|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$1,400.16
|
|
|
Service Code
|
NDC 00310621039
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$882.10 |
| Max. Negotiated Rate |
$1,260.14 |
| Rate for Payer: Aetna Commercial |
$1,190.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.10
|
| Rate for Payer: Cash Price |
$1,120.13
|
| Rate for Payer: Cofinity Advantage |
$980.11
|
| Rate for Payer: Cofinity Commercial |
$1,204.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.13
|
| Rate for Payer: Healthscope Commercial |
$1,260.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,050.12
|
| Rate for Payer: PHP Commercial |
$1,190.14
|
| Rate for Payer: Priority Health SBD |
$882.10
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
OP
|
$235.55
|
|
|
Service Code
|
NDC 49938010230
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$200.22
|
| Rate for Payer: Aetna Medicare |
$117.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.11
|
| Rate for Payer: BCBS Complete |
$94.22
|
| Rate for Payer: Cash Price |
$188.44
|
| Rate for Payer: Cofinity Advantage |
$164.88
|
| Rate for Payer: Cofinity Commercial |
$202.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.44
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.66
|
| Rate for Payer: PHP Commercial |
$200.22
|
| Rate for Payer: Priority Health SBD |
$148.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.11
|
| Rate for Payer: UHC Core |
$122.72
|
| Rate for Payer: UHC Exchange |
$92.57
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$235.55
|
|
|
Service Code
|
NDC 49938010230
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$200.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.11
|
| Rate for Payer: Cash Price |
$188.44
|
| Rate for Payer: Cofinity Advantage |
$164.88
|
| Rate for Payer: Cofinity Commercial |
$202.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.44
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.66
|
| Rate for Payer: PHP Commercial |
$200.22
|
| Rate for Payer: Priority Health SBD |
$148.40
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$79.78
|
|
|
Service Code
|
NDC 70954013510
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.26 |
| Max. Negotiated Rate |
$71.80 |
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.86
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cofinity Advantage |
$55.85
|
| Rate for Payer: Cofinity Commercial |
$68.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.82
|
| Rate for Payer: Healthscope Commercial |
$71.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.84
|
| Rate for Payer: PHP Commercial |
$67.81
|
| Rate for Payer: Priority Health SBD |
$50.26
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
OP
|
$79.78
|
|
|
Service Code
|
NDC 70954013510
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$71.80 |
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: Aetna Medicare |
$39.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.86
|
| Rate for Payer: BCBS Complete |
$31.91
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cofinity Advantage |
$55.85
|
| Rate for Payer: Cofinity Commercial |
$68.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.82
|
| Rate for Payer: Healthscope Commercial |
$71.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.84
|
| Rate for Payer: PHP Commercial |
$67.81
|
| Rate for Payer: Priority Health SBD |
$50.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.86
|
| Rate for Payer: UHC Core |
$41.57
|
| Rate for Payer: UHC Exchange |
$31.35
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.67 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$31.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Cash Price |
$29.48
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Advantage |
$65.18
|
| Rate for Payer: Cofinity Advantage |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$31.69
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$33.16
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.64
|
| Rate for Payer: PHP Commercial |
$31.32
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health SBD |
$23.22
|
| Rate for Payer: Priority Health SBD |
$58.67
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$93.12
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$31.32
|
| Rate for Payer: Aetna Medicare |
$18.43
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.95
|
| Rate for Payer: BCBS Complete |
$14.74
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$29.48
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$29.48
|
| Rate for Payer: Cofinity Advantage |
$65.18
|
| Rate for Payer: Cofinity Advantage |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$31.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$33.16
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.64
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$31.32
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: Priority Health SBD |
$23.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.82
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.73 |
| Max. Negotiated Rate |
$61.04 |
| Rate for Payer: Aetna Commercial |
$57.65
|
| Rate for Payer: Aetna Commercial |
$55.42
|
| Rate for Payer: Aetna Commercial |
$55.41
|
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Commercial |
$45.36
|
| Rate for Payer: Aetna Commercial |
$1,133.46
|
| Rate for Payer: Aetna Commercial |
$1,133.32
|
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Commercial |
$80.12
|
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.68
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$1,066.78
|
| Rate for Payer: Cash Price |
$38.42
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cash Price |
$42.69
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Cash Price |
$54.26
|
| Rate for Payer: Cash Price |
$55.79
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cofinity Advantage |
$45.63
|
| Rate for Payer: Cofinity Advantage |
$65.98
|
| Rate for Payer: Cofinity Advantage |
$37.35
|
| Rate for Payer: Cofinity Advantage |
$40.56
|
| Rate for Payer: Cofinity Advantage |
$48.82
|
| Rate for Payer: Cofinity Advantage |
$33.61
|
| Rate for Payer: Cofinity Advantage |
$933.44
|
| Rate for Payer: Cofinity Advantage |
$47.47
|
| Rate for Payer: Cofinity Advantage |
$933.32
|
| Rate for Payer: Cofinity Advantage |
$45.64
|
| Rate for Payer: Cofinity Commercial |
$56.07
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Cofinity Commercial |
$45.89
|
| Rate for Payer: Cofinity Commercial |
$56.06
|
| Rate for Payer: Cofinity Commercial |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$1,146.66
|
| Rate for Payer: Cofinity Commercial |
$1,146.79
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Cofinity Commercial |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$81.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.69
|
| Rate for Payer: Healthscope Commercial |
$1,199.99
|
| Rate for Payer: Healthscope Commercial |
$58.67
|
| Rate for Payer: Healthscope Commercial |
$58.68
|
| Rate for Payer: Healthscope Commercial |
$62.77
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Healthscope Commercial |
$43.22
|
| Rate for Payer: Healthscope Commercial |
$48.02
|
| Rate for Payer: Healthscope Commercial |
$84.83
|
| Rate for Payer: Healthscope Commercial |
$61.04
|
| Rate for Payer: Healthscope Commercial |
$1,200.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,000.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$999.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.69
|
| Rate for Payer: PHP Commercial |
$55.42
|
| Rate for Payer: PHP Commercial |
$40.82
|
| Rate for Payer: PHP Commercial |
$59.28
|
| Rate for Payer: PHP Commercial |
$55.41
|
| Rate for Payer: PHP Commercial |
$1,133.46
|
| Rate for Payer: PHP Commercial |
$1,133.32
|
| Rate for Payer: PHP Commercial |
$57.65
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: PHP Commercial |
$45.36
|
| Rate for Payer: PHP Commercial |
$80.12
|
| Rate for Payer: Priority Health SBD |
$840.09
|
| Rate for Payer: Priority Health SBD |
$30.25
|
| Rate for Payer: Priority Health SBD |
$33.62
|
| Rate for Payer: Priority Health SBD |
$36.50
|
| Rate for Payer: Priority Health SBD |
$43.94
|
| Rate for Payer: Priority Health SBD |
$59.38
|
| Rate for Payer: Priority Health SBD |
$41.08
|
| Rate for Payer: Priority Health SBD |
$41.07
|
| Rate for Payer: Priority Health SBD |
$839.99
|
| Rate for Payer: Priority Health SBD |
$42.73
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.94
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$52.15 |
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Commercial |
$57.65
|
| Rate for Payer: Aetna Commercial |
$1,133.46
|
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Commercial |
$80.12
|
| Rate for Payer: Aetna Commercial |
$1,133.32
|
| Rate for Payer: Aetna Commercial |
$45.36
|
| Rate for Payer: Aetna Commercial |
$55.41
|
| Rate for Payer: Aetna Commercial |
$55.42
|
| Rate for Payer: Aetna Medicare |
$47.13
|
| Rate for Payer: Aetna Medicare |
$666.74
|
| Rate for Payer: Aetna Medicare |
$666.66
|
| Rate for Payer: Aetna Medicare |
$28.97
|
| Rate for Payer: Aetna Medicare |
$33.91
|
| Rate for Payer: Aetna Medicare |
$32.59
|
| Rate for Payer: Aetna Medicare |
$32.60
|
| Rate for Payer: Aetna Medicare |
$34.87
|
| Rate for Payer: Aetna Medicare |
$24.01
|
| Rate for Payer: Aetna Medicare |
$26.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.76
|
| Rate for Payer: BCBS Complete |
$37.70
|
| Rate for Payer: BCBS Complete |
$27.90
|
| Rate for Payer: BCBS Complete |
$533.39
|
| Rate for Payer: BCBS Complete |
$533.33
|
| Rate for Payer: BCBS Complete |
$19.21
|
| Rate for Payer: BCBS Complete |
$26.08
|
| Rate for Payer: BCBS Complete |
$26.08
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS Complete |
$27.13
|
| Rate for Payer: BCBS Complete |
$21.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$42.69
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cash Price |
$55.79
|
| Rate for Payer: Cash Price |
$54.26
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cash Price |
$55.79
|
| Rate for Payer: Cash Price |
$42.69
|
| Rate for Payer: Cash Price |
$1,066.78
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cash Price |
$38.42
|
| Rate for Payer: Cash Price |
$1,066.78
|
| Rate for Payer: Cash Price |
$38.42
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Cash Price |
$54.26
|
| Rate for Payer: Cofinity Advantage |
$40.56
|
| Rate for Payer: Cofinity Advantage |
$47.47
|
| Rate for Payer: Cofinity Advantage |
$65.98
|
| Rate for Payer: Cofinity Advantage |
$37.35
|
| Rate for Payer: Cofinity Advantage |
$933.32
|
| Rate for Payer: Cofinity Advantage |
$33.61
|
| Rate for Payer: Cofinity Advantage |
$933.44
|
| Rate for Payer: Cofinity Advantage |
$45.64
|
| Rate for Payer: Cofinity Advantage |
$45.63
|
| Rate for Payer: Cofinity Advantage |
$48.82
|
| Rate for Payer: Cofinity Commercial |
$56.06
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Cofinity Commercial |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$56.07
|
| Rate for Payer: Cofinity Commercial |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$81.06
|
| Rate for Payer: Cofinity Commercial |
$1,146.66
|
| Rate for Payer: Cofinity Commercial |
$1,146.79
|
| Rate for Payer: Cofinity Commercial |
$45.89
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.66
|
| Rate for Payer: Healthscope Commercial |
$62.77
|
| Rate for Payer: Healthscope Commercial |
$1,199.99
|
| Rate for Payer: Healthscope Commercial |
$1,200.13
|
| Rate for Payer: Healthscope Commercial |
$43.22
|
| Rate for Payer: Healthscope Commercial |
$48.02
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Healthscope Commercial |
$58.67
|
| Rate for Payer: Healthscope Commercial |
$58.68
|
| Rate for Payer: Healthscope Commercial |
$61.04
|
| Rate for Payer: Healthscope Commercial |
$84.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,066.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,066.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,000.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$999.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.87
|
| Rate for Payer: PHP Commercial |
$59.28
|
| Rate for Payer: PHP Commercial |
$57.65
|
| Rate for Payer: PHP Commercial |
$40.82
|
| Rate for Payer: PHP Commercial |
$1,133.32
|
| Rate for Payer: PHP Commercial |
$80.12
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: PHP Commercial |
$45.36
|
| Rate for Payer: PHP Commercial |
$1,133.46
|
| Rate for Payer: PHP Commercial |
$55.41
|
| Rate for Payer: PHP Commercial |
$55.42
|
| Rate for Payer: Priority Health SBD |
$41.07
|
| Rate for Payer: Priority Health SBD |
$36.50
|
| Rate for Payer: Priority Health SBD |
$41.08
|
| Rate for Payer: Priority Health SBD |
$33.62
|
| Rate for Payer: Priority Health SBD |
$42.73
|
| Rate for Payer: Priority Health SBD |
$30.25
|
| Rate for Payer: Priority Health SBD |
$840.09
|
| Rate for Payer: Priority Health SBD |
$839.99
|
| Rate for Payer: Priority Health SBD |
$43.94
|
| Rate for Payer: Priority Health SBD |
$59.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN
|
Facility
|
OP
|
$47,230.34
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
193506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$42,507.31 |
| Rate for Payer: Aetna Commercial |
$40,145.79
|
| Rate for Payer: Aetna Medicare |
$57.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,699.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.79
|
| Rate for Payer: BCBS Complete |
$30.22
|
| Rate for Payer: BCBS MAPPO |
$55.03
|
| Rate for Payer: BCBS Trust/PPO |
$138.12
|
| Rate for Payer: BCN Commercial |
$138.12
|
| Rate for Payer: BCN Medicare Advantage |
$55.03
|
| Rate for Payer: Cash Price |
$37,784.27
|
| Rate for Payer: Cash Price |
$37,784.27
|
| Rate for Payer: Cofinity Advantage |
$33,061.24
|
| Rate for Payer: Cofinity Commercial |
$40,618.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37,784.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.03
|
| Rate for Payer: Healthscope Commercial |
$42,507.31
|
| Rate for Payer: Mclaren Medicaid |
$28.78
|
| Rate for Payer: Mclaren Medicare |
$55.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.78
|
| Rate for Payer: Meridian Medicaid |
$57.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,145.79
|
| Rate for Payer: Nomi Health Commercial |
$165.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35,422.75
|
| Rate for Payer: PACE Medicare |
$52.28
|
| Rate for Payer: PACE SWMI |
$55.03
|
| Rate for Payer: PHP Commercial |
$40,145.79
|
| Rate for Payer: PHP Medicare Advantage |
$55.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$175.27
|
| Rate for Payer: Priority Health Medicare |
$55.03
|
| Rate for Payer: Priority Health SBD |
$29,755.11
|
| Rate for Payer: Priority Health Tiered Network |
$140.22
|
| Rate for Payer: Railroad Medicare Medicare |
$55.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.85
|
| Rate for Payer: UHC Core |
$90.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$55.03
|
| Rate for Payer: UHC Exchange |
$90.85
|
| Rate for Payer: UHC Medicaid |
$28.78
|
| Rate for Payer: UHCCP Medicaid |
$28.78
|
| Rate for Payer: VA VA |
$55.03
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,647.38
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
176546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,817.85 |
| Max. Negotiated Rate |
$6,882.64 |
| Rate for Payer: Aetna Commercial |
$6,500.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,970.80
|
| Rate for Payer: Cash Price |
$6,117.90
|
| Rate for Payer: Cofinity Advantage |
$5,353.17
|
| Rate for Payer: Cofinity Commercial |
$6,576.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,117.90
|
| Rate for Payer: Healthscope Commercial |
$6,882.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,500.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,735.53
|
| Rate for Payer: PHP Commercial |
$6,500.27
|
| Rate for Payer: Priority Health SBD |
$4,817.85
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,647.38
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
176546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$6,882.64 |
| Rate for Payer: Aetna Commercial |
$6,500.27
|
| Rate for Payer: Aetna Commercial |
$2,109.72
|
| Rate for Payer: Aetna Medicare |
$73.60
|
| Rate for Payer: Aetna Medicare |
$73.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,613.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,970.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.46
|
| Rate for Payer: BCBS Complete |
$38.87
|
| Rate for Payer: BCBS Complete |
$38.87
|
| Rate for Payer: BCBS MAPPO |
$70.77
|
| Rate for Payer: BCBS MAPPO |
$70.77
|
| Rate for Payer: BCBS Trust/PPO |
$177.59
|
| Rate for Payer: BCBS Trust/PPO |
$177.59
|
| Rate for Payer: BCN Commercial |
$177.59
|
| Rate for Payer: BCN Commercial |
$177.59
|
| Rate for Payer: BCN Medicare Advantage |
$70.77
|
| Rate for Payer: BCN Medicare Advantage |
$70.77
|
| Rate for Payer: Cash Price |
$1,985.62
|
| Rate for Payer: Cash Price |
$6,117.90
|
| Rate for Payer: Cash Price |
$1,985.62
|
| Rate for Payer: Cash Price |
$6,117.90
|
| Rate for Payer: Cofinity Advantage |
$5,353.17
|
| Rate for Payer: Cofinity Advantage |
$1,737.41
|
| Rate for Payer: Cofinity Commercial |
$6,576.75
|
| Rate for Payer: Cofinity Commercial |
$2,134.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,117.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,985.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.77
|
| Rate for Payer: Healthscope Commercial |
$2,233.82
|
| Rate for Payer: Healthscope Commercial |
$6,882.64
|
| Rate for Payer: Mclaren Medicaid |
$37.01
|
| Rate for Payer: Mclaren Medicaid |
$37.01
|
| Rate for Payer: Mclaren Medicare |
$70.77
|
| Rate for Payer: Mclaren Medicare |
$70.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.31
|
| Rate for Payer: Meridian Medicaid |
$74.31
|
| Rate for Payer: Meridian Medicaid |
$74.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,500.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,109.72
|
| Rate for Payer: Nomi Health Commercial |
$212.31
|
| Rate for Payer: Nomi Health Commercial |
$212.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,861.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,735.53
|
| Rate for Payer: PACE Medicare |
$67.23
|
| Rate for Payer: PACE Medicare |
$67.23
|
| Rate for Payer: PACE SWMI |
$70.77
|
| Rate for Payer: PACE SWMI |
$70.77
|
| Rate for Payer: PHP Commercial |
$2,109.72
|
| Rate for Payer: PHP Commercial |
$6,500.27
|
| Rate for Payer: PHP Medicare Advantage |
$70.77
|
| Rate for Payer: PHP Medicare Advantage |
$70.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$225.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$225.09
|
| Rate for Payer: Priority Health Medicare |
$70.77
|
| Rate for Payer: Priority Health Medicare |
$70.77
|
| Rate for Payer: Priority Health SBD |
$4,817.85
|
| Rate for Payer: Priority Health SBD |
$1,563.67
|
| Rate for Payer: Priority Health Tiered Network |
$180.07
|
| Rate for Payer: Priority Health Tiered Network |
$180.07
|
| Rate for Payer: Railroad Medicare Medicare |
$70.77
|
| Rate for Payer: Railroad Medicare Medicare |
$70.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.80
|
| Rate for Payer: UHC Core |
$116.80
|
| Rate for Payer: UHC Core |
$116.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.77
|
| Rate for Payer: UHC Exchange |
$116.80
|
| Rate for Payer: UHC Exchange |
$116.80
|
| Rate for Payer: UHC Medicaid |
$37.01
|
| Rate for Payer: UHC Medicaid |
$37.01
|
| Rate for Payer: UHCCP Medicaid |
$37.01
|
| Rate for Payer: UHCCP Medicaid |
$37.01
|
| Rate for Payer: VA VA |
$70.77
|
| Rate for Payer: VA VA |
$70.77
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$7.44
|
| Rate for Payer: BCN Commercial |
$7.44
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Advantage |
$1,688.73
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Mclaren Medicaid |
$1.61
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.60
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.35
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,519.86 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Advantage |
$1,688.73
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.35
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
|
|
DARBEPOETIN ALFA 10 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$267.64
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
161505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.61 |
| Max. Negotiated Rate |
$240.88 |
| Rate for Payer: Aetna Commercial |
$227.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.97
|
| Rate for Payer: Cash Price |
$214.11
|
| Rate for Payer: Cofinity Advantage |
$187.35
|
| Rate for Payer: Cofinity Commercial |
$230.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.11
|
| Rate for Payer: Healthscope Commercial |
$240.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.73
|
| Rate for Payer: PHP Commercial |
$227.49
|
| Rate for Payer: Priority Health SBD |
$168.61
|
|
|
DARBEPOETIN ALFA 10 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$267.64
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
161505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$240.88 |
| Rate for Payer: Aetna Commercial |
$227.49
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$7.44
|
| Rate for Payer: BCN Commercial |
$7.44
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$214.11
|
| Rate for Payer: Cash Price |
$214.11
|
| Rate for Payer: Cofinity Advantage |
$187.35
|
| Rate for Payer: Cofinity Commercial |
$230.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$240.88
|
| Rate for Payer: Mclaren Medicaid |
$1.61
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.49
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.73
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$227.49
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$168.61
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$3,618.71
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,279.79 |
| Max. Negotiated Rate |
$3,256.84 |
| Rate for Payer: Aetna Commercial |
$3,075.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,352.16
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cofinity Advantage |
$2,533.10
|
| Rate for Payer: Cofinity Commercial |
$3,112.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,894.97
|
| Rate for Payer: Healthscope Commercial |
$3,256.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,714.03
|
| Rate for Payer: PHP Commercial |
$3,075.90
|
| Rate for Payer: Priority Health SBD |
$2,279.79
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$3,618.71
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3,256.84 |
| Rate for Payer: Aetna Commercial |
$3,075.90
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,352.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$7.44
|
| Rate for Payer: BCN Commercial |
$7.44
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cofinity Advantage |
$2,533.10
|
| Rate for Payer: Cofinity Commercial |
$3,112.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,894.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$3,256.84
|
| Rate for Payer: Mclaren Medicaid |
$1.61
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.90
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,714.03
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$3,075.90
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$2,279.79
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$4,824.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,039.71 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.20
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cofinity Advantage |
$3,377.45
|
| Rate for Payer: Cofinity Commercial |
$4,149.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,859.94
|
| Rate for Payer: Healthscope Commercial |
$4,342.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,101.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,618.70
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: Priority Health SBD |
$3,039.71
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$4,824.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$7.44
|
| Rate for Payer: BCN Commercial |
$7.44
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cofinity Advantage |
$3,377.45
|
| Rate for Payer: Cofinity Commercial |
$4,149.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,859.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$4,342.44
|
| Rate for Payer: Mclaren Medicaid |
$1.61
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,101.19
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,618.70
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$3,039.71
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$7.44
|
| Rate for Payer: BCN Commercial |
$7.44
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Advantage |
$468.36
|
| Rate for Payer: Cofinity Commercial |
$575.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Mclaren Medicaid |
$1.61
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.73
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.82
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$421.53
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$421.53 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Advantage |
$468.36
|
| Rate for Payer: Cofinity Commercial |
$575.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.27
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.82
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: Priority Health SBD |
$421.53
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,822.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$7.44
|
| Rate for Payer: BCN Commercial |
$7.44
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cofinity Advantage |
$4,116.28
|
| Rate for Payer: Cofinity Commercial |
$5,057.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,704.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$5,292.36
|
| Rate for Payer: Mclaren Medicaid |
$1.61
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,998.34
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,410.30
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$3,704.65
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,704.65 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,822.26
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cofinity Advantage |
$4,116.28
|
| Rate for Payer: Cofinity Commercial |
$5,057.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,704.32
|
| Rate for Payer: Healthscope Commercial |
$5,292.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,998.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,410.30
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: Priority Health SBD |
$3,704.65
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$964.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$7.44
|
| Rate for Payer: BCN Commercial |
$7.44
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cofinity Advantage |
$675.49
|
| Rate for Payer: Cofinity Commercial |
$829.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Mclaren Medicaid |
$1.61
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.24
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.74
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$607.94
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
