|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$1,400.16
|
|
|
Service Code
|
NDC 00310621039
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$910.10 |
| Max. Negotiated Rate |
$1,260.14 |
| Rate for Payer: Aetna Commercial |
$1,190.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,142.95
|
| Rate for Payer: BCN Commercial |
$1,082.04
|
| Rate for Payer: Cash Price |
$1,120.13
|
| Rate for Payer: Cofinity Commercial |
$1,204.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.13
|
| Rate for Payer: Healthscope Commercial |
$1,260.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.14
|
| Rate for Payer: Nomi Health Commercial |
$1,148.13
|
| Rate for Payer: PHP Commercial |
$1,190.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,218.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$938.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,232.14
|
| Rate for Payer: UHC Core |
$1,169.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.12
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$85.67
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$77.10 |
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Commercial |
$45.39
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$69.93
|
| Rate for Payer: BCBS Trust/PPO |
$74.94
|
| Rate for Payer: BCBS Trust/PPO |
$50.68
|
| Rate for Payer: BCBS Trust/PPO |
$43.59
|
| Rate for Payer: BCN Commercial |
$66.21
|
| Rate for Payer: BCN Commercial |
$41.27
|
| Rate for Payer: BCN Commercial |
$70.94
|
| Rate for Payer: BCN Commercial |
$47.98
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Healthscope Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$48.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$43.79
|
| Rate for Payer: Nomi Health Commercial |
$50.91
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Nomi Health Commercial |
$70.25
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$45.39
|
| Rate for Payer: PHP Commercial |
$72.82
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health HMO/PPO |
$74.53
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health HMO/PPO |
$46.46
|
| Rate for Payer: Priority Health HMO/PPO |
$54.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.39
|
| Rate for Payer: UHC Core |
$71.53
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Core |
$51.84
|
| Rate for Payer: UHC Core |
$44.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$53.40
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$48.06 |
| Rate for Payer: Aetna Commercial |
$45.39
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Medicare |
$16.14
|
| Rate for Payer: Aetna Medicare |
$13.88
|
| Rate for Payer: Aetna Medicare |
$22.27
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.69
|
| Rate for Payer: BCBS Complete |
$21.36
|
| Rate for Payer: BCBS Complete |
$24.83
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Complete |
$34.27
|
| Rate for Payer: BCBS MAPPO |
$13.35
|
| Rate for Payer: BCBS MAPPO |
$15.52
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$43.90
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCBS Trust/PPO |
$51.04
|
| Rate for Payer: BCBS Trust/PPO |
$70.43
|
| Rate for Payer: BCN Commercial |
$41.52
|
| Rate for Payer: BCN Commercial |
$66.61
|
| Rate for Payer: BCN Commercial |
$48.27
|
| Rate for Payer: BCN Commercial |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$15.52
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: BCN Medicare Advantage |
$13.35
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Cofinity Commercial |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.82
|
| Rate for Payer: Nomi Health Commercial |
$70.25
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Nomi Health Commercial |
$43.79
|
| Rate for Payer: Nomi Health Commercial |
$50.91
|
| Rate for Payer: PACE Senior Care Partners |
$12.68
|
| Rate for Payer: PACE Senior Care Partners |
$20.35
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE Senior Care Partners |
$14.74
|
| Rate for Payer: PACE SWMI |
$15.52
|
| Rate for Payer: PACE SWMI |
$13.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$72.82
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$45.39
|
| Rate for Payer: PHP Medicare Advantage |
$15.52
|
| Rate for Payer: PHP Medicare Advantage |
$13.35
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.71
|
| Rate for Payer: Priority Health HMO/PPO |
$54.01
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health HMO/PPO |
$74.53
|
| Rate for Payer: Priority Health HMO/PPO |
$46.46
|
| Rate for Payer: Priority Health Medicare |
$21.63
|
| Rate for Payer: Priority Health Medicare |
$13.48
|
| Rate for Payer: Priority Health Medicare |
$15.68
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.78
|
| Rate for Payer: Railroad Medicare Medicare |
$15.52
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: Railroad Medicare Medicare |
$13.35
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.63
|
| Rate for Payer: UHC Core |
$44.59
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Core |
$51.84
|
| Rate for Payer: UHC Core |
$71.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.52
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Exchange |
$15.52
|
| Rate for Payer: UHC Exchange |
$13.35
|
| Rate for Payer: UHC Exchange |
$21.42
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: UHC Medicare Advantage |
$13.35
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UHC Medicare Advantage |
$15.52
|
| Rate for Payer: VA VA |
$15.52
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: VA VA |
$21.42
|
| Rate for Payer: VA VA |
$13.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$86.56
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.26 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna Commercial |
$73.58
|
| Rate for Payer: Aetna Commercial |
$1,129.95
|
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Commercial |
$73.35
|
| Rate for Payer: Aetna Commercial |
$109.81
|
| Rate for Payer: BCBS Trust/PPO |
$70.44
|
| Rate for Payer: BCBS Trust/PPO |
$70.66
|
| Rate for Payer: BCBS Trust/PPO |
$70.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.15
|
| Rate for Payer: BCBS Trust/PPO |
$105.46
|
| Rate for Payer: BCN Commercial |
$66.68
|
| Rate for Payer: BCN Commercial |
$66.38
|
| Rate for Payer: BCN Commercial |
$99.84
|
| Rate for Payer: BCN Commercial |
$1,027.32
|
| Rate for Payer: BCN Commercial |
$66.89
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$69.25
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cofinity Commercial |
$74.44
|
| Rate for Payer: Cofinity Commercial |
$111.10
|
| Rate for Payer: Cofinity Commercial |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Cofinity Commercial |
$1,143.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.25
|
| Rate for Payer: Healthscope Commercial |
$1,196.42
|
| Rate for Payer: Healthscope Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$116.27
|
| Rate for Payer: Healthscope Commercial |
$77.66
|
| Rate for Payer: Healthscope Commercial |
$77.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.35
|
| Rate for Payer: Nomi Health Commercial |
$105.94
|
| Rate for Payer: Nomi Health Commercial |
$1,090.07
|
| Rate for Payer: Nomi Health Commercial |
$70.43
|
| Rate for Payer: Nomi Health Commercial |
$70.76
|
| Rate for Payer: Nomi Health Commercial |
$70.98
|
| Rate for Payer: PHP Commercial |
$73.01
|
| Rate for Payer: PHP Commercial |
$1,129.95
|
| Rate for Payer: PHP Commercial |
$109.81
|
| Rate for Payer: PHP Commercial |
$73.35
|
| Rate for Payer: PHP Commercial |
$73.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.97
|
| Rate for Payer: Priority Health HMO/PPO |
$112.40
|
| Rate for Payer: Priority Health HMO/PPO |
$75.31
|
| Rate for Payer: Priority Health HMO/PPO |
$74.72
|
| Rate for Payer: Priority Health HMO/PPO |
$75.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,156.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$890.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,169.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.94
|
| Rate for Payer: UHC Core |
$107.87
|
| Rate for Payer: UHC Core |
$1,110.01
|
| Rate for Payer: UHC Core |
$72.05
|
| Rate for Payer: UHC Core |
$72.28
|
| Rate for Payer: UHC Core |
$71.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.72
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,329.35
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$315.72 |
| Max. Negotiated Rate |
$1,196.42 |
| Rate for Payer: Aetna Commercial |
$1,129.95
|
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Commercial |
$73.35
|
| Rate for Payer: Aetna Commercial |
$109.81
|
| Rate for Payer: Aetna Commercial |
$73.58
|
| Rate for Payer: Aetna Medicare |
$22.33
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$345.63
|
| Rate for Payer: Aetna Medicare |
$22.44
|
| Rate for Payer: Aetna Medicare |
$22.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$415.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$415.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.97
|
| Rate for Payer: BCBS Complete |
$34.52
|
| Rate for Payer: BCBS Complete |
$51.68
|
| Rate for Payer: BCBS Complete |
$531.74
|
| Rate for Payer: BCBS Complete |
$34.36
|
| Rate for Payer: BCBS Complete |
$34.62
|
| Rate for Payer: BCBS MAPPO |
$21.47
|
| Rate for Payer: BCBS MAPPO |
$32.30
|
| Rate for Payer: BCBS MAPPO |
$332.34
|
| Rate for Payer: BCBS MAPPO |
$21.57
|
| Rate for Payer: BCBS MAPPO |
$21.64
|
| Rate for Payer: BCBS Trust/PPO |
$106.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,092.86
|
| Rate for Payer: BCBS Trust/PPO |
$70.61
|
| Rate for Payer: BCBS Trust/PPO |
$71.16
|
| Rate for Payer: BCBS Trust/PPO |
$70.94
|
| Rate for Payer: BCN Commercial |
$67.30
|
| Rate for Payer: BCN Commercial |
$100.45
|
| Rate for Payer: BCN Commercial |
$1,033.57
|
| Rate for Payer: BCN Commercial |
$66.78
|
| Rate for Payer: BCN Commercial |
$67.09
|
| Rate for Payer: BCN Medicare Advantage |
$21.64
|
| Rate for Payer: BCN Medicare Advantage |
$21.57
|
| Rate for Payer: BCN Medicare Advantage |
$32.30
|
| Rate for Payer: BCN Medicare Advantage |
$332.34
|
| Rate for Payer: BCN Medicare Advantage |
$21.47
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cash Price |
$69.25
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cofinity Commercial |
$74.44
|
| Rate for Payer: Cofinity Commercial |
$111.10
|
| Rate for Payer: Cofinity Commercial |
$1,143.24
|
| Rate for Payer: Cofinity Commercial |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.47
|
| Rate for Payer: Healthscope Commercial |
$1,196.42
|
| Rate for Payer: Healthscope Commercial |
$116.27
|
| Rate for Payer: Healthscope Commercial |
$77.66
|
| Rate for Payer: Healthscope Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$77.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$348.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$382.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.58
|
| Rate for Payer: Nomi Health Commercial |
$1,090.07
|
| Rate for Payer: Nomi Health Commercial |
$70.76
|
| Rate for Payer: Nomi Health Commercial |
$70.43
|
| Rate for Payer: Nomi Health Commercial |
$70.98
|
| Rate for Payer: Nomi Health Commercial |
$105.94
|
| Rate for Payer: PACE Senior Care Partners |
$30.68
|
| Rate for Payer: PACE Senior Care Partners |
$20.49
|
| Rate for Payer: PACE Senior Care Partners |
$315.72
|
| Rate for Payer: PACE Senior Care Partners |
$20.40
|
| Rate for Payer: PACE Senior Care Partners |
$20.56
|
| Rate for Payer: PACE SWMI |
$32.30
|
| Rate for Payer: PACE SWMI |
$21.57
|
| Rate for Payer: PACE SWMI |
$21.47
|
| Rate for Payer: PACE SWMI |
$332.34
|
| Rate for Payer: PACE SWMI |
$21.64
|
| Rate for Payer: PHP Commercial |
$73.58
|
| Rate for Payer: PHP Commercial |
$73.01
|
| Rate for Payer: PHP Commercial |
$73.35
|
| Rate for Payer: PHP Commercial |
$1,129.95
|
| Rate for Payer: PHP Commercial |
$109.81
|
| Rate for Payer: PHP Medicare Advantage |
$21.47
|
| Rate for Payer: PHP Medicare Advantage |
$21.57
|
| Rate for Payer: PHP Medicare Advantage |
$21.64
|
| Rate for Payer: PHP Medicare Advantage |
$32.30
|
| Rate for Payer: PHP Medicare Advantage |
$332.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.97
|
| Rate for Payer: Priority Health HMO/PPO |
$112.40
|
| Rate for Payer: Priority Health HMO/PPO |
$74.72
|
| Rate for Payer: Priority Health HMO/PPO |
$75.31
|
| Rate for Payer: Priority Health HMO/PPO |
$75.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,156.53
|
| Rate for Payer: Priority Health Medicare |
$21.86
|
| Rate for Payer: Priority Health Medicare |
$21.69
|
| Rate for Payer: Priority Health Medicare |
$335.66
|
| Rate for Payer: Priority Health Medicare |
$21.79
|
| Rate for Payer: Priority Health Medicare |
$32.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$890.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.00
|
| Rate for Payer: Railroad Medicare Medicare |
$21.57
|
| Rate for Payer: Railroad Medicare Medicare |
$21.47
|
| Rate for Payer: Railroad Medicare Medicare |
$32.30
|
| Rate for Payer: Railroad Medicare Medicare |
$332.34
|
| Rate for Payer: Railroad Medicare Medicare |
$21.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,169.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.58
|
| Rate for Payer: UHC Core |
$1,110.01
|
| Rate for Payer: UHC Core |
$72.28
|
| Rate for Payer: UHC Core |
$71.72
|
| Rate for Payer: UHC Core |
$72.05
|
| Rate for Payer: UHC Core |
$107.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$332.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.47
|
| Rate for Payer: UHC Exchange |
$21.47
|
| Rate for Payer: UHC Exchange |
$21.64
|
| Rate for Payer: UHC Exchange |
$32.30
|
| Rate for Payer: UHC Exchange |
$21.57
|
| Rate for Payer: UHC Exchange |
$332.34
|
| Rate for Payer: UHC Medicare Advantage |
$332.34
|
| Rate for Payer: UHC Medicare Advantage |
$21.64
|
| Rate for Payer: UHC Medicare Advantage |
$21.47
|
| Rate for Payer: UHC Medicare Advantage |
$32.30
|
| Rate for Payer: UHC Medicare Advantage |
$21.57
|
| Rate for Payer: VA VA |
$32.30
|
| Rate for Payer: VA VA |
$21.57
|
| Rate for Payer: VA VA |
$332.34
|
| Rate for Payer: VA VA |
$21.64
|
| Rate for Payer: VA VA |
$21.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.42
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna Medicare |
$627.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.90
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS MAPPO |
$603.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,983.29
|
| Rate for Payer: BCN Commercial |
$1,875.70
|
| Rate for Payer: BCN Medicare Advantage |
$603.12
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.12
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.35
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.27
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.60
|
| Rate for Payer: Nomi Health Commercial |
$1,978.23
|
| Rate for Payer: PACE Senior Care Partners |
$572.96
|
| Rate for Payer: PACE SWMI |
$603.12
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: PHP Medicare Advantage |
$603.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,568.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2,098.85
|
| Rate for Payer: Priority Health Medicare |
$609.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,616.35
|
| Rate for Payer: Railroad Medicare Medicare |
$603.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,122.97
|
| Rate for Payer: UHC Core |
$2,014.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$603.12
|
| Rate for Payer: UHC Exchange |
$603.12
|
| Rate for Payer: UHC Medicare Advantage |
$603.12
|
| Rate for Payer: UHCCP Medicaid |
$2.15
|
| Rate for Payer: VA VA |
$603.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.35
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,568.11 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,969.30
|
| Rate for Payer: BCN Commercial |
$1,864.36
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.60
|
| Rate for Payer: Nomi Health Commercial |
$1,978.23
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,568.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2,098.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,616.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,122.97
|
| Rate for Payer: UHC Core |
$2,014.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.35
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$3,618.71
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,352.16 |
| Max. Negotiated Rate |
$3,256.84 |
| Rate for Payer: Aetna Commercial |
$3,075.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,953.95
|
| Rate for Payer: BCN Commercial |
$2,796.54
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cofinity Commercial |
$3,112.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,894.97
|
| Rate for Payer: Healthscope Commercial |
$3,256.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,714.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.90
|
| Rate for Payer: Nomi Health Commercial |
$2,967.34
|
| Rate for Payer: PHP Commercial |
$3,075.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,352.16
|
| Rate for Payer: Priority Health HMO/PPO |
$3,148.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,424.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,184.46
|
| Rate for Payer: UHC Core |
$3,021.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,714.03
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$3,618.71
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$3,256.84 |
| Rate for Payer: Aetna Commercial |
$3,075.90
|
| Rate for Payer: Aetna Medicare |
$940.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,130.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,130.85
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS MAPPO |
$904.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,974.94
|
| Rate for Payer: BCN Commercial |
$2,813.55
|
| Rate for Payer: BCN Medicare Advantage |
$904.68
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cofinity Commercial |
$3,112.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,894.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$904.68
|
| Rate for Payer: Healthscope Commercial |
$3,256.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,714.03
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$949.91
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,040.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.90
|
| Rate for Payer: Nomi Health Commercial |
$2,967.34
|
| Rate for Payer: PACE Senior Care Partners |
$859.44
|
| Rate for Payer: PACE SWMI |
$904.68
|
| Rate for Payer: PHP Commercial |
$3,075.90
|
| Rate for Payer: PHP Medicare Advantage |
$904.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,352.16
|
| Rate for Payer: Priority Health HMO/PPO |
$3,148.28
|
| Rate for Payer: Priority Health Medicare |
$913.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,424.54
|
| Rate for Payer: Railroad Medicare Medicare |
$904.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,184.46
|
| Rate for Payer: UHC Core |
$3,021.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$904.68
|
| Rate for Payer: UHC Exchange |
$904.68
|
| Rate for Payer: UHC Medicare Advantage |
$904.68
|
| Rate for Payer: UHCCP Medicaid |
$2.15
|
| Rate for Payer: VA VA |
$904.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,714.03
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$4,824.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: Aetna Medicare |
$1,254.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,507.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,507.79
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS MAPPO |
$1,206.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,966.57
|
| Rate for Payer: BCN Commercial |
$3,751.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,206.23
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cofinity Commercial |
$4,149.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,859.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,206.23
|
| Rate for Payer: Healthscope Commercial |
$4,342.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,618.70
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,266.54
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,387.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,101.19
|
| Rate for Payer: Nomi Health Commercial |
$3,956.44
|
| Rate for Payer: PACE Senior Care Partners |
$1,145.92
|
| Rate for Payer: PACE SWMI |
$1,206.23
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,206.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,136.20
|
| Rate for Payer: Priority Health HMO/PPO |
$4,197.69
|
| Rate for Payer: Priority Health Medicare |
$1,218.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,232.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,206.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,245.94
|
| Rate for Payer: UHC Core |
$4,028.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,206.23
|
| Rate for Payer: UHC Exchange |
$1,206.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,206.23
|
| Rate for Payer: UHCCP Medicaid |
$2.15
|
| Rate for Payer: VA VA |
$1,206.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,618.70
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$4,824.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,136.20 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,938.59
|
| Rate for Payer: BCN Commercial |
$3,728.71
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cofinity Commercial |
$4,149.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,859.94
|
| Rate for Payer: Healthscope Commercial |
$4,342.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,618.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,101.19
|
| Rate for Payer: Nomi Health Commercial |
$3,956.44
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,136.20
|
| Rate for Payer: Priority Health HMO/PPO |
$4,197.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,232.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,245.94
|
| Rate for Payer: UHC Core |
$4,028.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,618.70
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna Medicare |
$173.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.09
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS MAPPO |
$167.27
|
| Rate for Payer: BCBS Trust/PPO |
$550.06
|
| Rate for Payer: BCN Commercial |
$520.22
|
| Rate for Payer: BCN Medicare Advantage |
$167.27
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Commercial |
$575.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.27
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.82
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.64
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.73
|
| Rate for Payer: Nomi Health Commercial |
$548.65
|
| Rate for Payer: PACE Senior Care Partners |
$158.91
|
| Rate for Payer: PACE SWMI |
$167.27
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: PHP Medicare Advantage |
$167.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.91
|
| Rate for Payer: Priority Health HMO/PPO |
$582.11
|
| Rate for Payer: Priority Health Medicare |
$168.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$448.29
|
| Rate for Payer: Railroad Medicare Medicare |
$167.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.80
|
| Rate for Payer: UHC Core |
$558.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.27
|
| Rate for Payer: UHC Exchange |
$167.27
|
| Rate for Payer: UHC Medicare Advantage |
$167.27
|
| Rate for Payer: UHCCP Medicaid |
$2.15
|
| Rate for Payer: VA VA |
$167.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.82
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$434.91 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: BCBS Trust/PPO |
$546.18
|
| Rate for Payer: BCN Commercial |
$517.07
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Commercial |
$575.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.27
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.73
|
| Rate for Payer: Nomi Health Commercial |
$548.65
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.91
|
| Rate for Payer: Priority Health HMO/PPO |
$582.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$448.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.80
|
| Rate for Payer: UHC Core |
$558.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.82
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,822.26 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: BCBS Trust/PPO |
$4,800.17
|
| Rate for Payer: BCN Commercial |
$4,544.37
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cofinity Commercial |
$5,057.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,704.32
|
| Rate for Payer: Healthscope Commercial |
$5,292.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,410.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,998.34
|
| Rate for Payer: Nomi Health Commercial |
$4,821.93
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,822.26
|
| Rate for Payer: Priority Health HMO/PPO |
$5,115.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,939.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,174.75
|
| Rate for Payer: UHC Core |
$4,910.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,410.30
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: Aetna Medicare |
$1,528.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,837.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,837.62
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS MAPPO |
$1,470.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,834.28
|
| Rate for Payer: BCN Commercial |
$4,572.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,470.10
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cofinity Commercial |
$5,057.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,704.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,470.10
|
| Rate for Payer: Healthscope Commercial |
$5,292.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,410.30
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,543.60
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,690.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,998.34
|
| Rate for Payer: Nomi Health Commercial |
$4,821.93
|
| Rate for Payer: PACE Senior Care Partners |
$1,396.60
|
| Rate for Payer: PACE SWMI |
$1,470.10
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,470.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,822.26
|
| Rate for Payer: Priority Health HMO/PPO |
$5,115.95
|
| Rate for Payer: Priority Health Medicare |
$1,484.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,939.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,470.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,174.75
|
| Rate for Payer: UHC Core |
$4,910.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,470.10
|
| Rate for Payer: UHC Exchange |
$1,470.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,470.10
|
| Rate for Payer: UHCCP Medicaid |
$2.15
|
| Rate for Payer: VA VA |
$1,470.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,410.30
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$964.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$627.24 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: BCBS Trust/PPO |
$787.72
|
| Rate for Payer: BCN Commercial |
$745.74
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cofinity Commercial |
$829.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.99
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.24
|
| Rate for Payer: Nomi Health Commercial |
$791.29
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.24
|
| Rate for Payer: Priority Health HMO/PPO |
$839.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$646.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.19
|
| Rate for Payer: UHC Core |
$805.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.74
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$964.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna Medicare |
$250.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$301.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$301.56
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS MAPPO |
$241.25
|
| Rate for Payer: BCBS Trust/PPO |
$793.32
|
| Rate for Payer: BCN Commercial |
$750.28
|
| Rate for Payer: BCN Medicare Advantage |
$241.25
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cofinity Commercial |
$829.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.25
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.74
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.31
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.24
|
| Rate for Payer: Nomi Health Commercial |
$791.29
|
| Rate for Payer: PACE Senior Care Partners |
$229.19
|
| Rate for Payer: PACE SWMI |
$241.25
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: PHP Medicare Advantage |
$241.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.24
|
| Rate for Payer: Priority Health HMO/PPO |
$839.54
|
| Rate for Payer: Priority Health Medicare |
$243.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$646.54
|
| Rate for Payer: Railroad Medicare Medicare |
$241.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.19
|
| Rate for Payer: UHC Core |
$805.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.25
|
| Rate for Payer: UHC Exchange |
$241.25
|
| Rate for Payer: UHC Medicare Advantage |
$241.25
|
| Rate for Payer: UHCCP Medicaid |
$2.15
|
| Rate for Payer: VA VA |
$241.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.74
|
|
|
DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$9,800.65
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$8,820.58 |
| Rate for Payer: Aetna Commercial |
$8,330.55
|
| Rate for Payer: Aetna Medicare |
$2,548.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,062.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,062.70
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS MAPPO |
$2,450.16
|
| Rate for Payer: BCBS Trust/PPO |
$8,057.11
|
| Rate for Payer: BCN Commercial |
$7,620.01
|
| Rate for Payer: BCN Medicare Advantage |
$2,450.16
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cofinity Commercial |
$8,428.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,840.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,450.16
|
| Rate for Payer: Healthscope Commercial |
$8,820.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,350.49
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,572.67
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,817.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,330.55
|
| Rate for Payer: Nomi Health Commercial |
$8,036.53
|
| Rate for Payer: PACE Senior Care Partners |
$2,327.65
|
| Rate for Payer: PACE SWMI |
$2,450.16
|
| Rate for Payer: PHP Commercial |
$8,330.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,450.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,370.42
|
| Rate for Payer: Priority Health HMO/PPO |
$8,526.57
|
| Rate for Payer: Priority Health Medicare |
$2,474.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,566.44
|
| Rate for Payer: Railroad Medicare Medicare |
$2,450.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,624.57
|
| Rate for Payer: UHC Core |
$8,183.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,450.16
|
| Rate for Payer: UHC Exchange |
$2,450.16
|
| Rate for Payer: UHC Medicare Advantage |
$2,450.16
|
| Rate for Payer: UHCCP Medicaid |
$2.15
|
| Rate for Payer: VA VA |
$2,450.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,350.49
|
|
|
DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$9,800.65
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,370.42 |
| Max. Negotiated Rate |
$8,820.58 |
| Rate for Payer: Aetna Commercial |
$8,330.55
|
| Rate for Payer: BCBS Trust/PPO |
$8,000.27
|
| Rate for Payer: BCN Commercial |
$7,573.94
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cofinity Commercial |
$8,428.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,840.52
|
| Rate for Payer: Healthscope Commercial |
$8,820.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,350.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,330.55
|
| Rate for Payer: Nomi Health Commercial |
$8,036.53
|
| Rate for Payer: PHP Commercial |
$8,330.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,370.42
|
| Rate for Payer: Priority Health HMO/PPO |
$8,526.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,566.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,624.57
|
| Rate for Payer: UHC Core |
$8,183.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,350.49
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$1,447.49
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: Aetna Medicare |
$376.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$452.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$452.34
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS MAPPO |
$361.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,189.98
|
| Rate for Payer: BCN Commercial |
$1,125.42
|
| Rate for Payer: BCN Medicare Advantage |
$361.87
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cofinity Commercial |
$1,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.87
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.62
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$379.97
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.37
|
| Rate for Payer: Nomi Health Commercial |
$1,186.94
|
| Rate for Payer: PACE Senior Care Partners |
$343.78
|
| Rate for Payer: PACE SWMI |
$361.87
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: PHP Medicare Advantage |
$361.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1,259.32
|
| Rate for Payer: Priority Health Medicare |
$365.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$969.82
|
| Rate for Payer: Railroad Medicare Medicare |
$361.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,273.79
|
| Rate for Payer: UHC Core |
$1,208.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$361.87
|
| Rate for Payer: UHC Exchange |
$361.87
|
| Rate for Payer: UHC Medicare Advantage |
$361.87
|
| Rate for Payer: UHCCP Medicaid |
$2.15
|
| Rate for Payer: VA VA |
$361.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.62
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$1,447.49
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$940.87 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,181.59
|
| Rate for Payer: BCN Commercial |
$1,118.62
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cofinity Commercial |
$1,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.99
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.37
|
| Rate for Payer: Nomi Health Commercial |
$1,186.94
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1,259.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$969.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,273.79
|
| Rate for Payer: UHC Core |
$1,208.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.62
|
|
|
DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,205.21
|
|
|
Service Code
|
CPT 11044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,147.75 |
| Max. Negotiated Rate |
$1,205.21 |
| Rate for Payer: BCBS Complete |
$1,205.21
|
| Rate for Payer: Mclaren Medicaid |
$1,147.75
|
| Rate for Payer: Meridian Medicaid |
$1,205.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,147.75
|
| Rate for Payer: UHCCP Medicaid |
$1,147.75
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$297.19
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$283.02 |
| Max. Negotiated Rate |
$297.19 |
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
IP
|
$86.16
|
|
|
Service Code
|
NDC 09900000199
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$77.54 |
| Rate for Payer: Aetna Commercial |
$73.24
|
| Rate for Payer: BCBS Trust/PPO |
$70.33
|
| Rate for Payer: BCN Commercial |
$66.58
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$77.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.24
|
| Rate for Payer: Nomi Health Commercial |
$70.65
|
| Rate for Payer: PHP Commercial |
$73.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO |
$74.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.82
|
| Rate for Payer: UHC Core |
$71.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.62
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
OP
|
$86.16
|
|
|
Service Code
|
NDC 09900000199
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$77.54 |
| Rate for Payer: Aetna Commercial |
$73.24
|
| Rate for Payer: Aetna Medicare |
$22.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.92
|
| Rate for Payer: BCBS Complete |
$34.46
|
| Rate for Payer: BCBS MAPPO |
$21.54
|
| Rate for Payer: BCBS Trust/PPO |
$70.83
|
| Rate for Payer: BCN Commercial |
$66.99
|
| Rate for Payer: BCN Medicare Advantage |
$21.54
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.54
|
| Rate for Payer: Healthscope Commercial |
$77.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.24
|
| Rate for Payer: Nomi Health Commercial |
$70.65
|
| Rate for Payer: PACE Senior Care Partners |
$20.46
|
| Rate for Payer: PACE SWMI |
$21.54
|
| Rate for Payer: PHP Commercial |
$73.24
|
| Rate for Payer: PHP Medicare Advantage |
$21.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO |
$74.96
|
| Rate for Payer: Priority Health Medicare |
$21.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.73
|
| Rate for Payer: Railroad Medicare Medicare |
$21.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.82
|
| Rate for Payer: UHC Core |
$71.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.54
|
| Rate for Payer: UHC Exchange |
$21.54
|
| Rate for Payer: UHC Medicare Advantage |
$21.54
|
| Rate for Payer: VA VA |
$21.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.62
|
|
