|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
NDC 43386009019
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Advantage |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health SBD |
$35.28
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
NDC 43386009019
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.01 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Advantage |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health SBD |
$35.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.40
|
| Rate for Payer: UHC Core |
$29.18
|
| Rate for Payer: UHC Exchange |
$22.01
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
NDC 52268010001
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Advantage |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.50
|
| Rate for Payer: UHC Core |
$36.47
|
| Rate for Payer: UHC Exchange |
$27.51
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
NDC 52268010001
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Advantage |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health SBD |
$44.10
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
IP
|
$9.52
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.19
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cofinity Advantage |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.62
|
| Rate for Payer: Healthscope Commercial |
$8.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.14
|
| Rate for Payer: PHP Commercial |
$8.09
|
| Rate for Payer: Priority Health SBD |
$6.00
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
OP
|
$9.52
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$8.09
|
| Rate for Payer: Aetna Medicare |
$4.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.19
|
| Rate for Payer: BCBS Complete |
$3.81
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cofinity Advantage |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.62
|
| Rate for Payer: Healthscope Commercial |
$8.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.14
|
| Rate for Payer: PHP Commercial |
$8.09
|
| Rate for Payer: Priority Health SBD |
$6.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.19
|
| Rate for Payer: UHC Core |
$4.96
|
| Rate for Payer: UHC Exchange |
$3.74
|
|
|
PEGASPARGASE 750 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$123,410.03
|
|
|
Service Code
|
HCPCS J9266
|
| Hospital Charge Code |
12519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77,748.32 |
| Max. Negotiated Rate |
$111,069.03 |
| Rate for Payer: Aetna Commercial |
$104,898.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80,216.52
|
| Rate for Payer: Cash Price |
$98,728.02
|
| Rate for Payer: Cofinity Advantage |
$86,387.02
|
| Rate for Payer: Cofinity Commercial |
$106,132.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98,728.02
|
| Rate for Payer: Healthscope Commercial |
$111,069.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104,898.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92,557.52
|
| Rate for Payer: PHP Commercial |
$104,898.53
|
| Rate for Payer: Priority Health SBD |
$77,748.32
|
|
|
PEGASPARGASE 750 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$123,410.03
|
|
|
Service Code
|
HCPCS J9266
|
| Hospital Charge Code |
12519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,865.78 |
| Max. Negotiated Rate |
$111,069.03 |
| Rate for Payer: Aetna Commercial |
$104,898.53
|
| Rate for Payer: Aetna Medicare |
$29,561.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80,216.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,530.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,530.07
|
| Rate for Payer: BCBS Complete |
$15,610.49
|
| Rate for Payer: BCBS MAPPO |
$28,424.06
|
| Rate for Payer: BCBS Trust/PPO |
$71,311.99
|
| Rate for Payer: BCN Commercial |
$71,311.99
|
| Rate for Payer: BCN Medicare Advantage |
$28,424.06
|
| Rate for Payer: Cash Price |
$98,728.02
|
| Rate for Payer: Cash Price |
$98,728.02
|
| Rate for Payer: Cofinity Advantage |
$86,387.02
|
| Rate for Payer: Cofinity Commercial |
$106,132.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98,728.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,424.06
|
| Rate for Payer: Healthscope Commercial |
$111,069.03
|
| Rate for Payer: Mclaren Medicaid |
$14,865.78
|
| Rate for Payer: Mclaren Medicare |
$28,424.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,845.26
|
| Rate for Payer: Meridian Medicaid |
$29,845.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,687.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$31,266.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104,898.53
|
| Rate for Payer: Nomi Health Commercial |
$85,272.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92,557.52
|
| Rate for Payer: PACE Medicare |
$27,002.86
|
| Rate for Payer: PACE SWMI |
$28,424.06
|
| Rate for Payer: PHP Commercial |
$104,898.53
|
| Rate for Payer: PHP Medicare Advantage |
$28,424.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,865.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89,648.58
|
| Rate for Payer: Priority Health Medicare |
$28,424.06
|
| Rate for Payer: Priority Health SBD |
$77,748.32
|
| Rate for Payer: Priority Health Tiered Network |
$71,718.86
|
| Rate for Payer: Railroad Medicare Medicare |
$28,424.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46,899.70
|
| Rate for Payer: UHC Core |
$46,899.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,424.06
|
| Rate for Payer: UHC Exchange |
$46,899.70
|
| Rate for Payer: UHC Medicaid |
$14,865.78
|
| Rate for Payer: UHCCP Medicaid |
$14,865.78
|
| Rate for Payer: VA VA |
$28,424.06
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR
|
Facility
|
OP
|
$4,519.13
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
173747
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$4,067.22 |
| Rate for Payer: Aetna Commercial |
$3,841.26
|
| Rate for Payer: Aetna Medicare |
$132.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,937.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.22
|
| Rate for Payer: BCBS Complete |
$69.96
|
| Rate for Payer: BCBS MAPPO |
$127.38
|
| Rate for Payer: BCBS Trust/PPO |
$770.41
|
| Rate for Payer: BCN Commercial |
$770.41
|
| Rate for Payer: BCN Medicare Advantage |
$127.38
|
| Rate for Payer: Cash Price |
$3,615.30
|
| Rate for Payer: Cash Price |
$3,615.30
|
| Rate for Payer: Cofinity Advantage |
$3,163.39
|
| Rate for Payer: Cofinity Commercial |
$3,886.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,615.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.38
|
| Rate for Payer: Healthscope Commercial |
$4,067.22
|
| Rate for Payer: Mclaren Medicaid |
$66.62
|
| Rate for Payer: Mclaren Medicare |
$127.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.75
|
| Rate for Payer: Meridian Medicaid |
$133.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$140.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,841.26
|
| Rate for Payer: Nomi Health Commercial |
$382.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,389.35
|
| Rate for Payer: PACE Medicare |
$121.01
|
| Rate for Payer: PACE SWMI |
$127.38
|
| Rate for Payer: PHP Commercial |
$3,841.26
|
| Rate for Payer: PHP Medicare Advantage |
$127.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$281.78
|
| Rate for Payer: Priority Health Medicare |
$127.38
|
| Rate for Payer: Priority Health SBD |
$2,847.05
|
| Rate for Payer: Priority Health Tiered Network |
$225.42
|
| Rate for Payer: Railroad Medicare Medicare |
$127.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.69
|
| Rate for Payer: UHC Core |
$202.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$127.38
|
| Rate for Payer: UHC Exchange |
$202.69
|
| Rate for Payer: UHC Medicaid |
$66.62
|
| Rate for Payer: UHCCP Medicaid |
$66.62
|
| Rate for Payer: VA VA |
$127.38
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR
|
Facility
|
IP
|
$4,519.13
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
173747
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,847.05 |
| Max. Negotiated Rate |
$4,067.22 |
| Rate for Payer: Aetna Commercial |
$3,841.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,937.43
|
| Rate for Payer: Cash Price |
$3,615.30
|
| Rate for Payer: Cofinity Advantage |
$3,163.39
|
| Rate for Payer: Cofinity Commercial |
$3,886.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,615.30
|
| Rate for Payer: Healthscope Commercial |
$4,067.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,841.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,389.35
|
| Rate for Payer: PHP Commercial |
$3,841.26
|
| Rate for Payer: Priority Health SBD |
$2,847.05
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$16,067.54
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,122.55 |
| Max. Negotiated Rate |
$14,460.79 |
| Rate for Payer: Aetna Commercial |
$13,657.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,443.90
|
| Rate for Payer: Cash Price |
$12,854.03
|
| Rate for Payer: Cofinity Advantage |
$11,247.28
|
| Rate for Payer: Cofinity Commercial |
$13,818.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,854.03
|
| Rate for Payer: Healthscope Commercial |
$14,460.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,657.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,050.66
|
| Rate for Payer: PHP Commercial |
$13,657.41
|
| Rate for Payer: Priority Health SBD |
$10,122.55
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$16,067.54
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$14,460.79 |
| Rate for Payer: Aetna Commercial |
$13,657.41
|
| Rate for Payer: Aetna Medicare |
$132.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,443.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.22
|
| Rate for Payer: BCBS Complete |
$69.96
|
| Rate for Payer: BCBS MAPPO |
$127.38
|
| Rate for Payer: BCBS Trust/PPO |
$770.41
|
| Rate for Payer: BCN Commercial |
$770.41
|
| Rate for Payer: BCN Medicare Advantage |
$127.38
|
| Rate for Payer: Cash Price |
$12,854.03
|
| Rate for Payer: Cash Price |
$12,854.03
|
| Rate for Payer: Cofinity Advantage |
$11,247.28
|
| Rate for Payer: Cofinity Commercial |
$13,818.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,854.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.38
|
| Rate for Payer: Healthscope Commercial |
$14,460.79
|
| Rate for Payer: Mclaren Medicaid |
$66.62
|
| Rate for Payer: Mclaren Medicare |
$127.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.75
|
| Rate for Payer: Meridian Medicaid |
$133.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$140.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,657.41
|
| Rate for Payer: Nomi Health Commercial |
$382.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,050.66
|
| Rate for Payer: PACE Medicare |
$121.01
|
| Rate for Payer: PACE SWMI |
$127.38
|
| Rate for Payer: PHP Commercial |
$13,657.41
|
| Rate for Payer: PHP Medicare Advantage |
$127.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$281.78
|
| Rate for Payer: Priority Health Medicare |
$127.38
|
| Rate for Payer: Priority Health SBD |
$10,122.55
|
| Rate for Payer: Priority Health Tiered Network |
$225.42
|
| Rate for Payer: Railroad Medicare Medicare |
$127.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.69
|
| Rate for Payer: UHC Core |
$202.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$127.38
|
| Rate for Payer: UHC Exchange |
$202.69
|
| Rate for Payer: UHC Medicaid |
$66.62
|
| Rate for Payer: UHCCP Medicaid |
$66.62
|
| Rate for Payer: VA VA |
$127.38
|
|
|
PEGFILGRASTIM-APGF 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$6,396.10
|
|
|
Service Code
|
HCPCS Q5122
|
| Hospital Charge Code |
195654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,029.54 |
| Max. Negotiated Rate |
$5,756.49 |
| Rate for Payer: Aetna Commercial |
$5,436.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,157.47
|
| Rate for Payer: Cash Price |
$5,116.88
|
| Rate for Payer: Cofinity Advantage |
$4,477.27
|
| Rate for Payer: Cofinity Commercial |
$5,500.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,116.88
|
| Rate for Payer: Healthscope Commercial |
$5,756.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,436.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,797.07
|
| Rate for Payer: PHP Commercial |
$5,436.69
|
| Rate for Payer: Priority Health SBD |
$4,029.54
|
|
|
PEGFILGRASTIM-APGF 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$6,396.10
|
|
|
Service Code
|
HCPCS Q5122
|
| Hospital Charge Code |
195654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$5,756.49 |
| Rate for Payer: Aetna Commercial |
$5,436.69
|
| Rate for Payer: Aetna Medicare |
$138.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,157.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$166.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$166.64
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$133.31
|
| Rate for Payer: BCBS Trust/PPO |
$333.80
|
| Rate for Payer: BCN Commercial |
$333.80
|
| Rate for Payer: BCN Medicare Advantage |
$133.31
|
| Rate for Payer: Cash Price |
$5,116.88
|
| Rate for Payer: Cash Price |
$5,116.88
|
| Rate for Payer: Cofinity Advantage |
$4,477.27
|
| Rate for Payer: Cofinity Commercial |
$5,500.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,116.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.31
|
| Rate for Payer: Healthscope Commercial |
$5,756.49
|
| Rate for Payer: Mclaren Medicaid |
$69.72
|
| Rate for Payer: Mclaren Medicare |
$133.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.98
|
| Rate for Payer: Meridian Medicaid |
$139.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$146.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,436.69
|
| Rate for Payer: Nomi Health Commercial |
$399.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,797.07
|
| Rate for Payer: PACE Medicare |
$126.64
|
| Rate for Payer: PACE SWMI |
$133.31
|
| Rate for Payer: PHP Commercial |
$5,436.69
|
| Rate for Payer: PHP Medicare Advantage |
$133.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$413.68
|
| Rate for Payer: Priority Health Medicare |
$133.31
|
| Rate for Payer: Priority Health SBD |
$4,029.54
|
| Rate for Payer: Priority Health Tiered Network |
$330.94
|
| Rate for Payer: Railroad Medicare Medicare |
$133.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.53
|
| Rate for Payer: UHC Core |
$219.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.31
|
| Rate for Payer: UHC Exchange |
$219.53
|
| Rate for Payer: UHC Medicaid |
$69.72
|
| Rate for Payer: UHCCP Medicaid |
$69.72
|
| Rate for Payer: VA VA |
$133.31
|
|
|
PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$6,368.78
|
|
|
Service Code
|
HCPCS Q5120
|
| Hospital Charge Code |
192102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,012.33 |
| Max. Negotiated Rate |
$5,731.90 |
| Rate for Payer: Aetna Commercial |
$5,413.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,139.71
|
| Rate for Payer: Cash Price |
$5,095.02
|
| Rate for Payer: Cofinity Advantage |
$4,458.15
|
| Rate for Payer: Cofinity Commercial |
$5,477.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,095.02
|
| Rate for Payer: Healthscope Commercial |
$5,731.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,413.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,776.59
|
| Rate for Payer: PHP Commercial |
$5,413.46
|
| Rate for Payer: Priority Health SBD |
$4,012.33
|
|
|
PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$6,368.78
|
|
|
Service Code
|
HCPCS Q5120
|
| Hospital Charge Code |
192102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.57 |
| Max. Negotiated Rate |
$5,731.90 |
| Rate for Payer: Aetna Commercial |
$5,413.46
|
| Rate for Payer: Aetna Medicare |
$124.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,139.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$149.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$149.55
|
| Rate for Payer: BCBS Complete |
$65.71
|
| Rate for Payer: BCBS MAPPO |
$119.64
|
| Rate for Payer: BCBS Trust/PPO |
$123.12
|
| Rate for Payer: BCN Commercial |
$123.12
|
| Rate for Payer: BCN Medicare Advantage |
$119.64
|
| Rate for Payer: Cash Price |
$5,095.02
|
| Rate for Payer: Cash Price |
$5,095.02
|
| Rate for Payer: Cofinity Advantage |
$4,458.15
|
| Rate for Payer: Cofinity Commercial |
$5,477.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,095.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.64
|
| Rate for Payer: Healthscope Commercial |
$5,731.90
|
| Rate for Payer: Mclaren Medicaid |
$62.57
|
| Rate for Payer: Mclaren Medicare |
$119.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.62
|
| Rate for Payer: Meridian Medicaid |
$125.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$131.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,413.46
|
| Rate for Payer: Nomi Health Commercial |
$358.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,776.59
|
| Rate for Payer: PACE Medicare |
$113.66
|
| Rate for Payer: PACE SWMI |
$119.64
|
| Rate for Payer: PHP Commercial |
$5,413.46
|
| Rate for Payer: PHP Medicare Advantage |
$119.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$95.64
|
| Rate for Payer: Priority Health Medicare |
$119.64
|
| Rate for Payer: Priority Health SBD |
$4,012.33
|
| Rate for Payer: Priority Health Tiered Network |
$76.51
|
| Rate for Payer: Railroad Medicare Medicare |
$119.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.83
|
| Rate for Payer: UHC Core |
$196.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$119.64
|
| Rate for Payer: UHC Exchange |
$196.83
|
| Rate for Payer: UHC Medicaid |
$62.57
|
| Rate for Payer: UHCCP Medicaid |
$62.57
|
| Rate for Payer: VA VA |
$119.64
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUT INJECTOR
|
Facility
|
IP
|
$8,837.40
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
206387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,567.56 |
| Max. Negotiated Rate |
$7,953.66 |
| Rate for Payer: Aetna Commercial |
$7,511.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,744.31
|
| Rate for Payer: Cash Price |
$7,069.92
|
| Rate for Payer: Cofinity Advantage |
$6,186.18
|
| Rate for Payer: Cofinity Commercial |
$7,600.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,069.92
|
| Rate for Payer: Healthscope Commercial |
$7,953.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,511.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,628.05
|
| Rate for Payer: PHP Commercial |
$7,511.79
|
| Rate for Payer: Priority Health SBD |
$5,567.56
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUT INJECTOR
|
Facility
|
OP
|
$8,837.40
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
206387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.07 |
| Max. Negotiated Rate |
$7,953.66 |
| Rate for Payer: Aetna Commercial |
$7,511.79
|
| Rate for Payer: Aetna Commercial |
$9,226.75
|
| Rate for Payer: Aetna Medicare |
$141.33
|
| Rate for Payer: Aetna Medicare |
$141.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,744.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,055.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.86
|
| Rate for Payer: BCBS Complete |
$74.63
|
| Rate for Payer: BCBS Complete |
$74.63
|
| Rate for Payer: BCBS MAPPO |
$135.89
|
| Rate for Payer: BCBS MAPPO |
$135.89
|
| Rate for Payer: BCBS Trust/PPO |
$406.39
|
| Rate for Payer: BCBS Trust/PPO |
$406.39
|
| Rate for Payer: BCN Commercial |
$406.39
|
| Rate for Payer: BCN Commercial |
$406.39
|
| Rate for Payer: BCN Medicare Advantage |
$135.89
|
| Rate for Payer: BCN Medicare Advantage |
$135.89
|
| Rate for Payer: Cash Price |
$8,684.00
|
| Rate for Payer: Cash Price |
$7,069.92
|
| Rate for Payer: Cash Price |
$7,069.92
|
| Rate for Payer: Cash Price |
$8,684.00
|
| Rate for Payer: Cofinity Advantage |
$7,598.50
|
| Rate for Payer: Cofinity Advantage |
$6,186.18
|
| Rate for Payer: Cofinity Commercial |
$7,600.16
|
| Rate for Payer: Cofinity Commercial |
$9,335.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,069.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,684.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.89
|
| Rate for Payer: Healthscope Commercial |
$7,953.66
|
| Rate for Payer: Healthscope Commercial |
$9,769.50
|
| Rate for Payer: Mclaren Medicaid |
$71.07
|
| Rate for Payer: Mclaren Medicaid |
$71.07
|
| Rate for Payer: Mclaren Medicare |
$135.89
|
| Rate for Payer: Mclaren Medicare |
$135.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.68
|
| Rate for Payer: Meridian Medicaid |
$142.68
|
| Rate for Payer: Meridian Medicaid |
$142.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$149.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$149.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,226.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,511.79
|
| Rate for Payer: Nomi Health Commercial |
$407.67
|
| Rate for Payer: Nomi Health Commercial |
$407.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,628.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,141.25
|
| Rate for Payer: PACE Medicare |
$129.10
|
| Rate for Payer: PACE Medicare |
$129.10
|
| Rate for Payer: PACE SWMI |
$135.89
|
| Rate for Payer: PACE SWMI |
$135.89
|
| Rate for Payer: PHP Commercial |
$7,511.79
|
| Rate for Payer: PHP Commercial |
$9,226.75
|
| Rate for Payer: PHP Medicare Advantage |
$135.89
|
| Rate for Payer: PHP Medicare Advantage |
$135.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$335.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$335.37
|
| Rate for Payer: Priority Health Medicare |
$135.89
|
| Rate for Payer: Priority Health Medicare |
$135.89
|
| Rate for Payer: Priority Health SBD |
$6,838.65
|
| Rate for Payer: Priority Health SBD |
$5,567.56
|
| Rate for Payer: Priority Health Tiered Network |
$268.30
|
| Rate for Payer: Priority Health Tiered Network |
$268.30
|
| Rate for Payer: Railroad Medicare Medicare |
$135.89
|
| Rate for Payer: Railroad Medicare Medicare |
$135.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.28
|
| Rate for Payer: UHC Core |
$267.28
|
| Rate for Payer: UHC Core |
$267.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$135.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$135.89
|
| Rate for Payer: UHC Exchange |
$267.28
|
| Rate for Payer: UHC Exchange |
$267.28
|
| Rate for Payer: UHC Medicaid |
$71.07
|
| Rate for Payer: UHC Medicaid |
$71.07
|
| Rate for Payer: UHCCP Medicaid |
$71.07
|
| Rate for Payer: UHCCP Medicaid |
$71.07
|
| Rate for Payer: VA VA |
$135.89
|
| Rate for Payer: VA VA |
$135.89
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
OP
|
$5,304.00
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
203866
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.07 |
| Max. Negotiated Rate |
$4,773.60 |
| Rate for Payer: Aetna Commercial |
$4,508.40
|
| Rate for Payer: Aetna Medicare |
$141.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,447.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.86
|
| Rate for Payer: BCBS Complete |
$74.63
|
| Rate for Payer: BCBS MAPPO |
$135.89
|
| Rate for Payer: BCBS Trust/PPO |
$406.39
|
| Rate for Payer: BCN Commercial |
$406.39
|
| Rate for Payer: BCN Medicare Advantage |
$135.89
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cofinity Advantage |
$3,712.80
|
| Rate for Payer: Cofinity Commercial |
$4,561.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,243.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.89
|
| Rate for Payer: Healthscope Commercial |
$4,773.60
|
| Rate for Payer: Mclaren Medicaid |
$71.07
|
| Rate for Payer: Mclaren Medicare |
$135.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.68
|
| Rate for Payer: Meridian Medicaid |
$142.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$149.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,508.40
|
| Rate for Payer: Nomi Health Commercial |
$407.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,978.00
|
| Rate for Payer: PACE Medicare |
$129.10
|
| Rate for Payer: PACE SWMI |
$135.89
|
| Rate for Payer: PHP Commercial |
$4,508.40
|
| Rate for Payer: PHP Medicare Advantage |
$135.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$335.37
|
| Rate for Payer: Priority Health Medicare |
$135.89
|
| Rate for Payer: Priority Health SBD |
$3,341.52
|
| Rate for Payer: Priority Health Tiered Network |
$268.30
|
| Rate for Payer: Railroad Medicare Medicare |
$135.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.28
|
| Rate for Payer: UHC Core |
$267.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$135.89
|
| Rate for Payer: UHC Exchange |
$267.28
|
| Rate for Payer: UHC Medicaid |
$71.07
|
| Rate for Payer: UHCCP Medicaid |
$71.07
|
| Rate for Payer: VA VA |
$135.89
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
IP
|
$5,304.00
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
203866
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,341.52 |
| Max. Negotiated Rate |
$4,773.60 |
| Rate for Payer: Aetna Commercial |
$4,508.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,447.60
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cofinity Advantage |
$3,712.80
|
| Rate for Payer: Cofinity Commercial |
$4,561.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,243.20
|
| Rate for Payer: Healthscope Commercial |
$4,773.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,508.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,978.00
|
| Rate for Payer: PHP Commercial |
$4,508.40
|
| Rate for Payer: Priority Health SBD |
$3,341.52
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,304.00
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
189200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.07 |
| Max. Negotiated Rate |
$4,773.60 |
| Rate for Payer: Aetna Commercial |
$4,508.40
|
| Rate for Payer: Aetna Medicare |
$141.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,447.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.86
|
| Rate for Payer: BCBS Complete |
$74.63
|
| Rate for Payer: BCBS MAPPO |
$135.89
|
| Rate for Payer: BCBS Trust/PPO |
$406.39
|
| Rate for Payer: BCN Commercial |
$406.39
|
| Rate for Payer: BCN Medicare Advantage |
$135.89
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cofinity Advantage |
$3,712.80
|
| Rate for Payer: Cofinity Commercial |
$4,561.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,243.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.89
|
| Rate for Payer: Healthscope Commercial |
$4,773.60
|
| Rate for Payer: Mclaren Medicaid |
$71.07
|
| Rate for Payer: Mclaren Medicare |
$135.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.68
|
| Rate for Payer: Meridian Medicaid |
$142.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$149.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,508.40
|
| Rate for Payer: Nomi Health Commercial |
$407.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,978.00
|
| Rate for Payer: PACE Medicare |
$129.10
|
| Rate for Payer: PACE SWMI |
$135.89
|
| Rate for Payer: PHP Commercial |
$4,508.40
|
| Rate for Payer: PHP Medicare Advantage |
$135.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$335.37
|
| Rate for Payer: Priority Health Medicare |
$135.89
|
| Rate for Payer: Priority Health SBD |
$3,341.52
|
| Rate for Payer: Priority Health Tiered Network |
$268.30
|
| Rate for Payer: Railroad Medicare Medicare |
$135.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.28
|
| Rate for Payer: UHC Core |
$267.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$135.89
|
| Rate for Payer: UHC Exchange |
$267.28
|
| Rate for Payer: UHC Medicaid |
$71.07
|
| Rate for Payer: UHCCP Medicaid |
$71.07
|
| Rate for Payer: VA VA |
$135.89
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,304.00
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
189200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,341.52 |
| Max. Negotiated Rate |
$4,773.60 |
| Rate for Payer: Aetna Commercial |
$4,508.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,447.60
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cofinity Advantage |
$3,712.80
|
| Rate for Payer: Cofinity Commercial |
$4,561.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,243.20
|
| Rate for Payer: Healthscope Commercial |
$4,773.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,508.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,978.00
|
| Rate for Payer: PHP Commercial |
$4,508.40
|
| Rate for Payer: Priority Health SBD |
$3,341.52
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,616.00
|
|
|
Service Code
|
HCPCS Q5108
|
| Hospital Charge Code |
187520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$5,054.40 |
| Rate for Payer: Aetna Commercial |
$4,773.60
|
| Rate for Payer: Aetna Commercial |
$3,845.40
|
| Rate for Payer: Aetna Medicare |
$82.68
|
| Rate for Payer: Aetna Medicare |
$82.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,650.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,940.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.38
|
| Rate for Payer: BCBS Complete |
$43.66
|
| Rate for Payer: BCBS Complete |
$43.66
|
| Rate for Payer: BCBS MAPPO |
$79.50
|
| Rate for Payer: BCBS MAPPO |
$79.50
|
| Rate for Payer: BCBS Trust/PPO |
$243.46
|
| Rate for Payer: BCBS Trust/PPO |
$243.46
|
| Rate for Payer: BCN Commercial |
$243.46
|
| Rate for Payer: BCN Commercial |
$243.46
|
| Rate for Payer: BCN Medicare Advantage |
$79.50
|
| Rate for Payer: BCN Medicare Advantage |
$79.50
|
| Rate for Payer: Cash Price |
$3,619.20
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cash Price |
$3,619.20
|
| Rate for Payer: Cofinity Advantage |
$3,166.80
|
| Rate for Payer: Cofinity Advantage |
$3,931.20
|
| Rate for Payer: Cofinity Commercial |
$4,829.76
|
| Rate for Payer: Cofinity Commercial |
$3,890.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,492.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,619.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.50
|
| Rate for Payer: Healthscope Commercial |
$5,054.40
|
| Rate for Payer: Healthscope Commercial |
$4,071.60
|
| Rate for Payer: Mclaren Medicaid |
$41.58
|
| Rate for Payer: Mclaren Medicaid |
$41.58
|
| Rate for Payer: Mclaren Medicare |
$79.50
|
| Rate for Payer: Mclaren Medicare |
$79.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.47
|
| Rate for Payer: Meridian Medicaid |
$83.47
|
| Rate for Payer: Meridian Medicaid |
$83.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,845.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,773.60
|
| Rate for Payer: Nomi Health Commercial |
$238.50
|
| Rate for Payer: Nomi Health Commercial |
$238.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,212.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,393.00
|
| Rate for Payer: PACE Medicare |
$75.53
|
| Rate for Payer: PACE Medicare |
$75.53
|
| Rate for Payer: PACE SWMI |
$79.50
|
| Rate for Payer: PACE SWMI |
$79.50
|
| Rate for Payer: PHP Commercial |
$4,773.60
|
| Rate for Payer: PHP Commercial |
$3,845.40
|
| Rate for Payer: PHP Medicare Advantage |
$79.50
|
| Rate for Payer: PHP Medicare Advantage |
$79.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$312.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$312.65
|
| Rate for Payer: Priority Health Medicare |
$79.50
|
| Rate for Payer: Priority Health Medicare |
$79.50
|
| Rate for Payer: Priority Health SBD |
$2,850.12
|
| Rate for Payer: Priority Health SBD |
$3,538.08
|
| Rate for Payer: Priority Health Tiered Network |
$250.12
|
| Rate for Payer: Priority Health Tiered Network |
$250.12
|
| Rate for Payer: Railroad Medicare Medicare |
$79.50
|
| Rate for Payer: Railroad Medicare Medicare |
$79.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.14
|
| Rate for Payer: UHC Core |
$163.14
|
| Rate for Payer: UHC Core |
$163.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$79.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$79.50
|
| Rate for Payer: UHC Exchange |
$163.14
|
| Rate for Payer: UHC Exchange |
$163.14
|
| Rate for Payer: UHC Medicaid |
$41.58
|
| Rate for Payer: UHC Medicaid |
$41.58
|
| Rate for Payer: UHCCP Medicaid |
$41.58
|
| Rate for Payer: UHCCP Medicaid |
$41.58
|
| Rate for Payer: VA VA |
$79.50
|
| Rate for Payer: VA VA |
$79.50
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,616.00
|
|
|
Service Code
|
HCPCS Q5108
|
| Hospital Charge Code |
187520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,538.08 |
| Max. Negotiated Rate |
$5,054.40 |
| Rate for Payer: Aetna Commercial |
$4,773.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,650.40
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cofinity Advantage |
$3,931.20
|
| Rate for Payer: Cofinity Commercial |
$4,829.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,492.80
|
| Rate for Payer: Healthscope Commercial |
$5,054.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,773.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,212.00
|
| Rate for Payer: PHP Commercial |
$4,773.60
|
| Rate for Payer: Priority Health SBD |
$3,538.08
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$79,931.78
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50,357.02 |
| Max. Negotiated Rate |
$71,938.60 |
| Rate for Payer: Aetna Commercial |
$67,942.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51,955.66
|
| Rate for Payer: Cash Price |
$63,945.42
|
| Rate for Payer: Cofinity Advantage |
$55,952.25
|
| Rate for Payer: Cofinity Commercial |
$68,741.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63,945.42
|
| Rate for Payer: Healthscope Commercial |
$71,938.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67,942.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59,948.83
|
| Rate for Payer: PHP Commercial |
$67,942.01
|
| Rate for Payer: Priority Health SBD |
$50,357.02
|
|
