|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
OP
|
$62.31
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$56.08 |
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna Medicare |
$31.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.50
|
| Rate for Payer: BCBS Complete |
$24.92
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$49.85
|
| Rate for Payer: Cash Price |
$49.85
|
| Rate for Payer: Cofinity Commercial |
$43.62
|
| Rate for Payer: Cofinity Commercial |
$53.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.85
|
| Rate for Payer: Healthscope Commercial |
$56.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.96
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.50
|
| Rate for Payer: Priority Health SBD |
$39.26
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.69
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$22.43
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$22.43
|
|
|
EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR
|
Facility
|
IP
|
$516.99
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
29031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$325.70 |
| Max. Negotiated Rate |
$465.29 |
| Rate for Payer: Aetna Commercial |
$439.44
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna Commercial |
$878.88
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$827.18
|
| Rate for Payer: Cash Price |
$413.59
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cofinity Commercial |
$723.79
|
| Rate for Payer: Cofinity Commercial |
$889.22
|
| Rate for Payer: Cofinity Commercial |
$444.61
|
| Rate for Payer: Cofinity Commercial |
$329.33
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$361.89
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Commercial |
$658.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$658.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$361.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$723.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$827.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Healthscope Commercial |
$465.29
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: Healthscope Commercial |
$930.58
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$878.88
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: PHP Commercial |
$439.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$672.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.04
|
| Rate for Payer: Priority Health SBD |
$651.41
|
| Rate for Payer: Priority Health SBD |
$325.70
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$592.79
|
|
|
EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR
|
Facility
|
OP
|
$940.93
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
29031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$846.84 |
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna Commercial |
$878.88
|
| Rate for Payer: Aetna Commercial |
$439.44
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna Medicare |
$258.50
|
| Rate for Payer: Aetna Medicare |
$516.99
|
| Rate for Payer: Aetna Medicare |
$470.46
|
| Rate for Payer: Aetna Medicare |
$235.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: BCBS Complete |
$376.37
|
| Rate for Payer: BCBS Complete |
$188.19
|
| Rate for Payer: BCBS Complete |
$413.59
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$827.18
|
| Rate for Payer: Cash Price |
$413.59
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$413.59
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$827.18
|
| Rate for Payer: Cofinity Commercial |
$329.33
|
| Rate for Payer: Cofinity Commercial |
$723.79
|
| Rate for Payer: Cofinity Commercial |
$889.22
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$361.89
|
| Rate for Payer: Cofinity Commercial |
$444.61
|
| Rate for Payer: Cofinity Commercial |
$658.65
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$658.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$723.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$361.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$827.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Healthscope Commercial |
$465.29
|
| Rate for Payer: Healthscope Commercial |
$930.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.79
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$439.44
|
| Rate for Payer: PHP Commercial |
$878.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$672.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.81
|
| Rate for Payer: Priority Health SBD |
$592.79
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$651.41
|
| Rate for Payer: Priority Health SBD |
$325.70
|
|
|
EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 59300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.22 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$69.22
|
| Rate for Payer: BCN Commercial |
$69.22
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.73
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,753.88
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
IP
|
$103.83
|
|
|
Service Code
|
NDC 31722004930
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.41 |
| Max. Negotiated Rate |
$93.45 |
| Rate for Payer: Aetna Commercial |
$88.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.49
|
| Rate for Payer: Cash Price |
$83.06
|
| Rate for Payer: Cofinity Commercial |
$72.68
|
| Rate for Payer: Cofinity Commercial |
$89.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.06
|
| Rate for Payer: Healthscope Commercial |
$93.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.26
|
| Rate for Payer: PHP Commercial |
$88.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.49
|
| Rate for Payer: Priority Health SBD |
$65.41
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
OP
|
$103.83
|
|
|
Service Code
|
NDC 31722004930
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.53 |
| Max. Negotiated Rate |
$93.45 |
| Rate for Payer: Aetna Commercial |
$88.26
|
| Rate for Payer: Aetna Medicare |
$51.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.49
|
| Rate for Payer: BCBS Complete |
$41.53
|
| Rate for Payer: Cash Price |
$83.06
|
| Rate for Payer: Cofinity Commercial |
$72.68
|
| Rate for Payer: Cofinity Commercial |
$89.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.06
|
| Rate for Payer: Healthscope Commercial |
$93.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.26
|
| Rate for Payer: PHP Commercial |
$88.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.49
|
| Rate for Payer: Priority Health SBD |
$65.41
|
|
|
EPLERENONE 50 MG TABLET
|
Facility
|
OP
|
$164.45
|
|
|
Service Code
|
NDC 00378103193
|
| Hospital Charge Code |
36984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.78 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna Commercial |
$139.78
|
| Rate for Payer: Aetna Medicare |
$82.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.89
|
| Rate for Payer: BCBS Complete |
$65.78
|
| Rate for Payer: Cash Price |
$131.56
|
| Rate for Payer: Cofinity Commercial |
$115.12
|
| Rate for Payer: Cofinity Commercial |
$141.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.56
|
| Rate for Payer: Healthscope Commercial |
$148.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.78
|
| Rate for Payer: PHP Commercial |
$139.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.89
|
| Rate for Payer: Priority Health SBD |
$103.60
|
|
|
EPLERENONE 50 MG TABLET
|
Facility
|
IP
|
$164.45
|
|
|
Service Code
|
NDC 00378103193
|
| Hospital Charge Code |
36984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna Commercial |
$139.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.89
|
| Rate for Payer: Cash Price |
$131.56
|
| Rate for Payer: Cofinity Commercial |
$141.43
|
| Rate for Payer: Cofinity Commercial |
$115.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.56
|
| Rate for Payer: Healthscope Commercial |
$148.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.78
|
| Rate for Payer: PHP Commercial |
$139.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.89
|
| Rate for Payer: Priority Health SBD |
$103.60
|
|
|
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 Commercial |
$349.66
|
| Rate for Payer: Cofinity Commercial |
$429.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.66
|
| 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: PHP Commercial |
$424.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.68
|
| Rate for Payer: Priority Health SBD |
$314.69
|
|
|
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 |
$3.46 |
| Max. Negotiated Rate |
$449.56 |
| Rate for Payer: Aetna Commercial |
$424.58
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.08
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$20.85
|
| Rate for Payer: BCN Commercial |
$20.85
|
| Rate for Payer: BCN Medicare Advantage |
$6.46
|
| Rate for Payer: Cash Price |
$399.61
|
| Rate for Payer: Cash Price |
$399.61
|
| Rate for Payer: Cofinity Commercial |
$349.66
|
| Rate for Payer: Cofinity Commercial |
$429.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$449.56
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Mclaren Medicare |
$6.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.78
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.58
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| Rate for Payer: PACE Medicare |
$6.14
|
| Rate for Payer: PACE SWMI |
$6.46
|
| Rate for Payer: PHP Commercial |
$424.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.66
|
| Rate for Payer: Priority Health Medicare |
$6.46
|
| Rate for Payer: Priority Health Narrow Network |
$17.33
|
| Rate for Payer: Priority Health SBD |
$314.69
|
| Rate for Payer: Railroad Medicare Medicare |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.46
|
| Rate for Payer: UHC Medicare Advantage |
$6.46
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.46
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,634.30
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
115705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,029.61 |
| Max. Negotiated Rate |
$1,470.87 |
| Rate for Payer: Aetna Commercial |
$1,389.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,062.30
|
| Rate for Payer: Cash Price |
$1,307.44
|
| Rate for Payer: Cofinity Commercial |
$1,144.01
|
| Rate for Payer: Cofinity Commercial |
$1,405.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,144.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,307.44
|
| Rate for Payer: Healthscope Commercial |
$1,470.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,389.16
|
| Rate for Payer: PHP Commercial |
$1,389.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,062.30
|
| Rate for Payer: Priority Health SBD |
$1,029.61
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,634.30
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
115705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$1,470.87 |
| Rate for Payer: Aetna Commercial |
$1,389.16
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,062.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.08
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$20.85
|
| Rate for Payer: BCN Commercial |
$20.85
|
| Rate for Payer: BCN Medicare Advantage |
$6.46
|
| Rate for Payer: Cash Price |
$1,307.44
|
| Rate for Payer: Cash Price |
$1,307.44
|
| Rate for Payer: Cofinity Commercial |
$1,405.50
|
| Rate for Payer: Cofinity Commercial |
$1,144.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,144.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,307.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$1,470.87
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Mclaren Medicare |
$6.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.78
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,389.16
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| Rate for Payer: PACE Medicare |
$6.14
|
| Rate for Payer: PACE SWMI |
$6.46
|
| Rate for Payer: PHP Commercial |
$1,389.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,062.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.66
|
| Rate for Payer: Priority Health Medicare |
$6.46
|
| Rate for Payer: Priority Health Narrow Network |
$17.33
|
| Rate for Payer: Priority Health SBD |
$1,029.61
|
| Rate for Payer: Railroad Medicare Medicare |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.46
|
| Rate for Payer: UHC Medicare Advantage |
$6.46
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.46
|
|
|
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 Commercial |
$699.32
|
| Rate for Payer: Cofinity Commercial |
$859.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$699.32
|
| 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: PHP Commercial |
$849.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.37
|
| 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 |
$3.46 |
| Max. Negotiated Rate |
$899.13 |
| Rate for Payer: Aetna Commercial |
$849.18
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.08
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$20.85
|
| Rate for Payer: BCN Commercial |
$20.85
|
| Rate for Payer: BCN Medicare Advantage |
$6.46
|
| Rate for Payer: Cash Price |
$799.22
|
| Rate for Payer: Cash Price |
$799.22
|
| Rate for Payer: Cofinity Commercial |
$859.17
|
| Rate for Payer: Cofinity Commercial |
$699.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$699.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$899.13
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Mclaren Medicare |
$6.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.78
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$849.18
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| Rate for Payer: PACE Medicare |
$6.14
|
| Rate for Payer: PACE SWMI |
$6.46
|
| Rate for Payer: PHP Commercial |
$849.18
|
| Rate for Payer: PHP Medicare Advantage |
$6.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.66
|
| Rate for Payer: Priority Health Medicare |
$6.46
|
| Rate for Payer: Priority Health Narrow Network |
$17.33
|
| Rate for Payer: Priority Health SBD |
$629.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.46
|
| Rate for Payer: UHC Medicare Advantage |
$6.46
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.46
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$181.34
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$163.21 |
| Rate for Payer: Aetna Commercial |
$154.14
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.08
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$20.85
|
| Rate for Payer: BCN Commercial |
$20.85
|
| Rate for Payer: BCN Medicare Advantage |
$6.46
|
| Rate for Payer: Cash Price |
$145.07
|
| Rate for Payer: Cash Price |
$145.07
|
| Rate for Payer: Cofinity Commercial |
$155.95
|
| Rate for Payer: Cofinity Commercial |
$126.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$163.21
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Mclaren Medicare |
$6.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.78
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.14
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| Rate for Payer: PACE Medicare |
$6.14
|
| Rate for Payer: PACE SWMI |
$6.46
|
| Rate for Payer: PHP Commercial |
$154.14
|
| Rate for Payer: PHP Medicare Advantage |
$6.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.66
|
| Rate for Payer: Priority Health Medicare |
$6.46
|
| Rate for Payer: Priority Health Narrow Network |
$17.33
|
| Rate for Payer: Priority Health SBD |
$114.24
|
| Rate for Payer: Railroad Medicare Medicare |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.46
|
| Rate for Payer: UHC Medicare Advantage |
$6.46
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.46
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$181.34
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$163.21 |
| Rate for Payer: Aetna Commercial |
$154.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.87
|
| Rate for Payer: Cash Price |
$145.07
|
| Rate for Payer: Cofinity Commercial |
$126.94
|
| Rate for Payer: Cofinity Commercial |
$155.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.07
|
| Rate for Payer: Healthscope Commercial |
$163.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.14
|
| Rate for Payer: PHP Commercial |
$154.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.87
|
| Rate for Payer: Priority Health SBD |
$114.24
|
|
|
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 |
$3.46 |
| Max. Negotiated Rate |
$1,620.94 |
| Rate for Payer: Aetna Commercial |
$1,530.89
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.08
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$20.85
|
| Rate for Payer: BCN Commercial |
$20.85
|
| Rate for Payer: BCN Medicare Advantage |
$6.46
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cofinity Commercial |
$1,260.74
|
| Rate for Payer: Cofinity Commercial |
$1,548.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,260.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,440.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$1,620.94
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Mclaren Medicare |
$6.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.78
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,530.89
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| Rate for Payer: PACE Medicare |
$6.14
|
| Rate for Payer: PACE SWMI |
$6.46
|
| Rate for Payer: PHP Commercial |
$1,530.89
|
| Rate for Payer: PHP Medicare Advantage |
$6.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,170.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.66
|
| Rate for Payer: Priority Health Medicare |
$6.46
|
| Rate for Payer: Priority Health Narrow Network |
$17.33
|
| Rate for Payer: Priority Health SBD |
$1,134.66
|
| Rate for Payer: Railroad Medicare Medicare |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.46
|
| Rate for Payer: UHC Medicare Advantage |
$6.46
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.46
|
|
|
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 Commercial |
$1,260.74
|
| Rate for Payer: Cofinity Commercial |
$1,548.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,260.74
|
| 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: PHP Commercial |
$1,530.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,170.68
|
| Rate for Payer: Priority Health SBD |
$1,134.66
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$362.61
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$326.35 |
| Rate for Payer: Aetna Commercial |
$308.22
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.08
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$20.85
|
| Rate for Payer: BCN Commercial |
$20.85
|
| Rate for Payer: BCN Medicare Advantage |
$6.46
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cofinity Commercial |
$311.84
|
| Rate for Payer: Cofinity Commercial |
$253.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$326.35
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Mclaren Medicare |
$6.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.78
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.22
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| Rate for Payer: PACE Medicare |
$6.14
|
| Rate for Payer: PACE SWMI |
$6.46
|
| Rate for Payer: PHP Commercial |
$308.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.66
|
| Rate for Payer: Priority Health Medicare |
$6.46
|
| Rate for Payer: Priority Health Narrow Network |
$17.33
|
| Rate for Payer: Priority Health SBD |
$228.44
|
| Rate for Payer: Railroad Medicare Medicare |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.46
|
| Rate for Payer: UHC Medicare Advantage |
$6.46
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.46
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$362.61
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$228.44 |
| Max. Negotiated Rate |
$326.35 |
| Rate for Payer: Aetna Commercial |
$308.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.70
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cofinity Commercial |
$253.83
|
| Rate for Payer: Cofinity Commercial |
$311.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.09
|
| Rate for Payer: Healthscope Commercial |
$326.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.22
|
| Rate for Payer: PHP Commercial |
$308.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.70
|
| Rate for Payer: Priority Health SBD |
$228.44
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$309.24
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.82 |
| Max. Negotiated Rate |
$278.32 |
| Rate for Payer: Aetna Commercial |
$262.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.01
|
| Rate for Payer: Cash Price |
$247.39
|
| Rate for Payer: Cofinity Commercial |
$216.47
|
| Rate for Payer: Cofinity Commercial |
$265.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.39
|
| Rate for Payer: Healthscope Commercial |
$278.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.85
|
| Rate for Payer: PHP Commercial |
$262.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.01
|
| Rate for Payer: Priority Health SBD |
$194.82
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$309.24
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$278.32 |
| Rate for Payer: Aetna Commercial |
$262.85
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.34
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.10
|
| Rate for Payer: BCN Commercial |
$21.10
|
| Rate for Payer: BCN Medicare Advantage |
$7.47
|
| Rate for Payer: Cash Price |
$247.39
|
| Rate for Payer: Cash Price |
$247.39
|
| Rate for Payer: Cofinity Commercial |
$265.95
|
| Rate for Payer: Cofinity Commercial |
$216.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$278.32
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: Meridian Medicaid |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.85
|
| Rate for Payer: Nomi Health Commercial |
$22.41
|
| Rate for Payer: PACE Medicare |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.47
|
| Rate for Payer: PHP Commercial |
$262.85
|
| Rate for Payer: PHP Medicare Advantage |
$7.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.92
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow Network |
$17.54
|
| Rate for Payer: Priority Health SBD |
$194.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.47
|
| Rate for Payer: UHC Medicare Advantage |
$7.47
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$7.47
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$618.48
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
195677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$389.64 |
| Max. Negotiated Rate |
$556.63 |
| Rate for Payer: Aetna Commercial |
$525.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.01
|
| Rate for Payer: Cash Price |
$494.78
|
| Rate for Payer: Cofinity Commercial |
$432.94
|
| Rate for Payer: Cofinity Commercial |
$531.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.78
|
| Rate for Payer: Healthscope Commercial |
$556.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.71
|
| Rate for Payer: PHP Commercial |
$525.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.01
|
| Rate for Payer: Priority Health SBD |
$389.64
|
|
