|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
NDC 79854020060
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.50
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS MAPPO |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$164.42
|
| Rate for Payer: BCN Commercial |
$155.50
|
| Rate for Payer: BCN Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: PACE Senior Care Partners |
$47.50
|
| Rate for Payer: PACE SWMI |
$50.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Medicare Advantage |
$50.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO |
$174.00
|
| Rate for Payer: Priority Health Medicare |
$50.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.00
|
| Rate for Payer: Railroad Medicare Medicare |
$50.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.00
|
| Rate for Payer: UHC Exchange |
$50.00
|
| Rate for Payer: UHC Medicare Advantage |
$50.00
|
| Rate for Payer: VA VA |
$50.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$15.21
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.75
|
| Rate for Payer: BCBS Complete |
$6.08
|
| Rate for Payer: BCBS MAPPO |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.50
|
| Rate for Payer: BCN Commercial |
$11.83
|
| Rate for Payer: BCN Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$12.47
|
| Rate for Payer: PACE Senior Care Partners |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.80
|
| Rate for Payer: PHP Commercial |
$12.93
|
| Rate for Payer: PHP Medicare Advantage |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.89
|
| Rate for Payer: Priority Health HMO/PPO |
$13.23
|
| Rate for Payer: Priority Health Medicare |
$3.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.19
|
| Rate for Payer: Railroad Medicare Medicare |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.38
|
| Rate for Payer: UHC Core |
$12.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.80
|
| Rate for Payer: UHC Exchange |
$3.80
|
| Rate for Payer: UHC Medicare Advantage |
$3.80
|
| Rate for Payer: VA VA |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.41
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Aetna Commercial |
$16.03
|
| Rate for Payer: BCBS Trust/PPO |
$15.40
|
| Rate for Payer: BCN Commercial |
$14.58
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Healthscope Commercial |
$16.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.26
|
| Rate for Payer: Priority Health HMO/PPO |
$16.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.60
|
| Rate for Payer: UHC Core |
$15.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.14
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Aetna Commercial |
$34.21
|
| Rate for Payer: BCBS Trust/PPO |
$32.86
|
| Rate for Payer: BCN Commercial |
$31.11
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$36.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: Priority Health HMO/PPO |
$35.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.42
|
| Rate for Payer: UHC Core |
$33.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.19
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Aetna Commercial |
$16.03
|
| Rate for Payer: Aetna Medicare |
$4.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.89
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS MAPPO |
$4.71
|
| Rate for Payer: BCBS Trust/PPO |
$15.50
|
| Rate for Payer: BCN Commercial |
$14.66
|
| Rate for Payer: BCN Medicare Advantage |
$4.71
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.71
|
| Rate for Payer: Healthscope Commercial |
$16.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: PACE Senior Care Partners |
$4.48
|
| Rate for Payer: PACE SWMI |
$4.71
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: PHP Medicare Advantage |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.26
|
| Rate for Payer: Priority Health HMO/PPO |
$16.41
|
| Rate for Payer: Priority Health Medicare |
$4.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.64
|
| Rate for Payer: Railroad Medicare Medicare |
$4.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.60
|
| Rate for Payer: UHC Core |
$15.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.71
|
| Rate for Payer: UHC Exchange |
$4.71
|
| Rate for Payer: UHC Medicare Advantage |
$4.71
|
| Rate for Payer: VA VA |
$4.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.14
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$15.21
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: BCBS Trust/PPO |
$12.42
|
| Rate for Payer: BCN Commercial |
$11.75
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$12.47
|
| Rate for Payer: PHP Commercial |
$12.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.89
|
| Rate for Payer: Priority Health HMO/PPO |
$13.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.38
|
| Rate for Payer: UHC Core |
$12.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.41
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Aetna Commercial |
$34.21
|
| Rate for Payer: Aetna Medicare |
$10.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.58
|
| Rate for Payer: BCBS Complete |
$16.10
|
| Rate for Payer: BCBS MAPPO |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$33.09
|
| Rate for Payer: BCN Commercial |
$31.29
|
| Rate for Payer: BCN Medicare Advantage |
$10.06
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.06
|
| Rate for Payer: Healthscope Commercial |
$36.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$33.01
|
| Rate for Payer: PACE Senior Care Partners |
$9.56
|
| Rate for Payer: PACE SWMI |
$10.06
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: PHP Medicare Advantage |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: Priority Health HMO/PPO |
$35.02
|
| Rate for Payer: Priority Health Medicare |
$10.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.97
|
| Rate for Payer: Railroad Medicare Medicare |
$10.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.42
|
| Rate for Payer: UHC Core |
$33.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.06
|
| Rate for Payer: UHC Exchange |
$10.06
|
| Rate for Payer: UHC Medicare Advantage |
$10.06
|
| Rate for Payer: VA VA |
$10.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.19
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS
|
Facility
|
OP
|
$103.92
|
|
|
Service Code
|
NDC 00065035902
|
| Hospital Charge Code |
9701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$93.53 |
| Rate for Payer: Aetna Commercial |
$88.33
|
| Rate for Payer: Aetna Medicare |
$27.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.48
|
| Rate for Payer: BCBS Complete |
$41.57
|
| Rate for Payer: BCBS MAPPO |
$25.98
|
| Rate for Payer: BCBS Trust/PPO |
$85.43
|
| Rate for Payer: BCN Commercial |
$80.80
|
| Rate for Payer: BCN Medicare Advantage |
$25.98
|
| Rate for Payer: Cash Price |
$83.14
|
| Rate for Payer: Cofinity Commercial |
$89.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.98
|
| Rate for Payer: Healthscope Commercial |
$93.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.33
|
| Rate for Payer: Nomi Health Commercial |
$85.21
|
| Rate for Payer: PACE Senior Care Partners |
$24.68
|
| Rate for Payer: PACE SWMI |
$25.98
|
| Rate for Payer: PHP Commercial |
$88.33
|
| Rate for Payer: PHP Medicare Advantage |
$25.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.55
|
| Rate for Payer: Priority Health HMO/PPO |
$90.41
|
| Rate for Payer: Priority Health Medicare |
$26.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.63
|
| Rate for Payer: Railroad Medicare Medicare |
$25.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.45
|
| Rate for Payer: UHC Core |
$86.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.98
|
| Rate for Payer: UHC Exchange |
$25.98
|
| Rate for Payer: UHC Medicare Advantage |
$25.98
|
| Rate for Payer: VA VA |
$25.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.94
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS
|
Facility
|
IP
|
$103.92
|
|
|
Service Code
|
NDC 00065035902
|
| Hospital Charge Code |
9701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.55 |
| Max. Negotiated Rate |
$93.53 |
| Rate for Payer: Aetna Commercial |
$88.33
|
| Rate for Payer: BCBS Trust/PPO |
$84.83
|
| Rate for Payer: BCN Commercial |
$80.31
|
| Rate for Payer: Cash Price |
$83.14
|
| Rate for Payer: Cofinity Commercial |
$89.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.14
|
| Rate for Payer: Healthscope Commercial |
$93.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.33
|
| Rate for Payer: Nomi Health Commercial |
$85.21
|
| Rate for Payer: PHP Commercial |
$88.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.55
|
| Rate for Payer: Priority Health HMO/PPO |
$90.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.45
|
| Rate for Payer: UHC Core |
$86.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.94
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
IP
|
$121.70
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.11 |
| Max. Negotiated Rate |
$109.53 |
| Rate for Payer: Aetna Commercial |
$103.44
|
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: BCBS Trust/PPO |
$99.34
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCN Commercial |
$94.05
|
| Rate for Payer: BCN Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$97.36
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Cofinity Commercial |
$104.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.36
|
| Rate for Payer: Healthscope Commercial |
$109.53
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.45
|
| Rate for Payer: Nomi Health Commercial |
$99.79
|
| Rate for Payer: Nomi Health Commercial |
$3.33
|
| Rate for Payer: PHP Commercial |
$103.44
|
| Rate for Payer: PHP Commercial |
$3.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.11
|
| Rate for Payer: Priority Health HMO/PPO |
$3.53
|
| Rate for Payer: Priority Health HMO/PPO |
$105.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.57
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: UHC Core |
$3.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
OP
|
$4.06
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: Aetna Commercial |
$103.44
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Aetna Medicare |
$31.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.03
|
| Rate for Payer: BCBS Complete |
$48.68
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: BCBS MAPPO |
$30.43
|
| Rate for Payer: BCBS MAPPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCBS Trust/PPO |
$100.05
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: BCN Commercial |
$94.62
|
| Rate for Payer: BCN Medicare Advantage |
$1.01
|
| Rate for Payer: BCN Medicare Advantage |
$30.43
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$97.36
|
| Rate for Payer: Cofinity Commercial |
$104.66
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.01
|
| Rate for Payer: Healthscope Commercial |
$109.53
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.44
|
| Rate for Payer: Nomi Health Commercial |
$3.33
|
| Rate for Payer: Nomi Health Commercial |
$99.79
|
| Rate for Payer: PACE Senior Care Partners |
$0.96
|
| Rate for Payer: PACE Senior Care Partners |
$28.90
|
| Rate for Payer: PACE SWMI |
$1.01
|
| Rate for Payer: PACE SWMI |
$30.43
|
| Rate for Payer: PHP Commercial |
$3.45
|
| Rate for Payer: PHP Commercial |
$103.44
|
| Rate for Payer: PHP Medicare Advantage |
$30.43
|
| Rate for Payer: PHP Medicare Advantage |
$1.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.11
|
| Rate for Payer: Priority Health HMO/PPO |
$105.88
|
| Rate for Payer: Priority Health HMO/PPO |
$3.53
|
| Rate for Payer: Priority Health Medicare |
$1.03
|
| Rate for Payer: Priority Health Medicare |
$30.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.54
|
| Rate for Payer: Railroad Medicare Medicare |
$30.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.57
|
| Rate for Payer: UHC Core |
$3.39
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.43
|
| Rate for Payer: UHC Exchange |
$30.43
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UHC Medicare Advantage |
$30.43
|
| Rate for Payer: UHC Medicare Advantage |
$1.01
|
| Rate for Payer: VA VA |
$30.43
|
| Rate for Payer: VA VA |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.28
|
|
|
DABIGATRAN ETEXILATE 75 MG CAPSULE
|
Facility
|
IP
|
$679.99
|
|
|
Service Code
|
NDC 00597035556
|
| Hospital Charge Code |
106490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$441.99 |
| Max. Negotiated Rate |
$611.99 |
| Rate for Payer: Aetna Commercial |
$577.99
|
| Rate for Payer: BCBS Trust/PPO |
$555.08
|
| Rate for Payer: BCN Commercial |
$525.50
|
| Rate for Payer: Cash Price |
$543.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.99
|
| Rate for Payer: Healthscope Commercial |
$611.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.99
|
| Rate for Payer: Nomi Health Commercial |
$557.59
|
| Rate for Payer: PHP Commercial |
$577.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.99
|
| Rate for Payer: Priority Health HMO/PPO |
$591.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$455.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.39
|
| Rate for Payer: UHC Core |
$567.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.99
|
|
|
DABIGATRAN ETEXILATE 75 MG CAPSULE
|
Facility
|
OP
|
$679.99
|
|
|
Service Code
|
NDC 00597035556
|
| Hospital Charge Code |
106490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.50 |
| Max. Negotiated Rate |
$611.99 |
| Rate for Payer: Aetna Commercial |
$577.99
|
| Rate for Payer: Aetna Medicare |
$176.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.50
|
| Rate for Payer: BCBS Complete |
$272.00
|
| Rate for Payer: BCBS MAPPO |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$559.02
|
| Rate for Payer: BCN Commercial |
$528.69
|
| Rate for Payer: BCN Medicare Advantage |
$170.00
|
| Rate for Payer: Cash Price |
$543.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.00
|
| Rate for Payer: Healthscope Commercial |
$611.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.99
|
| Rate for Payer: Nomi Health Commercial |
$557.59
|
| Rate for Payer: PACE Senior Care Partners |
$161.50
|
| Rate for Payer: PACE SWMI |
$170.00
|
| Rate for Payer: PHP Commercial |
$577.99
|
| Rate for Payer: PHP Medicare Advantage |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.99
|
| Rate for Payer: Priority Health HMO/PPO |
$591.59
|
| Rate for Payer: Priority Health Medicare |
$171.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$455.59
|
| Rate for Payer: Railroad Medicare Medicare |
$170.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.39
|
| Rate for Payer: UHC Core |
$567.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.00
|
| Rate for Payer: UHC Exchange |
$170.00
|
| Rate for Payer: UHC Medicare Advantage |
$170.00
|
| Rate for Payer: VA VA |
$170.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.99
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$218.92
|
|
|
Service Code
|
NDC 27505000367
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$142.30 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: BCBS Trust/PPO |
$178.70
|
| Rate for Payer: BCN Commercial |
$169.18
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.14
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: Nomi Health Commercial |
$179.51
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.30
|
| Rate for Payer: Priority Health HMO/PPO |
$190.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.65
|
| Rate for Payer: UHC Core |
$182.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.19
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$218.92
|
|
|
Service Code
|
NDC 27505000367
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.99 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: Aetna Medicare |
$56.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.41
|
| Rate for Payer: BCBS Complete |
$87.57
|
| Rate for Payer: BCBS MAPPO |
$54.73
|
| Rate for Payer: BCBS Trust/PPO |
$179.97
|
| Rate for Payer: BCN Commercial |
$170.21
|
| Rate for Payer: BCN Medicare Advantage |
$54.73
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.73
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: Nomi Health Commercial |
$179.51
|
| Rate for Payer: PACE Senior Care Partners |
$51.99
|
| Rate for Payer: PACE SWMI |
$54.73
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: PHP Medicare Advantage |
$54.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.30
|
| Rate for Payer: Priority Health HMO/PPO |
$190.46
|
| Rate for Payer: Priority Health Medicare |
$55.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.68
|
| Rate for Payer: Railroad Medicare Medicare |
$54.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.65
|
| Rate for Payer: UHC Core |
$182.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.73
|
| Rate for Payer: UHC Exchange |
$54.73
|
| Rate for Payer: UHC Medicare Advantage |
$54.73
|
| Rate for Payer: VA VA |
$54.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.19
|
|
|
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
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
OP
|
$1,400.16
|
|
|
Service Code
|
NDC 00310621039
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$332.54 |
| Max. Negotiated Rate |
$1,260.14 |
| Rate for Payer: Aetna Commercial |
$1,190.14
|
| Rate for Payer: Aetna Medicare |
$364.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.55
|
| Rate for Payer: BCBS Complete |
$560.06
|
| Rate for Payer: BCBS MAPPO |
$350.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,151.07
|
| Rate for Payer: BCN Commercial |
$1,088.62
|
| Rate for Payer: BCN Medicare Advantage |
$350.04
|
| 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: Health Alliance Plan Medicare Advantage |
$350.04
|
| Rate for Payer: Healthscope Commercial |
$1,260.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.14
|
| Rate for Payer: Nomi Health Commercial |
$1,148.13
|
| Rate for Payer: PACE Senior Care Partners |
$332.54
|
| Rate for Payer: PACE SWMI |
$350.04
|
| Rate for Payer: PHP Commercial |
$1,190.14
|
| Rate for Payer: PHP Medicare Advantage |
$350.04
|
| 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 Medicare |
$353.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$938.11
|
| Rate for Payer: Railroad Medicare Medicare |
$350.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,232.14
|
| Rate for Payer: UHC Core |
$1,169.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.04
|
| Rate for Payer: UHC Exchange |
$350.04
|
| Rate for Payer: UHC Medicare Advantage |
$350.04
|
| Rate for Payer: VA VA |
$350.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.12
|
|
|
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 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 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 |
$1,196.41
|
| 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 |
$1,196.41 |
| 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 |
$1,196.41
|
| 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 |
$2.12 |
| 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 |
$2.22
|
| 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 |
$2.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.27
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| 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 |
$2.12
|
| 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 |
$2.12
|
| 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
|
OP
|
$3,618.71
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.12 |
| 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 |
$2.22
|
| 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 |
$2.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$949.91
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| 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 |
$2.12
|
| 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 |
$2.12
|
| Rate for Payer: VA VA |
$904.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,714.03
|
|
|
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
|
|
