for Payer: PACE Medicare |
$46.82
|
| Rate for Payer: PACE SWMI |
$49.28
|
| Rate for Payer: PACE SWMI |
$49.28
|
| Rate for Payer: PACE SWMI |
$49.28
|
| Rate for Payer: PHP Commercial |
$54.21
|
| Rate for Payer: PHP Commercial |
$54.21
|
| Rate for Payer: PHP Commercial |
$54.21
|
| Rate for Payer: PHP Medicaid |
$26.41
|
| Rate for Payer: PHP Medicaid |
$26.41
|
| Rate for Payer: PHP Medicaid |
$26.41
|
| Rate for Payer: PHP Medicare Advantage |
$49.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,771.06
|
| 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 HMO/PPO/Tiered Network |
$51.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.03
|
| Rate for Payer: Priority Health Medicare |
$49.28
|
| Rate for Payer: Priority Health Medicare |
$49.28
|
| Rate for Payer: Priority Health Medicare |
$49.28
|
| Rate for Payer: Priority Health Narrow Network |
$40.82
|
| Rate for Payer: Priority Health Narrow Network |
$40.82
|
| Rate for Payer: Priority Health Narrow Network |
$40.82
|
| Rate for Payer: Railroad Medicare Medicare |
$49.28
|
| Rate for Payer: Railroad Medicare Medicare |
$49.28
|
| Rate for Payer: Railroad Medicare Medicare |
$49.28
|
| 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
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.28
|
| Rate for Payer: UHC Exchange |
$76.38
|
| Rate for Payer: UHC Exchange |
$76.38
|
| Rate for Payer: UHC Exchange |
$76.38
|
| Rate for Payer: UHC Medicare Advantage |
$49.28
|
| Rate for Payer: UHC Medicare Advantage |
$49.28
|
| Rate for Payer: UHC Medicare Advantage |
$49.28
|
| Rate for Payer: UHCCP DNSP |
$49.28
|
| Rate for Payer: UHCCP DNSP |
$49.28
|
| Rate for Payer: UHCCP DNSP |
$49.28
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
| Rate for Payer: VA VA |
$49.28
|
| Rate for Payer: VA VA |
$49.28
|
| Rate for Payer: VA VA |
$49.28
|
|
|
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
|
OP
|
$902.73
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
171059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.42 |
| 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 |
$49.30
|
| Rate for Payer: Aetna Medicare |
$49.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.62
|
| Rate for Payer: 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 |
$27.75
|
| Rate for Payer: BCBS Complete |
$27.75
|
| Rate for Payer: BCBS MAPPO |
$49.30
|
| Rate for Payer: BCBS MAPPO |
$49.30
|
| Rate for Payer: BCBS 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 |
$49.30
|
| Rate for Payer: BCN Medicare Advantage |
$49.30
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cash Price |
$2,888.74
|
| Rate for Payer: Cash Price |
$722.18
|
| Rate for Payer: Cash Price |
$722.18
|
| Rate for Payer: Cofinity Commercial |
$848.57
|
| Rate for Payer: Cofinity Commercial |
$3,394.26
|
| 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 |
$49.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.30
|
| 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 |
$49.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.30
|
| Rate for Payer: Mclaren Commercial |
$812.46
|
| Rate for Payer: Mclaren Commercial |
$3,249.83
|
| Rate for Payer: Mclaren Medicaid |
$26.42
|
| Rate for Payer: Mclaren Medicaid |
$26.42
|
| Rate for Payer: Mclaren Medicare |
$49.30
|
| Rate for Payer: Mclaren Medicare |
$49.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.76
|
| Rate for Payer: Meridian Medicaid |
$27.75
|
| Rate for Payer: Meridian Medicaid |
$27.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$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 |
$46.84
|
| Rate for Payer: PACE Medicare |
$46.84
|
| Rate for Payer: PACE SWMI |
$49.30
|
| Rate for Payer: PACE SWMI |
$49.30
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Medicaid |
$26.42
|
| Rate for Payer: PHP Medicaid |
$26.42
|
| Rate for Payer: PHP Medicare Advantage |
$49.30
|
| Rate for Payer: PHP Medicare Advantage |
$49.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.42
|
| Rate for Payer: Priority Health 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 |
$49.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.87
|
| Rate for Payer: Priority Health Medicare |
$49.30
|
| Rate for Payer: Priority Health Medicare |
$49.30
|
| Rate for Payer: Priority Health Narrow Network |
$39.90
|
| Rate for Payer: Priority Health Narrow Network |
$39.90
|
| Rate for Payer: Railroad Medicare Medicare |
$49.30
|
| Rate for Payer: Railroad Medicare Medicare |
$49.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,177.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$794.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.30
|
| Rate for Payer: UHC Exchange |
$76.42
|
| Rate for Payer: UHC Exchange |
$76.42
|
| Rate for Payer: UHC Medicare Advantage |
$49.30
|
| Rate for Payer: UHC Medicare Advantage |
$49.30
|
| Rate for Payer: UHCCP DNSP |
$49.30
|
| Rate for Payer: UHCCP DNSP |
$49.30
|
| Rate for Payer: UHCCP Medicaid |
$26.42
|
| Rate for Payer: UHCCP Medicaid |
$26.42
|
| Rate for Payer: VA VA |
$49.30
|
| Rate for Payer: VA VA |
$49.30
|
|
|
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
|
|
|
IMPACT PEPTIDE/VITAL 1.5 BOLUS FEED
|
Facility
|
OP
|
$15.72
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
150765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Medicare |
$7.86
|
| Rate for Payer: ASR ASR |
$15.25
|
| Rate for Payer: ASR Commercial |
$15.25
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: BCBS Trust/PPO |
$12.87
|
| 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: Priority Health HMO/PPO/Tiered Network |
$13.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.83
|
|
|
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
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$15.72
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Medicare |
$7.86
|
| Rate for Payer: ASR ASR |
$15.25
|
| Rate for Payer: ASR Commercial |
$15.25
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: BCBS Trust/PPO |
$12.87
|
| 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: Priority Health HMO/PPO/Tiered Network |
$13.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.83
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$15.72
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
168957
|
|
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
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CYCLIC FEED
|
Facility
|
IP
|
$15.72
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200091
|
|
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
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CYCLIC FEED
|
Facility
|
OP
|
$15.72
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Medicare |
$7.86
|
| Rate for Payer: ASR ASR |
$15.25
|
| Rate for Payer: ASR Commercial |
$15.25
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: BCBS Trust/PPO |
$12.87
|
| 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: Priority Health HMO/PPO/Tiered Network |
$13.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.83
|
|
|
IMPACT PEPTIDE/VITAL 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$15.72
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Medicare |
$7.86
|
| Rate for Payer: ASR ASR |
$15.25
|
| Rate for Payer: ASR Commercial |
$15.25
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: BCBS Trust/PPO |
$12.87
|
| 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: Priority Health HMO/PPO/Tiered Network |
$13.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.83
|
|
|
IMPACT PEPTIDE/VITAL 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$15.72
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200090
|
|
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
|
|
|
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE
|
Facility
|
OP
|
$301.75
|
|
|
Service Code
|
CPT 10060
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.11
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$186.49
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
INCLISIRAN 284 MG/1.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$8,880.51
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
198874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$8,880.51 |
| Rate for Payer: Aetna Commercial |
$7,992.46
|
| Rate for Payer: Aetna Medicare |
$12.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.35
|
| Rate for Payer: ASR ASR |
$8,614.09
|
| Rate for Payer: ASR Commercial |
$8,614.09
|
| Rate for Payer: BCBS Complete |
$6.91
|
| Rate for Payer: BCBS MAPPO |
$12.28
|
| Rate for Payer: BCBS Trust/PPO |
$7,272.25
|
| Rate for Payer: BCN Commercial |
$6,885.06
|
| Rate for Payer: BCN Medicare Advantage |
$12.28
|
| Rate for Payer: Cash Price |
$7,104.41
|
| Rate for Payer: Cash Price |
$7,104.41
|
| Rate for Payer: Cofinity Commercial |
$8,347.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,104.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.28
|
| Rate for Payer: Healthscope Commercial |
$8,880.51
|
| Rate for Payer: Healthscope Whirlpool |
$8,614.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.28
|
| Rate for Payer: Mclaren Commercial |
$7,992.46
|
| Rate for Payer: Mclaren Medicaid |
$6.58
|
| Rate for Payer: Mclaren Medicare |
$12.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.89
|
| Rate for Payer: Meridian Medicaid |
$6.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,548.43
|
| Rate for Payer: Nomi Health Commercial |
$7,282.02
|
| Rate for Payer: PACE Medicare |
$11.67
|
| Rate for Payer: PACE SWMI |
$12.28
|
| Rate for Payer: PHP Commercial |
$13.51
|
| Rate for Payer: PHP Medicaid |
$6.58
|
| Rate for Payer: PHP Medicare Advantage |
$12.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,772.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.74
|
| Rate for Payer: Priority Health Medicare |
$12.28
|
| Rate for Payer: Priority Health Narrow Network |
$10.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,814.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.28
|
| Rate for Payer: UHC Exchange |
$19.03
|
| Rate for Payer: UHC Medicare Advantage |
$12.28
|
| Rate for Payer: UHCCP DNSP |
$12.28
|
| Rate for Payer: UHCCP Medicaid |
$6.58
|
| Rate for Payer: VA VA |
$12.28
|
|
|
INCLISIRAN 284 MG/1.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$8,880.51
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
198874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,772.33 |
| Max. Negotiated Rate |
$8,880.51 |
| Rate for Payer: Aetna Commercial |
$7,992.46
|
| Rate for Payer: ASR ASR |
$8,614.09
|
| Rate for Payer: ASR Commercial |
$8,614.09
|
| Rate for Payer: BCBS Trust/PPO |
$7,236.73
|
| Rate for Payer: BCN Commercial |
$6,885.06
|
| Rate for Payer: Cash Price |
$7,104.41
|
| Rate for Payer: Cofinity Commercial |
$8,347.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,104.41
|
| Rate for Payer: Healthscope Commercial |
$8,880.51
|
| Rate for Payer: Healthscope Whirlpool |
$8,614.09
|
| Rate for Payer: Mclaren Commercial |
$7,992.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,548.43
|
| Rate for Payer: Nomi Health Commercial |
$7,282.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,772.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,814.85
|
|
|
INDAPAMIDE 2.5 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 43975030410
|
| Hospital Charge Code |
3879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.60 |
| Max. Negotiated Rate |
$350.15 |
| Rate for Payer: Aetna Commercial |
$315.14
|
| Rate for Payer: ASR ASR |
$339.65
|
| Rate for Payer: ASR Commercial |
$339.65
|
| Rate for Payer: BCBS Trust/PPO |
$285.34
|
| Rate for Payer: BCN Commercial |
$271.47
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$329.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$350.15
|
| Rate for Payer: Healthscope Whirlpool |
$339.65
|
| Rate for Payer: Mclaren Commercial |
$315.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Nomi Health Commercial |
$287.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.13
|
|
|
INDAPAMIDE 2.5 MG TABLET
|
Facility
|
OP
|
$253.80
|
|
|
Service Code
|
NDC 62559051101
|
| Hospital Charge Code |
3879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.52 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$228.42
|
| Rate for Payer: Aetna Medicare |
$126.90
|
| Rate for Payer: ASR ASR |
$246.19
|
| Rate for Payer: ASR Commercial |
$246.19
|
| Rate for Payer: BCBS Complete |
$101.52
|
| Rate for Payer: BCBS Trust/PPO |
$207.84
|
| Rate for Payer: BCN Commercial |
$196.77
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$238.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Healthscope Whirlpool |
$246.19
|
| Rate for Payer: Mclaren Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.38
|
| Rate for Payer: Priority Health Narrow Network |
$177.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.34
|
|
|
INDAPAMIDE 2.5 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 62559051101
|
| Hospital Charge Code |
3879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.97 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$228.42
|
| Rate for Payer: ASR ASR |
$246.19
|
| Rate for Payer: ASR Commercial |
$246.19
|
| Rate for Payer: BCBS Trust/PPO |
$206.82
|
| Rate for Payer: BCN Commercial |
$196.77
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$238.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Healthscope Whirlpool |
$246.19
|
| Rate for Payer: Mclaren Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.34
|
|
|
INDAPAMIDE 2.5 MG TABLET
|
Facility
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 43975030410
|
| Hospital Charge Code |
3879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.06 |
| Max. Negotiated Rate |
$350.15 |
| Rate for Payer: Aetna Commercial |
$315.14
|
| Rate for Payer: Aetna Medicare |
$175.08
|
| Rate for Payer: ASR ASR |
$339.65
|
| Rate for Payer: ASR Commercial |
$339.65
|
| Rate for Payer: BCBS Complete |
$140.06
|
| Rate for Payer: BCBS Trust/PPO |
$286.74
|
| Rate for Payer: BCN Commercial |
$271.47
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$329.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$350.15
|
| Rate for Payer: Healthscope Whirlpool |
$339.65
|
| Rate for Payer: Mclaren Commercial |
$315.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Nomi Health Commercial |
$287.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.80
|
| Rate for Payer: Priority Health Narrow Network |
$245.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.13
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 50268043011
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Medicare |
$1.20
|
| Rate for Payer: ASR ASR |
$2.33
|
| Rate for Payer: ASR Commercial |
$2.33
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: BCBS Trust/PPO |
$1.97
|
| Rate for Payer: BCN Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.92
|
| Rate for Payer: Healthscope Commercial |
$2.40
|
| Rate for Payer: Healthscope Whirlpool |
$2.33
|
| Rate for Payer: Mclaren Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.04
|
| Rate for Payer: Nomi Health Commercial |
$1.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.11
|
|
