|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$235.55
|
|
|
Service Code
|
NDC 49938-102-30
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.64 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna American Axle |
$153.11
|
| Rate for Payer: Aetna Commercial |
$200.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.11
|
| Rate for Payer: Cash Price |
$188.44
|
| Rate for Payer: Cofinity Commercial |
$164.88
|
| Rate for Payer: Cofinity Commercial |
$202.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.44
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.22
|
| Rate for Payer: PHP Commercial |
$200.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.88
|
| Rate for Payer: Priority Health SBD |
$148.40
|
| Rate for Payer: UMR Bronson Commercial |
$103.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.66
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$78.64
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$70.78 |
| Rate for Payer: Aetna American Axle |
$51.12
|
| Rate for Payer: Aetna Commercial |
$66.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.12
|
| Rate for Payer: BCBS Complete |
$31.46
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$62.91
|
| Rate for Payer: Cash Price |
$62.91
|
| Rate for Payer: Cofinity Commercial |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$55.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.91
|
| Rate for Payer: Healthscope Commercial |
$70.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.84
|
| Rate for Payer: PHP Commercial |
$66.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.05
|
| Rate for Payer: Priority Health SBD |
$49.54
|
| Rate for Payer: UMR Bronson Commercial |
$29.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.98
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$53.40
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$48.06 |
| Rate for Payer: Aetna American Axle |
$34.71
|
| Rate for Payer: Aetna American Axle |
$46.08
|
| Rate for Payer: Aetna American Axle |
$36.02
|
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna American Axle |
$55.69
|
| Rate for Payer: Aetna American Axle |
$51.12
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Commercial |
$45.39
|
| Rate for Payer: Aetna Commercial |
$47.10
|
| Rate for Payer: Aetna Commercial |
$60.26
|
| Rate for Payer: Aetna Commercial |
$66.84
|
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$56.71
|
| Rate for Payer: Cash Price |
$44.33
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cash Price |
$62.91
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$59.97
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Commercial |
$38.79
|
| Rate for Payer: Cofinity Commercial |
$47.65
|
| Rate for Payer: Cofinity Commercial |
$49.62
|
| Rate for Payer: Cofinity Commercial |
$60.97
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$55.05
|
| Rate for Payer: Cofinity Commercial |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$49.87
|
| Rate for Payer: Healthscope Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$70.78
|
| Rate for Payer: Healthscope Commercial |
$63.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.10
|
| Rate for Payer: PHP Commercial |
$45.39
|
| Rate for Payer: PHP Commercial |
$47.10
|
| Rate for Payer: PHP Commercial |
$60.26
|
| Rate for Payer: PHP Commercial |
$66.84
|
| Rate for Payer: PHP Commercial |
$72.82
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.97
|
| Rate for Payer: Priority Health SBD |
$53.97
|
| Rate for Payer: Priority Health SBD |
$49.54
|
| Rate for Payer: Priority Health SBD |
$44.66
|
| Rate for Payer: Priority Health SBD |
$34.91
|
| Rate for Payer: Priority Health SBD |
$33.64
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UMR Bronson Commercial |
$37.69
|
| Rate for Payer: UMR Bronson Commercial |
$23.50
|
| Rate for Payer: UMR Bronson Commercial |
$34.60
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
| Rate for Payer: UMR Bronson Commercial |
$31.19
|
| Rate for Payer: UMR Bronson Commercial |
$40.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.05
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$86.91
|
|
|
Service Code
|
HCPCS J0873
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.24 |
| Max. Negotiated Rate |
$78.22 |
| Rate for Payer: Aetna American Axle |
$56.49
|
| Rate for Payer: Aetna Commercial |
$73.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.49
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$74.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Healthscope Commercial |
$78.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.87
|
| Rate for Payer: PHP Commercial |
$73.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.84
|
| Rate for Payer: Priority Health SBD |
$54.75
|
| Rate for Payer: UMR Bronson Commercial |
$38.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.18
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,329.35
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$1,196.42 |
| Rate for Payer: Aetna American Axle |
$864.08
|
| Rate for Payer: Aetna American Axle |
$80.70
|
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$1,129.95
|
| Rate for Payer: Aetna Commercial |
$105.54
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: BCBS Complete |
$49.66
|
| Rate for Payer: BCBS Complete |
$531.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$106.78
|
| Rate for Payer: Cofinity Commercial |
$86.91
|
| Rate for Payer: Cofinity Commercial |
$1,143.24
|
| Rate for Payer: Cofinity Commercial |
$930.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$111.74
|
| Rate for Payer: Healthscope Commercial |
$1,196.42
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,129.95
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$105.54
|
| Rate for Payer: PHP Commercial |
$1,129.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$930.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.91
|
| Rate for Payer: Priority Health SBD |
$837.49
|
| Rate for Payer: Priority Health SBD |
$78.22
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UMR Bronson Commercial |
$491.86
|
| Rate for Payer: UMR Bronson Commercial |
$45.94
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$86.56
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.09 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna American Axle |
$56.26
|
| Rate for Payer: Aetna American Axle |
$83.97
|
| Rate for Payer: Aetna American Axle |
$866.66
|
| Rate for Payer: Aetna American Axle |
$41.74
|
| Rate for Payer: Aetna American Axle |
$61.27
|
| Rate for Payer: Aetna American Axle |
$864.08
|
| Rate for Payer: Aetna American Axle |
$56.09
|
| Rate for Payer: Aetna American Axle |
$55.83
|
| Rate for Payer: Aetna Commercial |
$1,133.32
|
| Rate for Payer: Aetna Commercial |
$1,129.95
|
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Commercial |
$80.12
|
| Rate for Payer: Aetna Commercial |
$73.58
|
| Rate for Payer: Aetna Commercial |
$109.81
|
| Rate for Payer: Aetna Commercial |
$73.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.83
|
| Rate for Payer: Cash Price |
$69.25
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cofinity Commercial |
$60.12
|
| Rate for Payer: Cofinity Commercial |
$111.10
|
| Rate for Payer: Cofinity Commercial |
$90.43
|
| Rate for Payer: Cofinity Commercial |
$1,143.24
|
| Rate for Payer: Cofinity Commercial |
$930.54
|
| Rate for Payer: Cofinity Commercial |
$1,146.66
|
| Rate for Payer: Cofinity Commercial |
$933.32
|
| Rate for Payer: Cofinity Commercial |
$44.95
|
| Rate for Payer: Cofinity Commercial |
$55.23
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Commercial |
$74.44
|
| Rate for Payer: Cofinity Commercial |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$81.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.35
|
| Rate for Payer: Healthscope Commercial |
$1,199.99
|
| Rate for Payer: Healthscope Commercial |
$116.27
|
| Rate for Payer: Healthscope Commercial |
$57.80
|
| Rate for Payer: Healthscope Commercial |
$77.90
|
| Rate for Payer: Healthscope Commercial |
$77.66
|
| Rate for Payer: Healthscope Commercial |
$84.83
|
| Rate for Payer: Healthscope Commercial |
$1,196.42
|
| Rate for Payer: Healthscope Commercial |
$77.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$933.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$999.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,129.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,133.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.12
|
| Rate for Payer: PHP Commercial |
$109.81
|
| Rate for Payer: PHP Commercial |
$73.01
|
| Rate for Payer: PHP Commercial |
$80.12
|
| Rate for Payer: PHP Commercial |
$1,133.32
|
| Rate for Payer: PHP Commercial |
$54.59
|
| Rate for Payer: PHP Commercial |
$73.35
|
| Rate for Payer: PHP Commercial |
$73.58
|
| Rate for Payer: PHP Commercial |
$1,129.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$930.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.59
|
| Rate for Payer: Priority Health SBD |
$81.39
|
| Rate for Payer: Priority Health SBD |
$837.49
|
| Rate for Payer: Priority Health SBD |
$40.46
|
| Rate for Payer: Priority Health SBD |
$54.11
|
| Rate for Payer: Priority Health SBD |
$54.36
|
| Rate for Payer: Priority Health SBD |
$54.53
|
| Rate for Payer: Priority Health SBD |
$59.38
|
| Rate for Payer: Priority Health SBD |
$839.99
|
| Rate for Payer: UMR Bronson Commercial |
$38.09
|
| Rate for Payer: UMR Bronson Commercial |
$28.26
|
| Rate for Payer: UMR Bronson Commercial |
$37.97
|
| Rate for Payer: UMR Bronson Commercial |
$37.79
|
| Rate for Payer: UMR Bronson Commercial |
$584.91
|
| Rate for Payer: UMR Bronson Commercial |
$586.66
|
| Rate for Payer: UMR Bronson Commercial |
$41.47
|
| Rate for Payer: UMR Bronson Commercial |
$56.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$999.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.72
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN
|
Facility
|
OP
|
$40,737.80
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
193506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$36,664.02 |
| Rate for Payer: Aetna American Axle |
$26,479.57
|
| Rate for Payer: Aetna Commercial |
$34,627.13
|
| Rate for Payer: Aetna Medicare |
$51.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,479.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.31
|
| Rate for Payer: BCBS Complete |
$28.17
|
| Rate for Payer: BCBS MAPPO |
$49.05
|
| Rate for Payer: BCBS Trust/PPO |
$158.49
|
| Rate for Payer: BCN Medicare Advantage |
$49.05
|
| Rate for Payer: Cash Price |
$32,590.24
|
| Rate for Payer: Cash Price |
$32,590.24
|
| Rate for Payer: Cofinity Commercial |
$35,034.51
|
| Rate for Payer: Cofinity Commercial |
$28,516.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,590.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.05
|
| Rate for Payer: Healthscope Commercial |
$36,664.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28,516.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,553.35
|
| Rate for Payer: Mclaren Medicaid |
$26.83
|
| Rate for Payer: Mclaren Medicare |
$49.05
|
| Rate for Payer: Meridian Medicaid |
$28.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34,627.13
|
| Rate for Payer: PACE Medicare |
$46.60
|
| Rate for Payer: PACE SWMI |
$49.05
|
| Rate for Payer: PHP Commercial |
$34,627.13
|
| Rate for Payer: PHP Medicare Advantage |
$49.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,516.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.82
|
| Rate for Payer: Priority Health Medicare |
$49.05
|
| Rate for Payer: Priority Health Narrow Network |
$115.86
|
| Rate for Payer: Priority Health SBD |
$25,664.81
|
| Rate for Payer: Railroad Medicare Medicare |
$49.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.05
|
| Rate for Payer: UHC Medicare Advantage |
$50.52
|
| Rate for Payer: UMR Bronson Commercial |
$15,072.99
|
| Rate for Payer: VA VA |
$49.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,553.35
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,130.12
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
176546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$1,917.11 |
| Rate for Payer: Aetna American Axle |
$1,384.58
|
| Rate for Payer: Aetna American Axle |
$4,499.83
|
| Rate for Payer: Aetna Commercial |
$1,810.60
|
| Rate for Payer: Aetna Commercial |
$5,884.40
|
| Rate for Payer: Aetna Medicare |
$64.17
|
| Rate for Payer: Aetna Medicare |
$64.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,499.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,384.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.13
|
| Rate for Payer: BCBS Complete |
$35.44
|
| Rate for Payer: BCBS Complete |
$35.44
|
| Rate for Payer: BCBS MAPPO |
$61.70
|
| Rate for Payer: BCBS MAPPO |
$61.70
|
| Rate for Payer: BCBS Trust/PPO |
$199.37
|
| Rate for Payer: BCBS Trust/PPO |
$199.37
|
| Rate for Payer: BCN Medicare Advantage |
$61.70
|
| Rate for Payer: BCN Medicare Advantage |
$61.70
|
| Rate for Payer: Cash Price |
$1,704.10
|
| Rate for Payer: Cash Price |
$5,538.26
|
| Rate for Payer: Cash Price |
$1,704.10
|
| Rate for Payer: Cash Price |
$5,538.26
|
| Rate for Payer: Cofinity Commercial |
$1,491.08
|
| Rate for Payer: Cofinity Commercial |
$5,953.63
|
| Rate for Payer: Cofinity Commercial |
$4,845.97
|
| Rate for Payer: Cofinity Commercial |
$1,831.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,704.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,538.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.70
|
| Rate for Payer: Healthscope Commercial |
$1,917.11
|
| Rate for Payer: Healthscope Commercial |
$6,230.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,845.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,491.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,597.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,192.12
|
| Rate for Payer: Mclaren Medicaid |
$33.75
|
| Rate for Payer: Mclaren Medicaid |
$33.75
|
| Rate for Payer: Mclaren Medicare |
$61.70
|
| Rate for Payer: Mclaren Medicare |
$61.70
|
| Rate for Payer: Meridian Medicaid |
$35.44
|
| Rate for Payer: Meridian Medicaid |
$35.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,884.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,810.60
|
| Rate for Payer: PACE Medicare |
$58.62
|
| Rate for Payer: PACE Medicare |
$58.62
|
| Rate for Payer: PACE SWMI |
$61.70
|
| Rate for Payer: PACE SWMI |
$61.70
|
| Rate for Payer: PHP Commercial |
$5,884.40
|
| Rate for Payer: PHP Commercial |
$1,810.60
|
| Rate for Payer: PHP Medicare Advantage |
$61.70
|
| Rate for Payer: PHP Medicare Advantage |
$61.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,491.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,845.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.49
|
| Rate for Payer: Priority Health Medicare |
$61.70
|
| Rate for Payer: Priority Health Medicare |
$61.70
|
| Rate for Payer: Priority Health Narrow Network |
$145.99
|
| Rate for Payer: Priority Health Narrow Network |
$145.99
|
| Rate for Payer: Priority Health SBD |
$4,361.38
|
| Rate for Payer: Priority Health SBD |
$1,341.98
|
| Rate for Payer: Railroad Medicare Medicare |
$61.70
|
| Rate for Payer: Railroad Medicare Medicare |
$61.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.70
|
| Rate for Payer: UHC Medicare Advantage |
$63.56
|
| Rate for Payer: UHC Medicare Advantage |
$63.56
|
| Rate for Payer: UMR Bronson Commercial |
$788.14
|
| Rate for Payer: UMR Bronson Commercial |
$2,561.44
|
| Rate for Payer: VA VA |
$61.70
|
| Rate for Payer: VA VA |
$61.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,192.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,597.59
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,922.82
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
176546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,046.04 |
| Max. Negotiated Rate |
$6,230.54 |
| Rate for Payer: Aetna American Axle |
$4,499.83
|
| Rate for Payer: Aetna Commercial |
$5,884.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,499.83
|
| Rate for Payer: Cash Price |
$5,538.26
|
| Rate for Payer: Cofinity Commercial |
$4,845.97
|
| Rate for Payer: Cofinity Commercial |
$5,953.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,538.26
|
| Rate for Payer: Healthscope Commercial |
$6,230.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,845.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,192.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,884.40
|
| Rate for Payer: PHP Commercial |
$5,884.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,845.97
|
| Rate for Payer: Priority Health SBD |
$4,361.38
|
| Rate for Payer: UMR Bronson Commercial |
$3,046.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,192.12
|
|
|
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 |
$1,061.49 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna American Axle |
$1,568.11
|
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Commercial |
$1,688.73
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,688.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,050.60
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,688.73
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,061.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.35
|
|
|
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 |
$1.60 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna American Axle |
$1,568.11
|
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Cofinity Commercial |
$1,688.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,688.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.35
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,050.60
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,688.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$6.92
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UMR Bronson Commercial |
$892.61
|
| Rate for Payer: VA VA |
$2.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.35
|
|
|
DARBEPOETIN ALFA 100 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
IP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,061.49 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna American Axle |
$1,568.11
|
| Rate for Payer: Aetna American Axle |
$1,446.61
|
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna Commercial |
$1,891.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,446.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cash Price |
$1,780.45
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Cofinity Commercial |
$1,688.73
|
| Rate for Payer: Cofinity Commercial |
$1,557.89
|
| Rate for Payer: Cofinity Commercial |
$1,913.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Healthscope Commercial |
$2,003.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,688.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,557.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,669.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,891.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,050.60
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: PHP Commercial |
$1,891.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,557.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,688.73
|
| Rate for Payer: Priority Health SBD |
$1,402.10
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,061.49
|
| Rate for Payer: UMR Bronson Commercial |
$979.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,669.17
|
|
|
DARBEPOETIN ALFA 100 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna American Axle |
$1,568.11
|
| Rate for Payer: Aetna American Axle |
$1,446.61
|
| Rate for Payer: Aetna Commercial |
$1,891.73
|
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,446.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.45
|
| Rate for Payer: BCBS Trust/PPO |
$9.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$1,780.45
|
| Rate for Payer: Cash Price |
$1,780.45
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Commercial |
$1,913.98
|
| Rate for Payer: Cofinity Commercial |
$1,557.89
|
| Rate for Payer: Cofinity Commercial |
$1,688.73
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Healthscope Commercial |
$2,003.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,557.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,688.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,669.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.35
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,891.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,050.60
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$1,891.73
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,557.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,688.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$6.92
|
| Rate for Payer: Priority Health Narrow Network |
$6.92
|
| Rate for Payer: Priority Health SBD |
$1,402.10
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UMR Bronson Commercial |
$823.46
|
| Rate for Payer: UMR Bronson Commercial |
$892.61
|
| Rate for Payer: VA VA |
$2.93
|
| Rate for Payer: VA VA |
$2.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,669.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.35
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$3,618.71
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,592.23 |
| Max. Negotiated Rate |
$3,256.84 |
| Rate for Payer: Aetna American Axle |
$2,352.16
|
| Rate for Payer: Aetna Commercial |
$3,075.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,352.16
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cofinity Commercial |
$2,533.10
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,533.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,714.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,075.90
|
| Rate for Payer: PHP Commercial |
$3,075.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,533.10
|
| Rate for Payer: Priority Health SBD |
$2,279.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,592.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,714.03
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$3,618.71
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3,256.84 |
| Rate for Payer: Aetna American Axle |
$2,352.16
|
| Rate for Payer: Aetna Commercial |
$3,075.90
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,352.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cofinity Commercial |
$3,112.09
|
| Rate for Payer: Cofinity Commercial |
$2,533.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,894.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$3,256.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,533.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,714.03
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,075.90
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$3,075.90
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,533.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$6.92
|
| Rate for Payer: Priority Health SBD |
$2,279.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,338.92
|
| Rate for Payer: VA VA |
$2.93
|
| 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 |
$2,122.97 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna American Axle |
$3,136.20
|
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.20
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cofinity Commercial |
$3,377.45
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3,377.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,618.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,101.19
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,377.45
|
| Rate for Payer: Priority Health SBD |
$3,039.71
|
| Rate for Payer: UMR Bronson Commercial |
$2,122.97
|
| 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 |
$1.60 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna American Axle |
$3,136.20
|
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| 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: Cofinity Commercial |
$3,377.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,859.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$4,342.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,377.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,618.70
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,101.19
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,377.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$6.92
|
| Rate for Payer: Priority Health SBD |
$3,039.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,785.22
|
| Rate for Payer: VA VA |
$2.93
|
| 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 |
$1.60 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna American Axle |
$434.91
|
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Commercial |
$468.36
|
| 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 |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.82
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.73
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$6.92
|
| Rate for Payer: Priority Health SBD |
$421.53
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UMR Bronson Commercial |
$247.56
|
| Rate for Payer: VA VA |
$2.93
|
| 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 |
$294.40 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna American Axle |
$434.91
|
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Commercial |
$468.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$468.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.73
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.36
|
| Rate for Payer: Priority Health SBD |
$421.53
|
| Rate for Payer: UMR Bronson Commercial |
$294.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.82
|
|
|
DARBEPOETIN ALFA 25 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna American Axle |
$434.91
|
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Commercial |
$468.36
|
| 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 |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.82
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.73
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$6.92
|
| Rate for Payer: Priority Health SBD |
$421.53
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UMR Bronson Commercial |
$247.56
|
| Rate for Payer: VA VA |
$2.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.82
|
|
|
DARBEPOETIN ALFA 25 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
IP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna American Axle |
$434.91
|
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Commercial |
$468.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$468.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.73
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.36
|
| Rate for Payer: Priority Health SBD |
$421.53
|
| Rate for Payer: UMR Bronson Commercial |
$294.40
|
| 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 |
$1.60 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna American Axle |
$3,822.26
|
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,822.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| 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: Cofinity Commercial |
$4,116.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,704.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$5,292.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,116.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,410.30
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,998.34
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,116.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$6.92
|
| Rate for Payer: Priority Health SBD |
$3,704.65
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UMR Bronson Commercial |
$2,175.75
|
| Rate for Payer: VA VA |
$2.93
|
| 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 |
$1.60 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna American Axle |
$627.24
|
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cofinity Commercial |
$675.49
|
| 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 |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.74
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$820.24
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$6.92
|
| Rate for Payer: Priority Health SBD |
$607.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UMR Bronson Commercial |
$357.05
|
| Rate for Payer: VA VA |
$2.93
|
| 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 |
$424.60 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna American Axle |
$627.24
|
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.24
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cofinity Commercial |
$675.49
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$675.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$820.24
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.49
|
| Rate for Payer: Priority Health SBD |
$607.94
|
| Rate for Payer: UMR Bronson Commercial |
$424.60
|
| 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 |
$4,312.29 |
| Max. Negotiated Rate |
$8,820.58 |
| Rate for Payer: Aetna American Axle |
$6,370.42
|
| Rate for Payer: Aetna Commercial |
$8,330.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,370.42
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cofinity Commercial |
$6,860.46
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$6,860.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,350.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,330.55
|
| Rate for Payer: PHP Commercial |
$8,330.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,860.46
|
| Rate for Payer: Priority Health SBD |
$6,174.41
|
| Rate for Payer: UMR Bronson Commercial |
$4,312.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,350.49
|
|
