|
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 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 |
$2.12 |
| 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 |
$2.22
|
| 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 |
$2.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,266.54
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| 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 |
$2.12
|
| 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 |
$2.12
|
| Rate for Payer: VA VA |
$1,206.23
|
| 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 |
$2.12 |
| 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 |
$2.22
|
| 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 |
$2.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.64
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| 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 |
$2.12
|
| 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 |
$2.12
|
| 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
|
OP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.12 |
| 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 |
$2.22
|
| 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 |
$2.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,543.61
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| 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 |
$2.12
|
| 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 |
$2.12
|
| Rate for Payer: VA VA |
$1,470.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,410.30
|
|
|
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 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 |
$2.12 |
| 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 |
$2.22
|
| 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 |
$2.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.31
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| 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 |
$2.12
|
| 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 |
$2.12
|
| Rate for Payer: VA VA |
$241.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.74
|
|
|
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 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 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 |
$2.12 |
| 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 |
$2.22
|
| 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 |
$2.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,572.67
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| 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 |
$2.12
|
| 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 |
$2.12
|
| Rate for Payer: VA VA |
$2,450.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,350.49
|
|
|
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
|
|
|
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 |
$2.12 |
| 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 |
$2.22
|
| 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 |
$2.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$379.97
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| 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 |
$2.12
|
| 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 |
$2.12
|
| Rate for Payer: VA VA |
$361.87
|
| 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
|
$1,230.09
|
|
|
Service Code
|
CPT 11044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,171.43 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$303.32
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$288.86 |
| Max. Negotiated Rate |
$303.32 |
| Rate for Payer: BCBS Complete |
$303.32
|
| Rate for Payer: Mclaren Medicaid |
$288.86
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.86
|
| Rate for Payer: UHCCP Medicaid |
$288.86
|
|
|
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 |
$26.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.93
|
| 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
|
|
|
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
|
|
|
DERMAPLANNING
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 00175
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
|
|
DESIPRAMINE 25 MG TABLET
|
Facility
|
OP
|
$500.16
|
|
|
Service Code
|
NDC 45963034202
|
| Hospital Charge Code |
2286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.79 |
| Max. Negotiated Rate |
$450.14 |
| Rate for Payer: Aetna Commercial |
$425.14
|
| Rate for Payer: Aetna Medicare |
$130.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.30
|
| Rate for Payer: BCBS Complete |
$200.06
|
| Rate for Payer: BCBS MAPPO |
$125.04
|
| Rate for Payer: BCBS Trust/PPO |
$411.18
|
| Rate for Payer: BCN Commercial |
$388.87
|
| Rate for Payer: BCN Medicare Advantage |
$125.04
|
| Rate for Payer: Cash Price |
$400.13
|
| Rate for Payer: Cofinity Commercial |
$430.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.04
|
| Rate for Payer: Healthscope Commercial |
$450.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.14
|
| Rate for Payer: Nomi Health Commercial |
$410.13
|
| Rate for Payer: PACE Senior Care Partners |
$118.79
|
| Rate for Payer: PACE SWMI |
$125.04
|
| Rate for Payer: PHP Commercial |
$425.14
|
| Rate for Payer: PHP Medicare Advantage |
$125.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.10
|
| Rate for Payer: Priority Health HMO/PPO |
$435.14
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.11
|
| Rate for Payer: Railroad Medicare Medicare |
$125.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.14
|
| Rate for Payer: UHC Core |
$417.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.04
|
| Rate for Payer: UHC Exchange |
$125.04
|
| Rate for Payer: UHC Medicare Advantage |
$125.04
|
| Rate for Payer: VA VA |
$125.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.12
|
|
|
DESIPRAMINE 25 MG TABLET
|
Facility
|
IP
|
$500.16
|
|
|
Service Code
|
NDC 45963034202
|
| Hospital Charge Code |
2286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.10 |
| Max. Negotiated Rate |
$450.14 |
| Rate for Payer: Aetna Commercial |
$425.14
|
| Rate for Payer: BCBS Trust/PPO |
$408.28
|
| Rate for Payer: BCN Commercial |
$386.52
|
| Rate for Payer: Cash Price |
$400.13
|
| Rate for Payer: Cofinity Commercial |
$430.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.13
|
| Rate for Payer: Healthscope Commercial |
$450.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.14
|
| Rate for Payer: Nomi Health Commercial |
$410.13
|
| Rate for Payer: PHP Commercial |
$425.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.10
|
| Rate for Payer: Priority Health HMO/PPO |
$435.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.14
|
| Rate for Payer: UHC Core |
$417.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.12
|
|
|
DESMOPRESSIN 0.2 MG TABLET
|
Facility
|
IP
|
$274.32
|
|
|
Service Code
|
NDC 68084060421
|
| Hospital Charge Code |
16053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.31 |
| Max. Negotiated Rate |
$246.89 |
| Rate for Payer: Aetna Commercial |
$233.17
|
| Rate for Payer: BCBS Trust/PPO |
$223.93
|
| Rate for Payer: BCN Commercial |
$211.99
|
| Rate for Payer: Cash Price |
$219.46
|
| Rate for Payer: Cofinity Commercial |
$235.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.46
|
| Rate for Payer: Healthscope Commercial |
$246.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.17
|
| Rate for Payer: Nomi Health Commercial |
$224.94
|
| Rate for Payer: PHP Commercial |
$233.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.31
|
| Rate for Payer: Priority Health HMO/PPO |
$238.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.40
|
| Rate for Payer: UHC Core |
$229.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.74
|
|
|
DESMOPRESSIN 0.2 MG TABLET
|
Facility
|
IP
|
$9.15
|
|
|
Service Code
|
NDC 68084060411
|
| Hospital Charge Code |
16053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$8.23 |
| Rate for Payer: Aetna Commercial |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$7.47
|
| Rate for Payer: BCN Commercial |
$7.07
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$7.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.32
|
| Rate for Payer: Healthscope Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.78
|
| Rate for Payer: Nomi Health Commercial |
$7.50
|
| Rate for Payer: PHP Commercial |
$7.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.95
|
| Rate for Payer: Priority Health HMO/PPO |
$7.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.05
|
| Rate for Payer: UHC Core |
$7.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.86
|
|
|
DESMOPRESSIN 0.2 MG TABLET
|
Facility
|
OP
|
$274.32
|
|
|
Service Code
|
NDC 68084060421
|
| Hospital Charge Code |
16053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.15 |
| Max. Negotiated Rate |
$246.89 |
| Rate for Payer: Aetna Commercial |
$233.17
|
| Rate for Payer: Aetna Medicare |
$71.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.72
|
| Rate for Payer: BCBS Complete |
$109.73
|
| Rate for Payer: BCBS MAPPO |
$68.58
|
| Rate for Payer: BCBS Trust/PPO |
$225.52
|
| Rate for Payer: BCN Commercial |
$213.28
|
| Rate for Payer: BCN Medicare Advantage |
$68.58
|
| Rate for Payer: Cash Price |
$219.46
|
| Rate for Payer: Cofinity Commercial |
$235.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$246.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.17
|
| Rate for Payer: Nomi Health Commercial |
$224.94
|
| Rate for Payer: PACE Senior Care Partners |
$65.15
|
| Rate for Payer: PACE SWMI |
$68.58
|
| Rate for Payer: PHP Commercial |
$233.17
|
| Rate for Payer: PHP Medicare Advantage |
$68.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.31
|
| Rate for Payer: Priority Health HMO/PPO |
$238.66
|
| Rate for Payer: Priority Health Medicare |
$69.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.79
|
| Rate for Payer: Railroad Medicare Medicare |
$68.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.40
|
| Rate for Payer: UHC Core |
$229.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.58
|
| Rate for Payer: UHC Exchange |
$68.58
|
| Rate for Payer: UHC Medicare Advantage |
$68.58
|
| Rate for Payer: VA VA |
$68.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.74
|
|
|
DESMOPRESSIN 0.2 MG TABLET
|
Facility
|
OP
|
$9.15
|
|
|
Service Code
|
NDC 68084060411
|
| Hospital Charge Code |
16053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$8.23 |
| Rate for Payer: Aetna Commercial |
$7.78
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.86
|
| Rate for Payer: BCBS Complete |
$3.66
|
| Rate for Payer: BCBS MAPPO |
$2.29
|
| Rate for Payer: BCBS Trust/PPO |
$7.52
|
| Rate for Payer: BCN Commercial |
$7.11
|
| Rate for Payer: BCN Medicare Advantage |
$2.29
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$7.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.78
|
| Rate for Payer: Nomi Health Commercial |
$7.50
|
| Rate for Payer: PACE Senior Care Partners |
$2.17
|
| Rate for Payer: PACE SWMI |
$2.29
|
| Rate for Payer: PHP Commercial |
$7.78
|
| Rate for Payer: PHP Medicare Advantage |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.95
|
| Rate for Payer: Priority Health HMO/PPO |
$7.96
|
| Rate for Payer: Priority Health Medicare |
$2.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.13
|
| Rate for Payer: Railroad Medicare Medicare |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.05
|
| Rate for Payer: UHC Core |
$7.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.29
|
| Rate for Payer: UHC Exchange |
$2.29
|
| Rate for Payer: UHC Medicare Advantage |
$2.29
|
| Rate for Payer: VA VA |
$2.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.86
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$600.09
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$540.08 |
| Rate for Payer: Aetna Commercial |
$510.08
|
| Rate for Payer: Aetna Commercial |
$167.03
|
| Rate for Payer: Aetna Commercial |
$587.46
|
| Rate for Payer: Aetna Commercial |
$179.41
|
| Rate for Payer: Aetna Commercial |
$184.69
|
| Rate for Payer: Aetna Medicare |
$56.49
|
| Rate for Payer: Aetna Medicare |
$51.09
|
| Rate for Payer: Aetna Medicare |
$156.02
|
| Rate for Payer: Aetna Medicare |
$54.88
|
| Rate for Payer: Aetna Medicare |
$179.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$187.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$187.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.98
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS MAPPO |
$150.02
|
| Rate for Payer: BCBS MAPPO |
$52.77
|
| Rate for Payer: BCBS MAPPO |
$49.13
|
| Rate for Payer: BCBS MAPPO |
$54.32
|
| Rate for Payer: BCBS MAPPO |
$172.78
|
| Rate for Payer: BCBS Trust/PPO |
$568.18
|
| Rate for Payer: BCBS Trust/PPO |
$493.33
|
| Rate for Payer: BCBS Trust/PPO |
$178.63
|
| Rate for Payer: BCBS Trust/PPO |
$173.52
|
| Rate for Payer: BCBS Trust/PPO |
$161.55
|
| Rate for Payer: BCN Commercial |
$168.94
|
| Rate for Payer: BCN Commercial |
$164.11
|
| Rate for Payer: BCN Commercial |
$466.57
|
| Rate for Payer: BCN Commercial |
$537.35
|
| Rate for Payer: BCN Commercial |
$152.79
|
| Rate for Payer: BCN Medicare Advantage |
$172.78
|
| Rate for Payer: BCN Medicare Advantage |
$49.13
|
| Rate for Payer: BCN Medicare Advantage |
$54.32
|
| Rate for Payer: BCN Medicare Advantage |
$150.02
|
| Rate for Payer: BCN Medicare Advantage |
$52.77
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cash Price |
$157.21
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cash Price |
$168.86
|
| Rate for Payer: Cash Price |
$480.07
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cash Price |
$480.07
|
| Rate for Payer: Cash Price |
$168.86
|
| Rate for Payer: Cash Price |
$157.21
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cofinity Commercial |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$186.86
|
| Rate for Payer: Cofinity Commercial |
$181.52
|
| Rate for Payer: Cofinity Commercial |
$516.08
|
| Rate for Payer: Cofinity Commercial |
$594.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.32
|
| Rate for Payer: Healthscope Commercial |
$622.02
|
| Rate for Payer: Healthscope Commercial |
$176.86
|
| Rate for Payer: Healthscope Commercial |
$195.55
|
| Rate for Payer: Healthscope Commercial |
$540.08
|
| Rate for Payer: Healthscope Commercial |
$189.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.38
|
| Rate for Payer: Mclaren Medicaid |
$2.54
|
| Rate for Payer: Mclaren Medicaid |
$2.54
|
| Rate for Payer: Mclaren Medicaid |
$2.54
|
| Rate for Payer: Mclaren Medicaid |
$2.54
|
| Rate for Payer: Mclaren Medicaid |
$2.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.52
|
| Rate for Payer: Meridian Medicaid |
$2.67
|
| Rate for Payer: Meridian Medicaid |
$2.67
|
| Rate for Payer: Meridian Medicaid |
$2.67
|
| Rate for Payer: Meridian Medicaid |
$2.67
|
| Rate for Payer: Meridian Medicaid |
$2.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.69
|
| Rate for Payer: Nomi Health Commercial |
$161.14
|
| Rate for Payer: Nomi Health Commercial |
$566.73
|
| Rate for Payer: Nomi Health Commercial |
$178.17
|
| Rate for Payer: Nomi Health Commercial |
$173.08
|
| Rate for Payer: Nomi Health Commercial |
$492.07
|
| Rate for Payer: PACE Senior Care Partners |
$51.60
|
| Rate for Payer: PACE Senior Care Partners |
$50.13
|
| Rate for Payer: PACE Senior Care Partners |
$164.14
|
| Rate for Payer: PACE Senior Care Partners |
$46.67
|
| Rate for Payer: PACE Senior Care Partners |
$142.52
|
| Rate for Payer: PACE SWMI |
$49.13
|
| Rate for Payer: PACE SWMI |
$172.78
|
| Rate for Payer: PACE SWMI |
$150.02
|
| Rate for Payer: PACE SWMI |
$54.32
|
| Rate for Payer: PACE SWMI |
$52.77
|
| Rate for Payer: PHP Commercial |
$587.46
|
| Rate for Payer: PHP Commercial |
$167.03
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Commercial |
$510.08
|
| Rate for Payer: PHP Commercial |
$179.41
|
| Rate for Payer: PHP Medicare Advantage |
$49.13
|
| Rate for Payer: PHP Medicare Advantage |
$52.77
|
| Rate for Payer: PHP Medicare Advantage |
$172.78
|
| Rate for Payer: PHP Medicare Advantage |
$54.32
|
| Rate for Payer: PHP Medicare Advantage |
$150.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health HMO/PPO |
$522.08
|
| Rate for Payer: Priority Health HMO/PPO |
$170.96
|
| Rate for Payer: Priority Health HMO/PPO |
$183.63
|
| Rate for Payer: Priority Health HMO/PPO |
$189.03
|
| Rate for Payer: Priority Health HMO/PPO |
$601.28
|
| Rate for Payer: Priority Health Medicare |
$151.52
|
| Rate for Payer: Priority Health Medicare |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$174.51
|
| Rate for Payer: Priority Health Medicare |
$49.62
|
| Rate for Payer: Priority Health Medicare |
$54.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$402.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.06
|
| Rate for Payer: Railroad Medicare Medicare |
$49.13
|
| Rate for Payer: Railroad Medicare Medicare |
$150.02
|
| Rate for Payer: Railroad Medicare Medicare |
$54.32
|
| Rate for Payer: Railroad Medicare Medicare |
$172.78
|
| Rate for Payer: Railroad Medicare Medicare |
$52.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.74
|
| Rate for Payer: UHC Core |
$181.43
|
| Rate for Payer: UHC Core |
$176.24
|
| Rate for Payer: UHC Core |
$164.09
|
| Rate for Payer: UHC Core |
$501.08
|
| Rate for Payer: UHC Core |
$577.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.13
|
| Rate for Payer: UHC Exchange |
$172.78
|
| Rate for Payer: UHC Exchange |
$49.13
|
| Rate for Payer: UHC Exchange |
$54.32
|
| Rate for Payer: UHC Exchange |
$150.02
|
| Rate for Payer: UHC Exchange |
$52.77
|
| Rate for Payer: UHC Medicare Advantage |
$150.02
|
| Rate for Payer: UHC Medicare Advantage |
$54.32
|
| Rate for Payer: UHC Medicare Advantage |
$52.77
|
| Rate for Payer: UHC Medicare Advantage |
$49.13
|
| Rate for Payer: UHC Medicare Advantage |
$172.78
|
| Rate for Payer: UHCCP Medicaid |
$2.54
|
| Rate for Payer: UHCCP Medicaid |
$2.54
|
| Rate for Payer: UHCCP Medicaid |
$2.54
|
| Rate for Payer: UHCCP Medicaid |
$2.54
|
| Rate for Payer: UHCCP Medicaid |
$2.54
|
| Rate for Payer: VA VA |
$172.78
|
| Rate for Payer: VA VA |
$49.13
|
| Rate for Payer: VA VA |
$54.32
|
| Rate for Payer: VA VA |
$52.77
|
| Rate for Payer: VA VA |
$150.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.30
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$691.13
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$449.23 |
| Max. Negotiated Rate |
$622.02 |
| Rate for Payer: Aetna Commercial |
$587.46
|
| Rate for Payer: Aetna Commercial |
$179.41
|
| Rate for Payer: Aetna Commercial |
$184.69
|
| Rate for Payer: Aetna Commercial |
$510.08
|
| Rate for Payer: Aetna Commercial |
$167.03
|
| Rate for Payer: BCBS Trust/PPO |
$489.85
|
| Rate for Payer: BCBS Trust/PPO |
$564.17
|
| Rate for Payer: BCBS Trust/PPO |
$177.37
|
| Rate for Payer: BCBS Trust/PPO |
$172.30
|
| Rate for Payer: BCBS Trust/PPO |
$160.41
|
| Rate for Payer: BCN Commercial |
$463.75
|
| Rate for Payer: BCN Commercial |
$167.91
|
| Rate for Payer: BCN Commercial |
$151.86
|
| Rate for Payer: BCN Commercial |
$163.11
|
| Rate for Payer: BCN Commercial |
$534.11
|
| Rate for Payer: Cash Price |
$157.21
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cash Price |
$168.86
|
| Rate for Payer: Cash Price |
$480.07
|
| Rate for Payer: Cofinity Commercial |
$594.37
|
| Rate for Payer: Cofinity Commercial |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$516.08
|
| Rate for Payer: Cofinity Commercial |
$186.86
|
| Rate for Payer: Cofinity Commercial |
$181.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.90
|
| Rate for Payer: Healthscope Commercial |
$189.96
|
| Rate for Payer: Healthscope Commercial |
$195.55
|
| Rate for Payer: Healthscope Commercial |
$176.86
|
| Rate for Payer: Healthscope Commercial |
$540.08
|
| Rate for Payer: Healthscope Commercial |
$622.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.08
|
| Rate for Payer: Nomi Health Commercial |
$161.14
|
| Rate for Payer: Nomi Health Commercial |
$173.08
|
| Rate for Payer: Nomi Health Commercial |
$178.17
|
| Rate for Payer: Nomi Health Commercial |
$492.07
|
| Rate for Payer: Nomi Health Commercial |
$566.73
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Commercial |
$179.41
|
| Rate for Payer: PHP Commercial |
$167.03
|
| Rate for Payer: PHP Commercial |
$510.08
|
| Rate for Payer: PHP Commercial |
$587.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.73
|
| Rate for Payer: Priority Health HMO/PPO |
$170.96
|
| Rate for Payer: Priority Health HMO/PPO |
$601.28
|
| Rate for Payer: Priority Health HMO/PPO |
$189.03
|
| Rate for Payer: Priority Health HMO/PPO |
$522.08
|
| Rate for Payer: Priority Health HMO/PPO |
$183.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$402.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.08
|
| Rate for Payer: UHC Core |
$164.09
|
| Rate for Payer: UHC Core |
$176.24
|
| Rate for Payer: UHC Core |
$501.08
|
| Rate for Payer: UHC Core |
$577.09
|
| Rate for Payer: UHC Core |
$181.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.07
|
|
