|
EPISTAXIS WITHOUT MCC
|
Facility
|
IP
|
$14,896.85
|
|
|
Service Code
|
MSDRG 151
|
| Min. Negotiated Rate |
$5,938.94 |
| Max. Negotiated Rate |
$14,896.85 |
| Rate for Payer: Aetna Medicare |
$6,501.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,814.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,814.40
|
| Rate for Payer: BCBS MAPPO |
$6,251.52
|
| Rate for Payer: BCBS Trust/PPO |
$14,896.85
|
| Rate for Payer: BCN Commercial |
$14,896.85
|
| Rate for Payer: BCN Medicare Advantage |
$6,251.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,251.52
|
| Rate for Payer: Mclaren Medicare |
$6,251.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,564.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,189.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,876.67
|
| Rate for Payer: Nomi Health Commercial |
$9,468.60
|
| Rate for Payer: PACE Medicare |
$5,938.94
|
| Rate for Payer: PACE SWMI |
$6,251.52
|
| Rate for Payer: PHP Medicare Advantage |
$6,251.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,833.65
|
| Rate for Payer: Priority Health Medicare |
$6,251.52
|
| Rate for Payer: Priority Health Tiered Network |
$9,466.92
|
| Rate for Payer: Railroad Medicare Medicare |
$6,251.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,964.20
|
| Rate for Payer: UHC Core |
$10,009.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,251.52
|
| Rate for Payer: UHC Exchange |
$8,174.56
|
| Rate for Payer: VA VA |
$6,251.52
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
OP
|
$98.64
|
|
|
Service Code
|
NDC 31722004930
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$88.78 |
| Rate for Payer: Aetna Commercial |
$83.84
|
| Rate for Payer: Aetna Medicare |
$49.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.12
|
| Rate for Payer: BCBS Complete |
$39.46
|
| Rate for Payer: Cash Price |
$78.91
|
| Rate for Payer: Cofinity Advantage |
$69.05
|
| Rate for Payer: Cofinity Commercial |
$84.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.91
|
| Rate for Payer: Healthscope Commercial |
$88.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.98
|
| Rate for Payer: PHP Commercial |
$83.84
|
| Rate for Payer: Priority Health SBD |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.12
|
| Rate for Payer: UHC Core |
$51.39
|
| Rate for Payer: UHC Exchange |
$38.77
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
IP
|
$98.64
|
|
|
Service Code
|
NDC 31722004930
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$88.78 |
| Rate for Payer: Aetna Commercial |
$83.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.12
|
| Rate for Payer: Cash Price |
$78.91
|
| Rate for Payer: Cofinity Advantage |
$69.05
|
| Rate for Payer: Cofinity Commercial |
$84.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.91
|
| Rate for Payer: Healthscope Commercial |
$88.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.98
|
| Rate for Payer: PHP Commercial |
$83.84
|
| Rate for Payer: Priority Health SBD |
$62.14
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
OP
|
$274.32
|
|
|
Service Code
|
NDC 31722004990
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.81 |
| Max. Negotiated Rate |
$246.89 |
| Rate for Payer: Aetna Commercial |
$233.17
|
| Rate for Payer: Aetna Medicare |
$137.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.31
|
| Rate for Payer: BCBS Complete |
$109.73
|
| Rate for Payer: Cash Price |
$219.46
|
| Rate for Payer: Cofinity Advantage |
$192.02
|
| Rate for Payer: Cofinity Commercial |
$235.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.46
|
| Rate for Payer: Healthscope Commercial |
$246.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.74
|
| Rate for Payer: PHP Commercial |
$233.17
|
| Rate for Payer: Priority Health SBD |
$172.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.31
|
| Rate for Payer: UHC Core |
$142.92
|
| Rate for Payer: UHC Exchange |
$107.81
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
IP
|
$274.32
|
|
|
Service Code
|
NDC 31722004990
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.82 |
| Max. Negotiated Rate |
$246.89 |
| Rate for Payer: Aetna Commercial |
$233.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.31
|
| Rate for Payer: Cash Price |
$219.46
|
| Rate for Payer: Cofinity Advantage |
$192.02
|
| Rate for Payer: Cofinity Commercial |
$235.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.46
|
| Rate for Payer: Healthscope Commercial |
$246.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.74
|
| Rate for Payer: PHP Commercial |
$233.17
|
| Rate for Payer: Priority Health SBD |
$172.82
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$499.51
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$449.56 |
| Rate for Payer: Aetna Commercial |
$424.58
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$19.06
|
| Rate for Payer: BCN Commercial |
$19.06
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$399.61
|
| Rate for Payer: Cash Price |
$399.61
|
| Rate for Payer: Cofinity Advantage |
$349.66
|
| Rate for Payer: Cofinity Commercial |
$429.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$449.56
|
| Rate for Payer: Mclaren Medicaid |
$3.82
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.58
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$374.63
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$424.58
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.96
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health SBD |
$314.69
|
| Rate for Payer: Priority Health Tiered Network |
$21.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC Core |
$12.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$12.77
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: VA VA |
$7.31
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$499.51
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$314.69 |
| Max. Negotiated Rate |
$449.56 |
| Rate for Payer: Aetna Commercial |
$424.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.68
|
| Rate for Payer: Cash Price |
$399.61
|
| Rate for Payer: Cofinity Advantage |
$349.66
|
| Rate for Payer: Cofinity Commercial |
$429.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.61
|
| Rate for Payer: Healthscope Commercial |
$449.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$374.63
|
| Rate for Payer: PHP Commercial |
$424.58
|
| Rate for Payer: Priority Health SBD |
$314.69
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,650.97
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
115705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,040.11 |
| Max. Negotiated Rate |
$1,485.87 |
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,073.13
|
| Rate for Payer: Cash Price |
$1,320.78
|
| Rate for Payer: Cofinity Advantage |
$1,155.68
|
| Rate for Payer: Cofinity Commercial |
$1,419.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.78
|
| Rate for Payer: Healthscope Commercial |
$1,485.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,403.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,238.23
|
| Rate for Payer: PHP Commercial |
$1,403.32
|
| Rate for Payer: Priority Health SBD |
$1,040.11
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,650.97
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
115705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$1,485.87 |
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,073.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$19.06
|
| Rate for Payer: BCN Commercial |
$19.06
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$1,320.78
|
| Rate for Payer: Cash Price |
$1,320.78
|
| Rate for Payer: Cofinity Advantage |
$1,155.68
|
| Rate for Payer: Cofinity Commercial |
$1,419.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$1,485.87
|
| Rate for Payer: Mclaren Medicaid |
$3.82
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,403.32
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,238.23
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$1,403.32
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.96
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health SBD |
$1,040.11
|
| Rate for Payer: Priority Health Tiered Network |
$21.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC Core |
$12.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$12.77
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: VA VA |
$7.31
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$999.03
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
14643
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$629.39 |
| Max. Negotiated Rate |
$899.13 |
| Rate for Payer: Aetna Commercial |
$849.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.37
|
| Rate for Payer: Cash Price |
$799.22
|
| Rate for Payer: Cofinity Advantage |
$699.32
|
| Rate for Payer: Cofinity Commercial |
$859.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.22
|
| Rate for Payer: Healthscope Commercial |
$899.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$849.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$749.27
|
| Rate for Payer: PHP Commercial |
$849.18
|
| Rate for Payer: Priority Health SBD |
$629.39
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$999.03
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
14643
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$899.13 |
| Rate for Payer: Aetna Commercial |
$849.18
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$19.06
|
| Rate for Payer: BCN Commercial |
$19.06
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$799.22
|
| Rate for Payer: Cash Price |
$799.22
|
| Rate for Payer: Cofinity Advantage |
$699.32
|
| Rate for Payer: Cofinity Commercial |
$859.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$899.13
|
| Rate for Payer: Mclaren Medicaid |
$3.82
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$849.18
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$749.27
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$849.18
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.96
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health SBD |
$629.39
|
| Rate for Payer: Priority Health Tiered Network |
$21.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC Core |
$12.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$12.77
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: VA VA |
$7.31
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$183.19
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$164.87 |
| Rate for Payer: Aetna Commercial |
$155.71
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$19.06
|
| Rate for Payer: BCN Commercial |
$19.06
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$146.55
|
| Rate for Payer: Cash Price |
$146.55
|
| Rate for Payer: Cofinity Advantage |
$128.23
|
| Rate for Payer: Cofinity Commercial |
$157.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$164.87
|
| Rate for Payer: Mclaren Medicaid |
$3.82
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.71
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.39
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$155.71
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.96
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health SBD |
$115.41
|
| Rate for Payer: Priority Health Tiered Network |
$21.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC Core |
$12.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$12.77
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: VA VA |
$7.31
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$183.19
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.41 |
| Max. Negotiated Rate |
$164.87 |
| Rate for Payer: Aetna Commercial |
$155.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.07
|
| Rate for Payer: Cash Price |
$146.55
|
| Rate for Payer: Cofinity Advantage |
$128.23
|
| Rate for Payer: Cofinity Commercial |
$157.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.55
|
| Rate for Payer: Healthscope Commercial |
$164.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.39
|
| Rate for Payer: PHP Commercial |
$155.71
|
| Rate for Payer: Priority Health SBD |
$115.41
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,801.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
24513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,134.66 |
| Max. Negotiated Rate |
$1,620.94 |
| Rate for Payer: Aetna Commercial |
$1,530.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.68
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cofinity Advantage |
$1,260.73
|
| Rate for Payer: Cofinity Commercial |
$1,548.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,440.84
|
| Rate for Payer: Healthscope Commercial |
$1,620.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,530.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.79
|
| Rate for Payer: PHP Commercial |
$1,530.89
|
| Rate for Payer: Priority Health SBD |
$1,134.66
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,801.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
24513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$1,620.94 |
| Rate for Payer: Aetna Commercial |
$1,530.89
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$19.06
|
| Rate for Payer: BCN Commercial |
$19.06
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cofinity Advantage |
$1,260.73
|
| Rate for Payer: Cofinity Commercial |
$1,548.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,440.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$1,620.94
|
| Rate for Payer: Mclaren Medicaid |
$3.82
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,530.89
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.79
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$1,530.89
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.96
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health SBD |
$1,134.66
|
| Rate for Payer: Priority Health Tiered Network |
$21.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC Core |
$12.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$12.77
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: VA VA |
$7.31
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$366.32
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.78 |
| Max. Negotiated Rate |
$329.69 |
| Rate for Payer: Aetna Commercial |
$311.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.11
|
| Rate for Payer: Cash Price |
$293.06
|
| Rate for Payer: Cofinity Advantage |
$256.42
|
| Rate for Payer: Cofinity Commercial |
$315.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.06
|
| Rate for Payer: Healthscope Commercial |
$329.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.74
|
| Rate for Payer: PHP Commercial |
$311.37
|
| Rate for Payer: Priority Health SBD |
$230.78
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$366.32
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$329.69 |
| Rate for Payer: Aetna Commercial |
$311.37
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$19.06
|
| Rate for Payer: BCN Commercial |
$19.06
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$293.06
|
| Rate for Payer: Cash Price |
$293.06
|
| Rate for Payer: Cofinity Advantage |
$256.42
|
| Rate for Payer: Cofinity Commercial |
$315.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$329.69
|
| Rate for Payer: Mclaren Medicaid |
$3.82
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.37
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.74
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$311.37
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.96
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health SBD |
$230.78
|
| Rate for Payer: Priority Health Tiered Network |
$21.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC Core |
$12.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$12.77
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: VA VA |
$7.31
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$333.28
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$299.95 |
| Rate for Payer: Aetna Commercial |
$283.29
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.22
|
| Rate for Payer: BCN Commercial |
$18.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$266.62
|
| Rate for Payer: Cash Price |
$266.62
|
| Rate for Payer: Cofinity Advantage |
$233.30
|
| Rate for Payer: Cofinity Commercial |
$286.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$299.95
|
| Rate for Payer: Mclaren Medicaid |
$4.12
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.29
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.96
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$283.29
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.77
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$209.97
|
| Rate for Payer: Priority Health Tiered Network |
$19.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.49
|
| Rate for Payer: UHC Core |
$12.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.88
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$333.28
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$209.97 |
| Max. Negotiated Rate |
$299.95 |
| Rate for Payer: Aetna Commercial |
$283.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.63
|
| Rate for Payer: Cash Price |
$266.62
|
| Rate for Payer: Cofinity Advantage |
$233.30
|
| Rate for Payer: Cofinity Commercial |
$286.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.62
|
| Rate for Payer: Healthscope Commercial |
$299.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.96
|
| Rate for Payer: PHP Commercial |
$283.29
|
| Rate for Payer: Priority Health SBD |
$209.97
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$666.56
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
195677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$599.90 |
| Rate for Payer: Aetna Commercial |
$566.58
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.22
|
| Rate for Payer: BCN Commercial |
$18.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$533.25
|
| Rate for Payer: Cash Price |
$533.25
|
| Rate for Payer: Cofinity Advantage |
$466.59
|
| Rate for Payer: Cofinity Commercial |
$573.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$599.90
|
| Rate for Payer: Mclaren Medicaid |
$4.12
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.58
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$499.92
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$566.58
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.77
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$419.93
|
| Rate for Payer: Priority Health Tiered Network |
$19.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.49
|
| Rate for Payer: UHC Core |
$12.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.88
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$666.56
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
195677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$419.93 |
| Max. Negotiated Rate |
$599.90 |
| Rate for Payer: Aetna Commercial |
$566.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.26
|
| Rate for Payer: Cash Price |
$533.25
|
| Rate for Payer: Cofinity Advantage |
$466.59
|
| Rate for Payer: Cofinity Commercial |
$573.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.25
|
| Rate for Payer: Healthscope Commercial |
$599.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$499.92
|
| Rate for Payer: PHP Commercial |
$566.58
|
| Rate for Payer: Priority Health SBD |
$419.93
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$83.56
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$75.20 |
| Rate for Payer: Aetna Commercial |
$71.03
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.22
|
| Rate for Payer: BCN Commercial |
$18.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$66.85
|
| Rate for Payer: Cash Price |
$66.85
|
| Rate for Payer: Cofinity Advantage |
$58.49
|
| Rate for Payer: Cofinity Commercial |
$71.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$75.20
|
| Rate for Payer: Mclaren Medicaid |
$4.12
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.03
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.67
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$71.03
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.77
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$52.64
|
| Rate for Payer: Priority Health Tiered Network |
$19.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.49
|
| Rate for Payer: UHC Core |
$12.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.88
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$83.56
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.64 |
| Max. Negotiated Rate |
$75.20 |
| Rate for Payer: Aetna Commercial |
$71.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.31
|
| Rate for Payer: Cash Price |
$66.85
|
| Rate for Payer: Cofinity Advantage |
$58.49
|
| Rate for Payer: Cofinity Commercial |
$71.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.85
|
| Rate for Payer: Healthscope Commercial |
$75.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.67
|
| Rate for Payer: PHP Commercial |
$71.03
|
| Rate for Payer: Priority Health SBD |
$52.64
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$125.33
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Aetna Commercial |
$106.53
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.22
|
| Rate for Payer: BCN Commercial |
$18.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$100.26
|
| Rate for Payer: Cash Price |
$100.26
|
| Rate for Payer: Cofinity Advantage |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$107.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$112.80
|
| Rate for Payer: Mclaren Medicaid |
$4.12
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.53
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.00
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$106.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.77
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$78.96
|
| Rate for Payer: Priority Health Tiered Network |
$19.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.49
|
| Rate for Payer: UHC Core |
$12.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.88
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$125.33
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.96 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Aetna Commercial |
$106.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.46
|
| Rate for Payer: Cash Price |
$100.26
|
| Rate for Payer: Cofinity Advantage |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$107.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.26
|
| Rate for Payer: Healthscope Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.00
|
| Rate for Payer: PHP Commercial |
$106.53
|
| Rate for Payer: Priority Health SBD |
$78.96
|
|
