|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$129.19
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.78 |
| Max. Negotiated Rate |
$116.27 |
| Rate for Payer: Aetna Commercial |
$109.81
|
| Rate for Payer: Aetna Commercial |
$55.42
|
| Rate for Payer: Aetna Commercial |
$55.41
|
| Rate for Payer: Aetna Medicare |
$16.95
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$16.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.38
|
| Rate for Payer: BCBS Complete |
$12.07
|
| Rate for Payer: BCBS Complete |
$23.91
|
| Rate for Payer: BCBS Complete |
$12.07
|
| Rate for Payer: BCBS MAPPO |
$16.30
|
| Rate for Payer: BCBS MAPPO |
$32.30
|
| Rate for Payer: BCBS MAPPO |
$16.30
|
| Rate for Payer: BCBS Trust/PPO |
$106.21
|
| Rate for Payer: BCBS Trust/PPO |
$53.59
|
| Rate for Payer: BCBS Trust/PPO |
$53.60
|
| Rate for Payer: BCN Commercial |
$53.59
|
| Rate for Payer: BCN Commercial |
$53.60
|
| Rate for Payer: BCN Commercial |
$106.21
|
| Rate for Payer: BCN Medicare Advantage |
$16.30
|
| Rate for Payer: BCN Medicare Advantage |
$16.30
|
| Rate for Payer: BCN Medicare Advantage |
$32.30
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cofinity Commercial |
$111.10
|
| Rate for Payer: Cofinity Commercial |
$56.06
|
| Rate for Payer: Cofinity Commercial |
$56.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.30
|
| Rate for Payer: Healthscope Commercial |
$58.67
|
| Rate for Payer: Healthscope Commercial |
$116.27
|
| Rate for Payer: Healthscope Commercial |
$58.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.89
|
| Rate for Payer: Mclaren Medicaid |
$22.78
|
| Rate for Payer: Mclaren Medicaid |
$11.49
|
| Rate for Payer: Mclaren Medicaid |
$11.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.11
|
| Rate for Payer: Meridian Medicaid |
$12.07
|
| Rate for Payer: Meridian Medicaid |
$23.91
|
| Rate for Payer: Meridian Medicaid |
$12.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.41
|
| Rate for Payer: Nomi Health Commercial |
$53.46
|
| Rate for Payer: Nomi Health Commercial |
$53.46
|
| Rate for Payer: Nomi Health Commercial |
$105.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.89
|
| Rate for Payer: PACE Senior Care Partners |
$15.48
|
| Rate for Payer: PACE Senior Care Partners |
$30.68
|
| Rate for Payer: PACE Senior Care Partners |
$15.48
|
| Rate for Payer: PACE SWMI |
$16.30
|
| Rate for Payer: PACE SWMI |
$16.30
|
| Rate for Payer: PACE SWMI |
$32.30
|
| Rate for Payer: PHP Commercial |
$109.81
|
| Rate for Payer: PHP Commercial |
$55.42
|
| Rate for Payer: PHP Commercial |
$55.41
|
| Rate for Payer: PHP Medicare Advantage |
$16.30
|
| Rate for Payer: PHP Medicare Advantage |
$32.30
|
| Rate for Payer: PHP Medicare Advantage |
$16.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$112.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.72
|
| Rate for Payer: Priority Health Medicare |
$16.46
|
| Rate for Payer: Priority Health Medicare |
$16.46
|
| Rate for Payer: Priority Health Medicare |
$32.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.92
|
| Rate for Payer: Railroad Medicare Medicare |
$16.30
|
| Rate for Payer: Railroad Medicare Medicare |
$16.30
|
| Rate for Payer: Railroad Medicare Medicare |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.69
|
| Rate for Payer: UHC Core |
$107.87
|
| Rate for Payer: UHC Core |
$54.44
|
| Rate for Payer: UHC Core |
$54.43
|
| Rate for Payer: UHC Exchange |
$16.30
|
| Rate for Payer: UHC Exchange |
$16.30
|
| Rate for Payer: UHC Exchange |
$32.30
|
| Rate for Payer: UHC Medicaid |
$22.78
|
| Rate for Payer: UHC Medicaid |
$11.49
|
| Rate for Payer: UHC Medicaid |
$11.49
|
| Rate for Payer: UHC Medicare Advantage |
$16.30
|
| Rate for Payer: UHC Medicare Advantage |
$32.30
|
| Rate for Payer: UHC Medicare Advantage |
$16.30
|
| Rate for Payer: UHCCP Medicaid |
$11.49
|
| Rate for Payer: UHCCP Medicaid |
$22.78
|
| Rate for Payer: UHCCP Medicaid |
$11.49
|
| Rate for Payer: VA VA |
$32.30
|
| Rate for Payer: VA VA |
$16.30
|
| Rate for Payer: VA VA |
$16.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.90
|
|
|
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 |
$425.32 |
| 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 |
$446.55
|
| Rate for Payer: BCBS MAPPO |
$603.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,983.29
|
| Rate for Payer: BCN Commercial |
$1,983.29
|
| Rate for Payer: BCN Medicare Advantage |
$603.12
|
| 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 |
$425.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.27
|
| Rate for Payer: Meridian Medicaid |
$446.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$663.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.60
|
| Rate for Payer: Nomi Health Commercial |
$1,978.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.35
|
| 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 |
$425.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,098.85
|
| Rate for Payer: Priority Health Medicare |
$609.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,679.08
|
| 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 Exchange |
$603.12
|
| Rate for Payer: UHC Medicaid |
$425.32
|
| Rate for Payer: UHC Medicare Advantage |
$603.12
|
| Rate for Payer: UHCCP Medicaid |
$425.32
|
| 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 |
$1,679.08 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,992.46
|
| Rate for Payer: BCN Commercial |
$1,992.46
|
| 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: Opus (Opus Packaging Group) HMA |
$1,809.35
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,098.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,679.08
|
| 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 10 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$267.64
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
161505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.18 |
| Max. Negotiated Rate |
$240.88 |
| Rate for Payer: Aetna Commercial |
$227.49
|
| Rate for Payer: Aetna Medicare |
$69.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.64
|
| Rate for Payer: BCBS Complete |
$49.54
|
| Rate for Payer: BCBS MAPPO |
$66.91
|
| Rate for Payer: BCBS Trust/PPO |
$220.03
|
| Rate for Payer: BCN Commercial |
$220.03
|
| Rate for Payer: BCN Medicare Advantage |
$66.91
|
| Rate for Payer: Cash Price |
$214.11
|
| Rate for Payer: Cofinity Commercial |
$230.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.91
|
| Rate for Payer: Healthscope Commercial |
$240.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.73
|
| Rate for Payer: Mclaren Medicaid |
$47.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.26
|
| Rate for Payer: Meridian Medicaid |
$49.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.49
|
| Rate for Payer: Nomi Health Commercial |
$219.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.73
|
| Rate for Payer: PACE Senior Care Partners |
$63.56
|
| Rate for Payer: PACE SWMI |
$66.91
|
| Rate for Payer: PHP Commercial |
$227.49
|
| Rate for Payer: PHP Medicare Advantage |
$66.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$232.85
|
| Rate for Payer: Priority Health Medicare |
$67.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.28
|
| Rate for Payer: Railroad Medicare Medicare |
$66.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.52
|
| Rate for Payer: UHC Core |
$223.48
|
| Rate for Payer: UHC Exchange |
$66.91
|
| Rate for Payer: UHC Medicaid |
$47.18
|
| Rate for Payer: UHC Medicare Advantage |
$66.91
|
| Rate for Payer: UHCCP Medicaid |
$47.18
|
| Rate for Payer: VA VA |
$66.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.73
|
|
|
DARBEPOETIN ALFA 10 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$267.64
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
161505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.28 |
| Max. Negotiated Rate |
$240.88 |
| Rate for Payer: Aetna Commercial |
$227.49
|
| Rate for Payer: BCBS Trust/PPO |
$221.04
|
| Rate for Payer: BCN Commercial |
$221.04
|
| Rate for Payer: Cash Price |
$214.11
|
| Rate for Payer: Cofinity Commercial |
$230.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.11
|
| Rate for Payer: Healthscope Commercial |
$240.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.49
|
| Rate for Payer: Nomi Health Commercial |
$219.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.73
|
| Rate for Payer: PHP Commercial |
$227.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$232.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.52
|
| Rate for Payer: UHC Core |
$223.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.73
|
|
|
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 |
$637.98 |
| 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 |
$669.82
|
| Rate for Payer: BCBS MAPPO |
$904.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,974.94
|
| Rate for Payer: BCN Commercial |
$2,974.94
|
| Rate for Payer: BCN Medicare Advantage |
$904.68
|
| 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 |
$637.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$949.91
|
| Rate for Payer: Meridian Medicaid |
$669.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,040.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$995.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.90
|
| Rate for Payer: Nomi Health Commercial |
$2,967.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,714.03
|
| 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 |
$637.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,148.28
|
| Rate for Payer: Priority Health Medicare |
$913.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,518.62
|
| 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 Exchange |
$904.68
|
| Rate for Payer: UHC Medicaid |
$637.98
|
| Rate for Payer: UHC Medicare Advantage |
$904.68
|
| Rate for Payer: UHCCP Medicaid |
$637.98
|
| 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 |
$2,518.62 |
| Max. Negotiated Rate |
$3,256.84 |
| Rate for Payer: Aetna Commercial |
$3,075.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,988.69
|
| Rate for Payer: BCN Commercial |
$2,988.69
|
| 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: Opus (Opus Packaging Group) HMA |
$2,714.03
|
| Rate for Payer: PHP Commercial |
$3,075.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,148.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,518.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,184.46
|
| Rate for Payer: UHC Core |
$3,021.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,714.03
|
|
|
DARBEPOETIN ALFA 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 |
$3,358.15 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,984.91
|
| Rate for Payer: BCN Commercial |
$3,984.91
|
| 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: Opus (Opus Packaging Group) HMA |
$3,618.70
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,197.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,358.15
|
| 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 |
$850.64 |
| 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 |
$893.09
|
| Rate for Payer: BCBS MAPPO |
$1,206.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,966.57
|
| Rate for Payer: BCN Commercial |
$3,966.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,206.23
|
| 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 |
$850.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,266.54
|
| Rate for Payer: Meridian Medicaid |
$893.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,387.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,326.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,101.19
|
| Rate for Payer: Nomi Health Commercial |
$3,956.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,618.70
|
| 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 |
$850.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,197.69
|
| Rate for Payer: Priority Health Medicare |
$1,218.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,358.15
|
| 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 Exchange |
$1,206.23
|
| Rate for Payer: UHC Medicaid |
$850.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,206.23
|
| Rate for Payer: UHCCP Medicaid |
$850.64
|
| 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
|
IP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$465.69 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: BCBS Trust/PPO |
$552.60
|
| Rate for Payer: BCN Commercial |
$552.60
|
| 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: Opus (Opus Packaging Group) HMA |
$501.82
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$582.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$465.69
|
| 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 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 |
$117.96 |
| 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 |
$123.85
|
| Rate for Payer: BCBS MAPPO |
$167.27
|
| Rate for Payer: BCBS Trust/PPO |
$550.06
|
| Rate for Payer: BCN Commercial |
$550.06
|
| Rate for Payer: BCN Medicare Advantage |
$167.27
|
| 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 |
$117.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.64
|
| Rate for Payer: Meridian Medicaid |
$123.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$184.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.73
|
| Rate for Payer: Nomi Health Commercial |
$548.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.82
|
| 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 |
$117.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$582.11
|
| Rate for Payer: Priority Health Medicare |
$168.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$465.69
|
| 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 Exchange |
$167.27
|
| Rate for Payer: UHC Medicaid |
$117.96
|
| Rate for Payer: UHC Medicare Advantage |
$167.27
|
| Rate for Payer: UHCCP Medicaid |
$117.96
|
| Rate for Payer: VA VA |
$167.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.82
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,092.76 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: BCBS Trust/PPO |
$4,856.62
|
| Rate for Payer: BCN Commercial |
$4,856.62
|
| 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: Opus (Opus Packaging Group) HMA |
$4,410.30
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,115.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,092.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,174.75
|
| Rate for Payer: UHC Core |
$4,910.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,410.30
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,036.71 |
| 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 |
$1,088.46
|
| Rate for Payer: BCBS MAPPO |
$1,470.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,834.28
|
| Rate for Payer: BCN Commercial |
$4,834.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,470.10
|
| 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 |
$1,036.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,543.61
|
| Rate for Payer: Meridian Medicaid |
$1,088.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,690.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,617.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,998.34
|
| Rate for Payer: Nomi Health Commercial |
$4,821.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,410.30
|
| 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 |
$1,036.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,115.95
|
| Rate for Payer: Priority Health Medicare |
$1,484.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,092.76
|
| 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 Exchange |
$1,470.10
|
| Rate for Payer: UHC Medicaid |
$1,036.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,470.10
|
| Rate for Payer: UHCCP Medicaid |
$1,036.71
|
| Rate for Payer: VA VA |
$1,470.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,410.30
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$964.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.13 |
| 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 |
$178.62
|
| Rate for Payer: BCBS MAPPO |
$241.25
|
| Rate for Payer: BCBS Trust/PPO |
$793.32
|
| Rate for Payer: BCN Commercial |
$793.32
|
| Rate for Payer: BCN Medicare Advantage |
$241.25
|
| 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 |
$170.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.31
|
| Rate for Payer: Meridian Medicaid |
$178.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.24
|
| Rate for Payer: Nomi Health Commercial |
$791.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.74
|
| 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 |
$170.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$839.54
|
| Rate for Payer: Priority Health Medicare |
$243.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$671.63
|
| 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 Exchange |
$241.25
|
| Rate for Payer: UHC Medicaid |
$170.13
|
| Rate for Payer: UHC Medicare Advantage |
$241.25
|
| Rate for Payer: UHCCP Medicaid |
$170.13
|
| 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 |
$671.63 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: BCBS Trust/PPO |
$796.99
|
| Rate for Payer: BCN Commercial |
$796.99
|
| 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: 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: Opus (Opus Packaging Group) HMA |
$723.74
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$839.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$671.63
|
| 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 |
$6,821.25 |
| Max. Negotiated Rate |
$8,820.58 |
| Rate for Payer: Aetna Commercial |
$8,330.55
|
| Rate for Payer: BCBS Trust/PPO |
$8,094.36
|
| Rate for Payer: BCN Commercial |
$8,094.36
|
| 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: Opus (Opus Packaging Group) HMA |
$7,350.49
|
| Rate for Payer: PHP Commercial |
$8,330.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,526.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,821.25
|
| 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 |
$1,727.85 |
| 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 |
$1,814.10
|
| Rate for Payer: BCBS MAPPO |
$2,450.16
|
| Rate for Payer: BCBS Trust/PPO |
$8,057.11
|
| Rate for Payer: BCN Commercial |
$8,057.11
|
| Rate for Payer: BCN Medicare Advantage |
$2,450.16
|
| 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 |
$1,727.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,572.67
|
| Rate for Payer: Meridian Medicaid |
$1,814.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,817.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,695.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,330.55
|
| Rate for Payer: Nomi Health Commercial |
$8,036.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,350.49
|
| 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 |
$1,727.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,526.57
|
| Rate for Payer: Priority Health Medicare |
$2,474.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,821.25
|
| 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 Exchange |
$2,450.16
|
| Rate for Payer: UHC Medicaid |
$1,727.85
|
| Rate for Payer: UHC Medicare Advantage |
$2,450.16
|
| Rate for Payer: UHCCP Medicaid |
$1,727.85
|
| 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 |
$1,007.45 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,195.48
|
| Rate for Payer: BCN Commercial |
$1,195.48
|
| 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: Opus (Opus Packaging Group) HMA |
$1,085.62
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,259.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,007.45
|
| 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 |
$255.19 |
| 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 |
$267.93
|
| Rate for Payer: BCBS MAPPO |
$361.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,189.98
|
| Rate for Payer: BCN Commercial |
$1,189.98
|
| Rate for Payer: BCN Medicare Advantage |
$361.87
|
| 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 |
$255.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$379.97
|
| Rate for Payer: Meridian Medicaid |
$267.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$398.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.37
|
| Rate for Payer: Nomi Health Commercial |
$1,186.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,085.62
|
| 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 |
$255.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,259.32
|
| Rate for Payer: Priority Health Medicare |
$365.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,007.45
|
| 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 Exchange |
$361.87
|
| Rate for Payer: UHC Medicaid |
$255.19
|
| Rate for Payer: UHC Medicare Advantage |
$361.87
|
| Rate for Payer: UHCCP Medicaid |
$255.19
|
| Rate for Payer: VA VA |
$361.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.62
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$14,867.60
|
|
|
Service Code
|
APR-DRG 1791
|
| Min. Negotiated Rate |
$14,159.62 |
| Max. Negotiated Rate |
$14,867.60 |
| Rate for Payer: BCBS Complete |
$14,867.60
|
| Rate for Payer: Mclaren Medicaid |
$14,159.62
|
| Rate for Payer: Meridian Medicaid |
$14,867.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,159.62
|
| Rate for Payer: UHC Medicaid |
$14,159.62
|
| Rate for Payer: UHCCP Medicaid |
$14,159.62
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$21,781.87
|
|
|
Service Code
|
APR-DRG 1793
|
| Min. Negotiated Rate |
$20,744.64 |
| Max. Negotiated Rate |
$21,781.87 |
| Rate for Payer: BCBS Complete |
$21,781.87
|
| Rate for Payer: Mclaren Medicaid |
$20,744.64
|
| Rate for Payer: Meridian Medicaid |
$21,781.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,744.64
|
| Rate for Payer: UHC Medicaid |
$20,744.64
|
| Rate for Payer: UHCCP Medicaid |
$20,744.64
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$17,617.22
|
|
|
Service Code
|
APR-DRG 1792
|
| Min. Negotiated Rate |
$16,778.30 |
| Max. Negotiated Rate |
$17,617.22 |
| Rate for Payer: BCBS Complete |
$17,617.22
|
| Rate for Payer: Mclaren Medicaid |
$16,778.30
|
| Rate for Payer: Meridian Medicaid |
$17,617.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,778.30
|
| Rate for Payer: UHC Medicaid |
$16,778.30
|
| Rate for Payer: UHCCP Medicaid |
$16,778.30
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$28,590.45
|
|
|
Service Code
|
APR-DRG 1794
|
| Min. Negotiated Rate |
$27,229.00 |
| Max. Negotiated Rate |
$28,590.45 |
| Rate for Payer: BCBS Complete |
$28,590.45
|
| Rate for Payer: Mclaren Medicaid |
$27,229.00
|
| Rate for Payer: Meridian Medicaid |
$28,590.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$27,229.00
|
| Rate for Payer: UHC Medicaid |
$27,229.00
|
| Rate for Payer: UHCCP Medicaid |
$27,229.00
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$8,795.20
|
|
|
Service Code
|
APR-DRG 0424
|
| Min. Negotiated Rate |
$8,376.38 |
| Max. Negotiated Rate |
$8,795.20 |
| Rate for Payer: BCBS Complete |
$8,795.20
|
| Rate for Payer: Mclaren Medicaid |
$8,376.38
|
| Rate for Payer: Meridian Medicaid |
$8,795.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,376.38
|
| Rate for Payer: UHC Medicaid |
$8,376.38
|
| Rate for Payer: UHCCP Medicaid |
$8,376.38
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$5,858.38
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$5,579.41 |
| Max. Negotiated Rate |
$5,858.38 |
| Rate for Payer: BCBS Complete |
$5,858.38
|
| Rate for Payer: Mclaren Medicaid |
$5,579.41
|
| Rate for Payer: Meridian Medicaid |
$5,858.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,579.41
|
| Rate for Payer: UHC Medicaid |
$5,579.41
|
| Rate for Payer: UHCCP Medicaid |
$5,579.41
|
|
