|
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 |
$3.81 |
| 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 Commercial |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.66
|
| 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: PHP Commercial |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.19
|
| Rate for Payer: Priority Health SBD |
$6.00
|
|
|
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 Commercial |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.66
|
| 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: PHP Commercial |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.19
|
| Rate for Payer: Priority Health SBD |
$6.00
|
|
|
PEGASPARGASE 750 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$120,400.03
|
|
|
Service Code
|
HCPCS J9266
|
| Hospital Charge Code |
12519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75,852.02 |
| Max. Negotiated Rate |
$108,360.03 |
| Rate for Payer: Aetna Commercial |
$102,340.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78,260.02
|
| Rate for Payer: Cash Price |
$96,320.02
|
| Rate for Payer: Cofinity Commercial |
$103,544.03
|
| Rate for Payer: Cofinity Commercial |
$84,280.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$84,280.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96,320.02
|
| Rate for Payer: Healthscope Commercial |
$108,360.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102,340.03
|
| Rate for Payer: PHP Commercial |
$102,340.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78,260.02
|
| Rate for Payer: Priority Health SBD |
$75,852.02
|
|
|
PEGASPARGASE 750 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$120,400.03
|
|
|
Service Code
|
HCPCS J9266
|
| Hospital Charge Code |
12519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,509.80 |
| Max. Negotiated Rate |
$108,360.03 |
| Rate for Payer: Aetna Commercial |
$102,340.03
|
| Rate for Payer: Aetna Medicare |
$28,153.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78,260.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,838.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,838.16
|
| Rate for Payer: BCBS Complete |
$15,235.29
|
| Rate for Payer: BCBS MAPPO |
$27,070.53
|
| Rate for Payer: BCBS Trust/PPO |
$76,469.13
|
| Rate for Payer: BCN Commercial |
$76,469.13
|
| Rate for Payer: BCN Medicare Advantage |
$27,070.53
|
| Rate for Payer: Cash Price |
$96,320.02
|
| Rate for Payer: Cash Price |
$96,320.02
|
| Rate for Payer: Cofinity Commercial |
$103,544.03
|
| Rate for Payer: Cofinity Commercial |
$84,280.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$84,280.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96,320.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,070.53
|
| Rate for Payer: Healthscope Commercial |
$108,360.03
|
| Rate for Payer: Mclaren Medicaid |
$14,509.80
|
| Rate for Payer: Mclaren Medicare |
$27,070.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,424.06
|
| Rate for Payer: Meridian Medicaid |
$15,235.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,131.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102,340.03
|
| Rate for Payer: Nomi Health Commercial |
$81,211.59
|
| Rate for Payer: PACE Medicare |
$25,717.00
|
| Rate for Payer: PACE SWMI |
$27,070.53
|
| Rate for Payer: PHP Commercial |
$102,340.03
|
| Rate for Payer: PHP Medicare Advantage |
$27,070.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,509.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78,260.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77,909.48
|
| Rate for Payer: Priority Health Medicare |
$27,070.53
|
| Rate for Payer: Priority Health Narrow Network |
$62,327.58
|
| Rate for Payer: Priority Health SBD |
$75,852.02
|
| Rate for Payer: Railroad Medicare Medicare |
$27,070.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76,200.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,070.53
|
| Rate for Payer: UHC Medicare Advantage |
$27,070.53
|
| Rate for Payer: UHCCP Medicaid |
$15,240.71
|
| Rate for Payer: VA VA |
$27,070.53
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR
|
Facility
|
OP
|
$11,749.74
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
173747
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$10,574.77 |
| Rate for Payer: Aetna Commercial |
$9,987.28
|
| Rate for Payer: Aetna Medicare |
$20.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,637.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.98
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: BCBS MAPPO |
$19.98
|
| Rate for Payer: BCBS Trust/PPO |
$871.90
|
| Rate for Payer: BCN Commercial |
$871.90
|
| Rate for Payer: BCN Medicare Advantage |
$19.98
|
| Rate for Payer: Cash Price |
$9,399.79
|
| Rate for Payer: Cash Price |
$9,399.79
|
| Rate for Payer: Cofinity Commercial |
$8,224.82
|
| Rate for Payer: Cofinity Commercial |
$10,104.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,224.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,399.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$10,574.77
|
| Rate for Payer: Mclaren Medicaid |
$10.71
|
| Rate for Payer: Mclaren Medicare |
$19.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.98
|
| Rate for Payer: Meridian Medicaid |
$11.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,987.28
|
| Rate for Payer: Nomi Health Commercial |
$59.94
|
| Rate for Payer: PACE Medicare |
$18.98
|
| Rate for Payer: PACE SWMI |
$19.98
|
| Rate for Payer: PHP Commercial |
$9,987.28
|
| Rate for Payer: PHP Medicare Advantage |
$19.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,637.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.64
|
| Rate for Payer: Priority Health Medicare |
$19.98
|
| Rate for Payer: Priority Health Narrow Network |
$71.71
|
| Rate for Payer: Priority Health SBD |
$7,402.34
|
| Rate for Payer: Railroad Medicare Medicare |
$19.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.98
|
| Rate for Payer: UHC Medicare Advantage |
$19.98
|
| Rate for Payer: UHCCP Medicaid |
$11.25
|
| Rate for Payer: VA VA |
$19.98
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR
|
Facility
|
IP
|
$11,749.74
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
173747
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,402.34 |
| Max. Negotiated Rate |
$10,574.77 |
| Rate for Payer: Aetna Commercial |
$9,987.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,637.33
|
| Rate for Payer: Cash Price |
$9,399.79
|
| Rate for Payer: Cofinity Commercial |
$10,104.78
|
| Rate for Payer: Cofinity Commercial |
$8,224.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,224.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,399.79
|
| Rate for Payer: Healthscope Commercial |
$10,574.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,987.28
|
| Rate for Payer: PHP Commercial |
$9,987.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,637.33
|
| Rate for Payer: Priority Health SBD |
$7,402.34
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$9,392.27
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$8,453.04 |
| Rate for Payer: Aetna Commercial |
$7,983.43
|
| Rate for Payer: Aetna Medicare |
$20.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,104.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.98
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: BCBS MAPPO |
$19.98
|
| Rate for Payer: BCBS Trust/PPO |
$871.90
|
| Rate for Payer: BCN Commercial |
$871.90
|
| Rate for Payer: BCN Medicare Advantage |
$19.98
|
| Rate for Payer: Cash Price |
$7,513.82
|
| Rate for Payer: Cash Price |
$7,513.82
|
| Rate for Payer: Cofinity Commercial |
$8,077.35
|
| Rate for Payer: Cofinity Commercial |
$6,574.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,574.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,513.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$8,453.04
|
| Rate for Payer: Mclaren Medicaid |
$10.71
|
| Rate for Payer: Mclaren Medicare |
$19.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.98
|
| Rate for Payer: Meridian Medicaid |
$11.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,983.43
|
| Rate for Payer: Nomi Health Commercial |
$59.94
|
| Rate for Payer: PACE Medicare |
$18.98
|
| Rate for Payer: PACE SWMI |
$19.98
|
| Rate for Payer: PHP Commercial |
$7,983.43
|
| Rate for Payer: PHP Medicare Advantage |
$19.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,104.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.64
|
| Rate for Payer: Priority Health Medicare |
$19.98
|
| Rate for Payer: Priority Health Narrow Network |
$71.71
|
| Rate for Payer: Priority Health SBD |
$5,917.13
|
| Rate for Payer: Railroad Medicare Medicare |
$19.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.98
|
| Rate for Payer: UHC Medicare Advantage |
$19.98
|
| Rate for Payer: UHCCP Medicaid |
$11.25
|
| Rate for Payer: VA VA |
$19.98
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$9,392.27
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,917.13 |
| Max. Negotiated Rate |
$8,453.04 |
| Rate for Payer: Aetna Commercial |
$7,983.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,104.98
|
| Rate for Payer: Cash Price |
$7,513.82
|
| Rate for Payer: Cofinity Commercial |
$6,574.59
|
| Rate for Payer: Cofinity Commercial |
$8,077.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,574.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,513.82
|
| Rate for Payer: Healthscope Commercial |
$8,453.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,983.43
|
| Rate for Payer: PHP Commercial |
$7,983.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,104.98
|
| Rate for Payer: Priority Health SBD |
$5,917.13
|
|
|
PEGFILGRASTIM-APGF 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,301.28
|
|
|
Service Code
|
HCPCS Q5122
|
| Hospital Charge Code |
195654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,339.81 |
| Max. Negotiated Rate |
$4,771.15 |
| Rate for Payer: Aetna Commercial |
$4,506.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,445.83
|
| Rate for Payer: Cash Price |
$4,241.02
|
| Rate for Payer: Cofinity Commercial |
$3,710.90
|
| Rate for Payer: Cofinity Commercial |
$4,559.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,710.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,241.02
|
| Rate for Payer: Healthscope Commercial |
$4,771.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,506.09
|
| Rate for Payer: PHP Commercial |
$4,506.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,445.83
|
| Rate for Payer: Priority Health SBD |
$3,339.81
|
|
|
PEGFILGRASTIM-APGF 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,301.28
|
|
|
Service Code
|
HCPCS Q5122
|
| Hospital Charge Code |
195654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$4,771.15 |
| Rate for Payer: Aetna Commercial |
$4,506.09
|
| Rate for Payer: Aetna Medicare |
$121.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,445.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.26
|
| Rate for Payer: BCBS Complete |
$65.85
|
| Rate for Payer: BCBS MAPPO |
$117.01
|
| Rate for Payer: BCBS Trust/PPO |
$359.09
|
| Rate for Payer: BCN Commercial |
$359.09
|
| Rate for Payer: BCN Medicare Advantage |
$117.01
|
| Rate for Payer: Cash Price |
$4,241.02
|
| Rate for Payer: Cash Price |
$4,241.02
|
| Rate for Payer: Cofinity Commercial |
$4,559.10
|
| Rate for Payer: Cofinity Commercial |
$3,710.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,710.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,241.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.01
|
| Rate for Payer: Healthscope Commercial |
$4,771.15
|
| Rate for Payer: Mclaren Medicaid |
$62.72
|
| Rate for Payer: Mclaren Medicare |
$117.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.86
|
| Rate for Payer: Meridian Medicaid |
$65.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,506.09
|
| Rate for Payer: Nomi Health Commercial |
$351.03
|
| Rate for Payer: PACE Medicare |
$111.16
|
| Rate for Payer: PACE SWMI |
$117.01
|
| Rate for Payer: PHP Commercial |
$4,506.09
|
| Rate for Payer: PHP Medicare Advantage |
$117.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,445.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.88
|
| Rate for Payer: Priority Health Medicare |
$117.01
|
| Rate for Payer: Priority Health Narrow Network |
$222.30
|
| Rate for Payer: Priority Health SBD |
$3,339.81
|
| Rate for Payer: Railroad Medicare Medicare |
$117.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.01
|
| Rate for Payer: UHC Medicare Advantage |
$117.01
|
| Rate for Payer: UHCCP Medicaid |
$65.88
|
| Rate for Payer: VA VA |
$117.01
|
|
|
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 |
$13.24 |
| Max. Negotiated Rate |
$5,731.90 |
| Rate for Payer: Aetna Commercial |
$5,413.46
|
| Rate for Payer: Aetna Medicare |
$25.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,139.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.89
|
| Rate for Payer: BCBS Complete |
$13.91
|
| Rate for Payer: BCBS MAPPO |
$24.71
|
| Rate for Payer: BCBS Trust/PPO |
$544.16
|
| Rate for Payer: BCN Commercial |
$544.16
|
| Rate for Payer: BCN Medicare Advantage |
$24.71
|
| Rate for Payer: Cash Price |
$5,095.02
|
| Rate for Payer: Cash Price |
$5,095.02
|
| Rate for Payer: Cofinity Commercial |
$5,477.15
|
| Rate for Payer: Cofinity Commercial |
$4,458.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,458.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,095.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.71
|
| Rate for Payer: Healthscope Commercial |
$5,731.90
|
| Rate for Payer: Mclaren Medicaid |
$13.24
|
| Rate for Payer: Mclaren Medicare |
$24.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.95
|
| Rate for Payer: Meridian Medicaid |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,413.46
|
| Rate for Payer: Nomi Health Commercial |
$74.13
|
| Rate for Payer: PACE Medicare |
$23.47
|
| Rate for Payer: PACE SWMI |
$24.71
|
| Rate for Payer: PHP Commercial |
$5,413.46
|
| Rate for Payer: PHP Medicare Advantage |
$24.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,139.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$997.96
|
| Rate for Payer: Priority Health Medicare |
$24.71
|
| Rate for Payer: Priority Health Narrow Network |
$798.37
|
| Rate for Payer: Priority Health SBD |
$4,012.33
|
| Rate for Payer: Railroad Medicare Medicare |
$24.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.71
|
| Rate for Payer: UHC Medicare Advantage |
$24.71
|
| Rate for Payer: UHCCP Medicaid |
$13.91
|
| Rate for Payer: VA VA |
$24.71
|
|
|
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 Commercial |
$4,458.15
|
| Rate for Payer: Cofinity Commercial |
$5,477.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,458.15
|
| 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: PHP Commercial |
$5,413.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,139.71
|
| Rate for Payer: Priority Health SBD |
$4,012.33
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUT INJECTOR
|
Facility
|
OP
|
$8,837.40
|
|
|
Service Code
|
NDC 70114013001
|
| Hospital Charge Code |
206387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,534.96 |
| Max. Negotiated Rate |
$7,953.66 |
| Rate for Payer: Aetna Commercial |
$7,511.79
|
| Rate for Payer: Aetna Medicare |
$4,418.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,744.31
|
| Rate for Payer: BCBS Complete |
$3,534.96
|
| Rate for Payer: Cash Price |
$7,069.92
|
| Rate for Payer: Cofinity Commercial |
$6,186.18
|
| Rate for Payer: Cofinity Commercial |
$7,600.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,186.18
|
| 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: PHP Commercial |
$7,511.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,744.31
|
| Rate for Payer: Priority Health SBD |
$5,567.56
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUT INJECTOR
|
Facility
|
IP
|
$8,837.40
|
|
|
Service Code
|
NDC 70114013001
|
| 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 Commercial |
$6,186.18
|
| Rate for Payer: Cofinity Commercial |
$7,600.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,186.18
|
| 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: PHP Commercial |
$7,511.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,744.31
|
| Rate for Payer: Priority Health SBD |
$5,567.56
|
|
|
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 |
$72.65 |
| Max. Negotiated Rate |
$4,773.60 |
| Rate for Payer: Aetna Commercial |
$4,508.40
|
| Rate for Payer: Aetna Medicare |
$140.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,447.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.44
|
| Rate for Payer: BCBS Complete |
$76.29
|
| Rate for Payer: BCBS MAPPO |
$135.55
|
| Rate for Payer: BCBS Trust/PPO |
$405.01
|
| Rate for Payer: BCN Commercial |
$405.01
|
| Rate for Payer: BCN Medicare Advantage |
$135.55
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cofinity Commercial |
$4,561.44
|
| Rate for Payer: Cofinity Commercial |
$3,712.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,712.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,243.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.55
|
| Rate for Payer: Healthscope Commercial |
$4,773.60
|
| Rate for Payer: Mclaren Medicaid |
$72.65
|
| Rate for Payer: Mclaren Medicare |
$135.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.33
|
| Rate for Payer: Meridian Medicaid |
$76.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,508.40
|
| Rate for Payer: Nomi Health Commercial |
$406.65
|
| Rate for Payer: PACE Medicare |
$128.77
|
| Rate for Payer: PACE SWMI |
$135.55
|
| Rate for Payer: PHP Commercial |
$4,508.40
|
| Rate for Payer: PHP Medicare Advantage |
$135.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,447.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$412.64
|
| Rate for Payer: Priority Health Medicare |
$135.55
|
| Rate for Payer: Priority Health Narrow Network |
$330.11
|
| Rate for Payer: Priority Health SBD |
$3,341.52
|
| Rate for Payer: Railroad Medicare Medicare |
$135.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.55
|
| Rate for Payer: UHC Medicare Advantage |
$135.55
|
| Rate for Payer: UHCCP Medicaid |
$76.31
|
| Rate for Payer: VA VA |
$135.55
|
|
|
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 Commercial |
$3,712.80
|
| Rate for Payer: Cofinity Commercial |
$4,561.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,712.80
|
| 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: PHP Commercial |
$4,508.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,447.60
|
| 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 |
$72.65 |
| Max. Negotiated Rate |
$4,773.60 |
| Rate for Payer: Aetna Commercial |
$4,508.40
|
| Rate for Payer: Aetna Medicare |
$140.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,447.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.44
|
| Rate for Payer: BCBS Complete |
$76.29
|
| Rate for Payer: BCBS MAPPO |
$135.55
|
| Rate for Payer: BCBS Trust/PPO |
$405.01
|
| Rate for Payer: BCN Commercial |
$405.01
|
| Rate for Payer: BCN Medicare Advantage |
$135.55
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cofinity Commercial |
$4,561.44
|
| Rate for Payer: Cofinity Commercial |
$3,712.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,712.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,243.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.55
|
| Rate for Payer: Healthscope Commercial |
$4,773.60
|
| Rate for Payer: Mclaren Medicaid |
$72.65
|
| Rate for Payer: Mclaren Medicare |
$135.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.33
|
| Rate for Payer: Meridian Medicaid |
$76.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,508.40
|
| Rate for Payer: Nomi Health Commercial |
$406.65
|
| Rate for Payer: PACE Medicare |
$128.77
|
| Rate for Payer: PACE SWMI |
$135.55
|
| Rate for Payer: PHP Commercial |
$4,508.40
|
| Rate for Payer: PHP Medicare Advantage |
$135.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,447.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$412.64
|
| Rate for Payer: Priority Health Medicare |
$135.55
|
| Rate for Payer: Priority Health Narrow Network |
$330.11
|
| Rate for Payer: Priority Health SBD |
$3,341.52
|
| Rate for Payer: Railroad Medicare Medicare |
$135.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.55
|
| Rate for Payer: UHC Medicare Advantage |
$135.55
|
| Rate for Payer: UHCCP Medicaid |
$76.31
|
| Rate for Payer: VA VA |
$135.55
|
|
|
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 Commercial |
$3,712.80
|
| Rate for Payer: Cofinity Commercial |
$4,561.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,712.80
|
| 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: PHP Commercial |
$4,508.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,447.60
|
| Rate for Payer: Priority Health SBD |
$3,341.52
|
|
|
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 Commercial |
$3,931.20
|
| Rate for Payer: Cofinity Commercial |
$4,829.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,931.20
|
| 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: PHP Commercial |
$4,773.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,650.40
|
| Rate for Payer: Priority Health SBD |
$3,538.08
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,226.02
|
|
|
Service Code
|
HCPCS Q5108
|
| Hospital Charge Code |
187520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.16 |
| Max. Negotiated Rate |
$4,703.42 |
| Rate for Payer: Aetna Commercial |
$4,442.12
|
| Rate for Payer: Aetna Commercial |
$4,773.60
|
| Rate for Payer: Aetna Medicare |
$130.31
|
| Rate for Payer: Aetna Medicare |
$130.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,650.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,396.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.62
|
| Rate for Payer: BCBS Complete |
$70.52
|
| Rate for Payer: BCBS Complete |
$70.52
|
| Rate for Payer: BCBS MAPPO |
$125.30
|
| Rate for Payer: BCBS MAPPO |
$125.30
|
| Rate for Payer: BCBS Trust/PPO |
$375.76
|
| Rate for Payer: BCBS Trust/PPO |
$375.76
|
| Rate for Payer: BCN Commercial |
$375.76
|
| Rate for Payer: BCN Commercial |
$375.76
|
| Rate for Payer: BCN Medicare Advantage |
$125.30
|
| Rate for Payer: BCN Medicare Advantage |
$125.30
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cash Price |
$4,180.82
|
| Rate for Payer: Cash Price |
$4,180.82
|
| Rate for Payer: Cofinity Commercial |
$4,829.76
|
| Rate for Payer: Cofinity Commercial |
$3,931.20
|
| Rate for Payer: Cofinity Commercial |
$3,658.21
|
| Rate for Payer: Cofinity Commercial |
$4,494.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,658.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,931.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,492.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,180.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.30
|
| Rate for Payer: Healthscope Commercial |
$4,703.42
|
| Rate for Payer: Healthscope Commercial |
$5,054.40
|
| Rate for Payer: Mclaren Medicaid |
$67.16
|
| Rate for Payer: Mclaren Medicaid |
$67.16
|
| Rate for Payer: Mclaren Medicare |
$125.30
|
| Rate for Payer: Mclaren Medicare |
$125.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.56
|
| Rate for Payer: Meridian Medicaid |
$70.52
|
| Rate for Payer: Meridian Medicaid |
$70.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,773.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,442.12
|
| Rate for Payer: Nomi Health Commercial |
$375.90
|
| Rate for Payer: Nomi Health Commercial |
$375.90
|
| Rate for Payer: PACE Medicare |
$119.04
|
| Rate for Payer: PACE Medicare |
$119.04
|
| Rate for Payer: PACE SWMI |
$125.30
|
| Rate for Payer: PACE SWMI |
$125.30
|
| Rate for Payer: PHP Commercial |
$4,773.60
|
| Rate for Payer: PHP Commercial |
$4,442.12
|
| Rate for Payer: PHP Medicare Advantage |
$125.30
|
| Rate for Payer: PHP Medicare Advantage |
$125.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,650.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,396.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.08
|
| Rate for Payer: Priority Health Medicare |
$125.30
|
| Rate for Payer: Priority Health Medicare |
$125.30
|
| Rate for Payer: Priority Health Narrow Network |
$312.06
|
| Rate for Payer: Priority Health Narrow Network |
$312.06
|
| Rate for Payer: Priority Health SBD |
$3,292.39
|
| Rate for Payer: Priority Health SBD |
$3,538.08
|
| Rate for Payer: Railroad Medicare Medicare |
$125.30
|
| Rate for Payer: Railroad Medicare Medicare |
$125.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.30
|
| Rate for Payer: UHC Medicare Advantage |
$125.30
|
| Rate for Payer: UHC Medicare Advantage |
$125.30
|
| Rate for Payer: UHCCP Medicaid |
$70.54
|
| Rate for Payer: UHCCP Medicaid |
$70.54
|
| Rate for Payer: VA VA |
$125.30
|
| Rate for Payer: VA VA |
$125.30
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$76,228.88
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,902.83 |
| Max. Negotiated Rate |
$68,605.99 |
| Rate for Payer: Aetna Commercial |
$64,794.55
|
| Rate for Payer: Aetna Medicare |
$3,692.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49,548.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,437.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,437.56
|
| Rate for Payer: BCBS Complete |
$1,997.97
|
| Rate for Payer: BCBS MAPPO |
$3,550.05
|
| Rate for Payer: BCBS Trust/PPO |
$10,028.22
|
| Rate for Payer: BCN Commercial |
$10,028.22
|
| Rate for Payer: BCN Medicare Advantage |
$3,550.05
|
| Rate for Payer: Cash Price |
$60,983.10
|
| Rate for Payer: Cash Price |
$60,983.10
|
| Rate for Payer: Cofinity Commercial |
$65,556.84
|
| Rate for Payer: Cofinity Commercial |
$53,360.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$53,360.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60,983.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,550.05
|
| Rate for Payer: Healthscope Commercial |
$68,605.99
|
| Rate for Payer: Mclaren Medicaid |
$1,902.83
|
| Rate for Payer: Mclaren Medicare |
$3,550.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,727.55
|
| Rate for Payer: Meridian Medicaid |
$1,997.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,082.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64,794.55
|
| Rate for Payer: Nomi Health Commercial |
$10,650.15
|
| Rate for Payer: PACE Medicare |
$3,372.55
|
| Rate for Payer: PACE SWMI |
$3,550.05
|
| Rate for Payer: PHP Commercial |
$64,794.55
|
| Rate for Payer: PHP Medicare Advantage |
$3,550.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,902.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49,548.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,021.71
|
| Rate for Payer: Priority Health Medicare |
$3,550.05
|
| Rate for Payer: Priority Health Narrow Network |
$8,017.37
|
| Rate for Payer: Priority Health SBD |
$48,024.19
|
| Rate for Payer: Railroad Medicare Medicare |
$3,550.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,993.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,550.05
|
| Rate for Payer: UHC Medicare Advantage |
$3,550.05
|
| Rate for Payer: UHCCP Medicaid |
$1,998.68
|
| Rate for Payer: VA VA |
$3,550.05
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$76,228.88
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48,024.19 |
| Max. Negotiated Rate |
$68,605.99 |
| Rate for Payer: Aetna Commercial |
$64,794.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49,548.77
|
| Rate for Payer: Cash Price |
$60,983.10
|
| Rate for Payer: Cofinity Commercial |
$53,360.22
|
| Rate for Payer: Cofinity Commercial |
$65,556.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$53,360.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60,983.10
|
| Rate for Payer: Healthscope Commercial |
$68,605.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64,794.55
|
| Rate for Payer: PHP Commercial |
$64,794.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49,548.77
|
| Rate for Payer: Priority Health SBD |
$48,024.19
|
|
|
PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 57410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$113.02 |
| 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 |
$1,620.97
|
| Rate for Payer: BCN Commercial |
$1,620.97
|
| 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) |
$113.02
|
| 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
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25,961.54
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16,355.77 |
| Max. Negotiated Rate |
$23,365.39 |
| Rate for Payer: Aetna Commercial |
$22,067.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,875.00
|
| Rate for Payer: Cash Price |
$20,769.23
|
| Rate for Payer: Cofinity Commercial |
$18,173.08
|
| Rate for Payer: Cofinity Commercial |
$22,326.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,173.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,769.23
|
| Rate for Payer: Healthscope Commercial |
$23,365.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,067.31
|
| Rate for Payer: PHP Commercial |
$22,067.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,875.00
|
| Rate for Payer: Priority Health SBD |
$16,355.77
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25,961.54
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$23,365.39 |
| Rate for Payer: Aetna Commercial |
$22,067.31
|
| Rate for Payer: Aetna Medicare |
$59.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,875.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.00
|
| Rate for Payer: BCBS Complete |
$32.42
|
| Rate for Payer: BCBS MAPPO |
$57.60
|
| Rate for Payer: BCBS Trust/PPO |
$164.44
|
| Rate for Payer: BCN Commercial |
$164.44
|
| Rate for Payer: BCN Medicare Advantage |
$57.60
|
| Rate for Payer: Cash Price |
$20,769.23
|
| Rate for Payer: Cash Price |
$20,769.23
|
| Rate for Payer: Cofinity Commercial |
$22,326.92
|
| Rate for Payer: Cofinity Commercial |
$18,173.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,173.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,769.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.60
|
| Rate for Payer: Healthscope Commercial |
$23,365.39
|
| Rate for Payer: Mclaren Medicaid |
$30.87
|
| Rate for Payer: Mclaren Medicare |
$57.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.48
|
| Rate for Payer: Meridian Medicaid |
$32.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,067.31
|
| Rate for Payer: Nomi Health Commercial |
$172.80
|
| Rate for Payer: PACE Medicare |
$54.72
|
| Rate for Payer: PACE SWMI |
$57.60
|
| Rate for Payer: PHP Commercial |
$22,067.31
|
| Rate for Payer: PHP Medicare Advantage |
$57.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,875.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.55
|
| Rate for Payer: Priority Health Medicare |
$57.60
|
| Rate for Payer: Priority Health Narrow Network |
$134.04
|
| Rate for Payer: Priority Health SBD |
$16,355.77
|
| Rate for Payer: Railroad Medicare Medicare |
$57.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.60
|
| Rate for Payer: UHC Medicare Advantage |
$57.60
|
| Rate for Payer: UHCCP Medicaid |
$32.43
|
| Rate for Payer: VA VA |
$57.60
|
|
