|
EPINEPHRINE INFUSION (IV PREMIX)
|
Facility
|
IP
|
$10.50
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
301238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna American Axle |
$6.82
|
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.82
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$7.35
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.92
|
| Rate for Payer: PHP Commercial |
$8.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.35
|
| Rate for Payer: Priority Health SBD |
$6.62
|
| Rate for Payer: UMR Bronson Commercial |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
|
|
EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR
|
Facility
|
IP
|
$940.93
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
29031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$414.01 |
| Max. Negotiated Rate |
$846.84 |
| Rate for Payer: Aetna American Axle |
$611.60
|
| Rate for Payer: Aetna American Axle |
$305.81
|
| Rate for Payer: Aetna American Axle |
$1,165.51
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna Commercial |
$1,524.13
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Commercial |
$1,255.16
|
| Rate for Payer: Cofinity Commercial |
$1,542.06
|
| Rate for Payer: Cofinity Commercial |
$329.33
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,434.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Healthscope Commercial |
$1,613.78
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$658.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,255.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$799.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,524.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$399.90
|
| Rate for Payer: PHP Commercial |
$1,524.13
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,255.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.65
|
| Rate for Payer: Priority Health SBD |
$592.79
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$1,129.65
|
| Rate for Payer: UMR Bronson Commercial |
$788.96
|
| Rate for Payer: UMR Bronson Commercial |
$207.01
|
| Rate for Payer: UMR Bronson Commercial |
$414.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.70
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$295.20
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
13671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.89 |
| Max. Negotiated Rate |
$265.68 |
| Rate for Payer: Aetna American Axle |
$191.88
|
| Rate for Payer: Aetna Commercial |
$250.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.88
|
| Rate for Payer: Cash Price |
$236.16
|
| Rate for Payer: Cofinity Commercial |
$206.64
|
| Rate for Payer: Cofinity Commercial |
$253.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.16
|
| Rate for Payer: Healthscope Commercial |
$265.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.92
|
| Rate for Payer: PHP Commercial |
$250.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.64
|
| Rate for Payer: Priority Health SBD |
$185.98
|
| Rate for Payer: UMR Bronson Commercial |
$129.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.40
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$295.20
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
13671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$265.68 |
| Rate for Payer: Aetna American Axle |
$191.88
|
| Rate for Payer: Aetna Commercial |
$250.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.88
|
| Rate for Payer: BCBS Complete |
$118.08
|
| Rate for Payer: BCBS Trust/PPO |
$4.44
|
| Rate for Payer: Cash Price |
$236.16
|
| Rate for Payer: Cash Price |
$236.16
|
| Rate for Payer: Cofinity Commercial |
$253.87
|
| Rate for Payer: Cofinity Commercial |
$206.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.16
|
| Rate for Payer: Healthscope Commercial |
$265.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.92
|
| Rate for Payer: PHP Commercial |
$250.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.64
|
| Rate for Payer: Priority Health SBD |
$185.98
|
| Rate for Payer: UMR Bronson Commercial |
$109.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.40
|
|
|
EPISTAXIS WITH MCC
|
Facility
|
IP
|
$31,918.86
|
|
|
Service Code
|
MS-DRG 150
|
| Min. Negotiated Rate |
$10,109.83 |
| Max. Negotiated Rate |
$31,918.86 |
| Rate for Payer: Aetna Medicare |
$11,067.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,302.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,302.41
|
| Rate for Payer: BCBS MAPPO |
$10,641.93
|
| Rate for Payer: BCBS Trust/PPO |
$31,918.86
|
| Rate for Payer: BCN Medicare Advantage |
$10,641.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,641.93
|
| Rate for Payer: Mclaren Medicare |
$10,641.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,174.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,238.22
|
| Rate for Payer: PACE Medicare |
$10,109.83
|
| Rate for Payer: PACE SWMI |
$10,641.93
|
| Rate for Payer: PHP Medicare Advantage |
$10,641.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,862.97
|
| Rate for Payer: Priority Health Medicare |
$10,641.93
|
| Rate for Payer: Priority Health Narrow Network |
$15,090.38
|
| Rate for Payer: Railroad Medicare Medicare |
$10,641.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,051.38
|
| Rate for Payer: UHC Core |
$16,441.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,641.93
|
| Rate for Payer: UHC Exchange |
$13,071.39
|
| Rate for Payer: UHC Medicare Advantage |
$10,961.19
|
| Rate for Payer: VA VA |
$10,641.93
|
|
|
EPISTAXIS WITHOUT MCC
|
Facility
|
IP
|
$15,992.10
|
|
|
Service Code
|
MS-DRG 151
|
| Min. Negotiated Rate |
$6,128.82 |
| Max. Negotiated Rate |
$15,992.10 |
| Rate for Payer: Aetna Medicare |
$6,709.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,064.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,064.24
|
| Rate for Payer: BCBS MAPPO |
$6,451.39
|
| Rate for Payer: BCBS Trust/PPO |
$15,992.10
|
| Rate for Payer: BCN Medicare Advantage |
$6,451.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,451.39
|
| Rate for Payer: Mclaren Medicare |
$6,451.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,773.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,419.10
|
| Rate for Payer: PACE Medicare |
$6,128.82
|
| Rate for Payer: PACE SWMI |
$6,451.39
|
| Rate for Payer: PHP Medicare Advantage |
$6,451.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,059.48
|
| Rate for Payer: Priority Health Medicare |
$6,451.39
|
| Rate for Payer: Priority Health Narrow Network |
$8,847.58
|
| Rate for Payer: Railroad Medicare Medicare |
$6,451.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,756.26
|
| Rate for Payer: UHC Core |
$9,639.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,451.39
|
| Rate for Payer: UHC Exchange |
$7,663.84
|
| Rate for Payer: UHC Medicare Advantage |
$6,644.93
|
| Rate for Payer: VA VA |
$6,451.39
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
IP
|
$187.35
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$168.62 |
| Rate for Payer: Aetna American Axle |
$121.78
|
| Rate for Payer: Aetna Commercial |
$159.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.78
|
| Rate for Payer: Cash Price |
$149.88
|
| Rate for Payer: Cofinity Commercial |
$131.14
|
| Rate for Payer: Cofinity Commercial |
$161.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.88
|
| Rate for Payer: Healthscope Commercial |
$168.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.25
|
| Rate for Payer: PHP Commercial |
$159.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.14
|
| Rate for Payer: Priority Health SBD |
$118.03
|
| Rate for Payer: UMR Bronson Commercial |
$82.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.51
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
IP
|
$11.50
|
|
|
Service Code
|
NDC 60687-451-11
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$10.35 |
| Rate for Payer: Aetna American Axle |
$7.48
|
| Rate for Payer: Aetna Commercial |
$9.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.48
|
| Rate for Payer: Cash Price |
$9.20
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Cofinity Commercial |
$9.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.20
|
| Rate for Payer: Healthscope Commercial |
$10.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.78
|
| Rate for Payer: PHP Commercial |
$9.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.05
|
| Rate for Payer: Priority Health SBD |
$7.24
|
| Rate for Payer: UMR Bronson Commercial |
$5.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.62
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
IP
|
$344.88
|
|
|
Service Code
|
NDC 60687-451-21
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.75 |
| Max. Negotiated Rate |
$310.39 |
| Rate for Payer: Aetna American Axle |
$224.17
|
| Rate for Payer: Aetna Commercial |
$293.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.17
|
| Rate for Payer: Cash Price |
$275.90
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Cofinity Commercial |
$296.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.90
|
| Rate for Payer: Healthscope Commercial |
$310.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.15
|
| Rate for Payer: PHP Commercial |
$293.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.42
|
| Rate for Payer: Priority Health SBD |
$217.27
|
| Rate for Payer: UMR Bronson Commercial |
$151.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.66
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
IP
|
$121.40
|
|
|
Service Code
|
NDC 0378-1030-93
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.42 |
| Max. Negotiated Rate |
$109.26 |
| Rate for Payer: Aetna American Axle |
$78.91
|
| Rate for Payer: Aetna Commercial |
$103.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.91
|
| Rate for Payer: Cash Price |
$97.12
|
| Rate for Payer: Cofinity Commercial |
$104.40
|
| Rate for Payer: Cofinity Commercial |
$84.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.12
|
| Rate for Payer: Healthscope Commercial |
$109.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.19
|
| Rate for Payer: PHP Commercial |
$103.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.98
|
| Rate for Payer: Priority Health SBD |
$76.48
|
| Rate for Payer: UMR Bronson Commercial |
$53.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.05
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
IP
|
$187.35
|
|
|
Service Code
|
NDC 66993-343-30
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$168.62 |
| Rate for Payer: Aetna American Axle |
$121.78
|
| Rate for Payer: Aetna Commercial |
$159.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.78
|
| Rate for Payer: Cash Price |
$149.88
|
| Rate for Payer: Cofinity Commercial |
$131.14
|
| Rate for Payer: Cofinity Commercial |
$161.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.88
|
| Rate for Payer: Healthscope Commercial |
$168.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.25
|
| Rate for Payer: PHP Commercial |
$159.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.14
|
| Rate for Payer: Priority Health SBD |
$118.03
|
| Rate for Payer: UMR Bronson Commercial |
$82.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.51
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
IP
|
$187.35
|
|
|
Service Code
|
NDC 59762-1710-2
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$168.62 |
| Rate for Payer: Aetna American Axle |
$121.78
|
| Rate for Payer: Aetna Commercial |
$159.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.78
|
| Rate for Payer: Cash Price |
$149.88
|
| Rate for Payer: Cofinity Commercial |
$131.14
|
| Rate for Payer: Cofinity Commercial |
$161.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.88
|
| Rate for Payer: Healthscope Commercial |
$168.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.25
|
| Rate for Payer: PHP Commercial |
$159.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.14
|
| Rate for Payer: Priority Health SBD |
$118.03
|
| Rate for Payer: UMR Bronson Commercial |
$82.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.51
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$499.51
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.78 |
| Max. Negotiated Rate |
$449.56 |
| Rate for Payer: Aetna American Axle |
$324.68
|
| Rate for Payer: Aetna Commercial |
$424.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.68
|
| Rate for Payer: Cash Price |
$399.61
|
| Rate for Payer: Cofinity Commercial |
$349.66
|
| Rate for Payer: Cofinity Commercial |
$429.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.61
|
| Rate for Payer: Healthscope Commercial |
$449.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.58
|
| Rate for Payer: PHP Commercial |
$424.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.66
|
| Rate for Payer: Priority Health SBD |
$314.69
|
| Rate for Payer: UMR Bronson Commercial |
$219.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.63
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$499.51
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$449.56 |
| Rate for Payer: Aetna American Axle |
$324.68
|
| Rate for Payer: Aetna Commercial |
$424.58
|
| Rate for Payer: Aetna Medicare |
$9.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$28.70
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$399.61
|
| Rate for Payer: Cash Price |
$399.61
|
| Rate for Payer: Cofinity Commercial |
$429.58
|
| Rate for Payer: Cofinity Commercial |
$349.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$449.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.63
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.58
|
| Rate for Payer: PACE Medicare |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PHP Commercial |
$424.58
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.84
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Narrow Network |
$16.67
|
| Rate for Payer: Priority Health SBD |
$314.69
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.89
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: UMR Bronson Commercial |
$184.82
|
| Rate for Payer: VA VA |
$8.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.63
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$999.03
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
14643
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$439.57 |
| Max. Negotiated Rate |
$899.13 |
| Rate for Payer: Aetna American Axle |
$649.37
|
| Rate for Payer: Aetna Commercial |
$849.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.37
|
| Rate for Payer: Cash Price |
$799.22
|
| Rate for Payer: Cofinity Commercial |
$699.32
|
| Rate for Payer: Cofinity Commercial |
$859.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.22
|
| Rate for Payer: Healthscope Commercial |
$899.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$699.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$749.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$849.18
|
| Rate for Payer: PHP Commercial |
$849.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$699.32
|
| Rate for Payer: Priority Health SBD |
$629.39
|
| Rate for Payer: UMR Bronson Commercial |
$439.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$749.27
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,024.25
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
14643
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$921.82 |
| Rate for Payer: Aetna American Axle |
$665.76
|
| Rate for Payer: Aetna American Axle |
$649.37
|
| Rate for Payer: Aetna Commercial |
$849.18
|
| Rate for Payer: Aetna Commercial |
$870.61
|
| Rate for Payer: Aetna Medicare |
$9.24
|
| Rate for Payer: Aetna Medicare |
$9.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$665.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$28.70
|
| Rate for Payer: BCBS Trust/PPO |
$28.70
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$799.22
|
| Rate for Payer: Cash Price |
$819.40
|
| Rate for Payer: Cash Price |
$819.40
|
| Rate for Payer: Cash Price |
$799.22
|
| Rate for Payer: Cofinity Commercial |
$716.98
|
| Rate for Payer: Cofinity Commercial |
$859.17
|
| Rate for Payer: Cofinity Commercial |
$699.32
|
| Rate for Payer: Cofinity Commercial |
$880.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$899.13
|
| Rate for Payer: Healthscope Commercial |
$921.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$699.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$716.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$768.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$749.27
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$849.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.61
|
| Rate for Payer: PACE Medicare |
$8.44
|
| Rate for Payer: PACE Medicare |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PHP Commercial |
$870.61
|
| Rate for Payer: PHP Commercial |
$849.18
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$699.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.84
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Narrow Network |
$16.67
|
| Rate for Payer: Priority Health Narrow Network |
$16.67
|
| Rate for Payer: Priority Health SBD |
$645.28
|
| Rate for Payer: Priority Health SBD |
$629.39
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.89
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: UMR Bronson Commercial |
$378.97
|
| Rate for Payer: UMR Bronson Commercial |
$369.64
|
| Rate for Payer: VA VA |
$8.89
|
| Rate for Payer: VA VA |
$8.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$768.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$749.27
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$181.34
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$163.21 |
| Rate for Payer: Aetna American Axle |
$117.87
|
| Rate for Payer: Aetna Commercial |
$154.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.87
|
| Rate for Payer: Cash Price |
$145.07
|
| Rate for Payer: Cofinity Commercial |
$126.94
|
| Rate for Payer: Cofinity Commercial |
$155.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.07
|
| Rate for Payer: Healthscope Commercial |
$163.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.14
|
| Rate for Payer: PHP Commercial |
$154.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.94
|
| Rate for Payer: Priority Health SBD |
$114.24
|
| Rate for Payer: UMR Bronson Commercial |
$79.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.00
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$181.34
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$163.21 |
| Rate for Payer: Aetna American Axle |
$117.87
|
| Rate for Payer: Aetna Commercial |
$154.14
|
| Rate for Payer: Aetna Medicare |
$9.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$28.70
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$145.07
|
| Rate for Payer: Cash Price |
$145.07
|
| Rate for Payer: Cofinity Commercial |
$126.94
|
| Rate for Payer: Cofinity Commercial |
$155.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$163.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.00
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.14
|
| Rate for Payer: PACE Medicare |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PHP Commercial |
$154.14
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.84
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Narrow Network |
$16.67
|
| Rate for Payer: Priority Health SBD |
$114.24
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.89
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: UMR Bronson Commercial |
$67.10
|
| Rate for Payer: VA VA |
$8.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.00
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,801.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
24513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$792.46 |
| Max. Negotiated Rate |
$1,620.94 |
| Rate for Payer: Aetna American Axle |
$1,170.68
|
| Rate for Payer: Aetna Commercial |
$1,530.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.68
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cofinity Commercial |
$1,260.74
|
| Rate for Payer: Cofinity Commercial |
$1,548.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,440.84
|
| Rate for Payer: Healthscope Commercial |
$1,620.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,260.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,350.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,530.89
|
| Rate for Payer: PHP Commercial |
$1,530.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.74
|
| Rate for Payer: Priority Health SBD |
$1,134.66
|
| Rate for Payer: UMR Bronson Commercial |
$792.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,350.79
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,801.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
24513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$1,620.94 |
| Rate for Payer: Aetna American Axle |
$1,170.68
|
| Rate for Payer: Aetna Commercial |
$1,530.89
|
| Rate for Payer: Aetna Medicare |
$9.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$28.70
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cofinity Commercial |
$1,260.74
|
| Rate for Payer: Cofinity Commercial |
$1,548.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,440.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$1,620.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,260.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,350.79
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,530.89
|
| Rate for Payer: PACE Medicare |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PHP Commercial |
$1,530.89
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.84
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Narrow Network |
$16.67
|
| Rate for Payer: Priority Health SBD |
$1,134.66
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.89
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: UMR Bronson Commercial |
$666.39
|
| Rate for Payer: VA VA |
$8.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,350.79
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$227.26
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$204.53 |
| Rate for Payer: Aetna American Axle |
$147.72
|
| Rate for Payer: Aetna American Axle |
$235.70
|
| Rate for Payer: Aetna Commercial |
$308.22
|
| Rate for Payer: Aetna Commercial |
$193.17
|
| Rate for Payer: Aetna Medicare |
$9.24
|
| Rate for Payer: Aetna Medicare |
$9.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$28.70
|
| Rate for Payer: BCBS Trust/PPO |
$28.70
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cash Price |
$181.81
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cash Price |
$181.81
|
| Rate for Payer: Cofinity Commercial |
$195.44
|
| Rate for Payer: Cofinity Commercial |
$159.08
|
| Rate for Payer: Cofinity Commercial |
$253.83
|
| Rate for Payer: Cofinity Commercial |
$311.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$204.53
|
| Rate for Payer: Healthscope Commercial |
$326.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.44
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.22
|
| Rate for Payer: PACE Medicare |
$8.44
|
| Rate for Payer: PACE Medicare |
$8.44
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PHP Commercial |
$308.22
|
| Rate for Payer: PHP Commercial |
$193.17
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.84
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Narrow Network |
$16.67
|
| Rate for Payer: Priority Health Narrow Network |
$16.67
|
| Rate for Payer: Priority Health SBD |
$228.44
|
| Rate for Payer: Priority Health SBD |
$143.17
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.89
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: UMR Bronson Commercial |
$84.09
|
| Rate for Payer: UMR Bronson Commercial |
$134.17
|
| Rate for Payer: VA VA |
$8.89
|
| Rate for Payer: VA VA |
$8.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.96
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$227.26
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.99 |
| Max. Negotiated Rate |
$204.53 |
| Rate for Payer: Aetna American Axle |
$147.72
|
| Rate for Payer: Aetna American Axle |
$235.70
|
| Rate for Payer: Aetna Commercial |
$308.22
|
| Rate for Payer: Aetna Commercial |
$193.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.72
|
| Rate for Payer: Cash Price |
$181.81
|
| Rate for Payer: Cash Price |
$290.09
|
| Rate for Payer: Cofinity Commercial |
$311.84
|
| Rate for Payer: Cofinity Commercial |
$195.44
|
| Rate for Payer: Cofinity Commercial |
$159.08
|
| Rate for Payer: Cofinity Commercial |
$253.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.81
|
| Rate for Payer: Healthscope Commercial |
$204.53
|
| Rate for Payer: Healthscope Commercial |
$326.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.17
|
| Rate for Payer: PHP Commercial |
$308.22
|
| Rate for Payer: PHP Commercial |
$193.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.83
|
| Rate for Payer: Priority Health SBD |
$228.44
|
| Rate for Payer: Priority Health SBD |
$143.17
|
| Rate for Payer: UMR Bronson Commercial |
$99.99
|
| Rate for Payer: UMR Bronson Commercial |
$159.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.96
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$325.28
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$292.75 |
| Rate for Payer: Aetna American Axle |
$211.43
|
| Rate for Payer: Aetna Commercial |
$276.49
|
| Rate for Payer: Aetna Medicare |
$8.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.78
|
| Rate for Payer: BCBS Complete |
$4.49
|
| Rate for Payer: BCBS MAPPO |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$24.49
|
| Rate for Payer: BCN Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$260.22
|
| Rate for Payer: Cash Price |
$260.22
|
| Rate for Payer: Cofinity Commercial |
$279.74
|
| Rate for Payer: Cofinity Commercial |
$227.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$292.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.96
|
| Rate for Payer: Mclaren Medicaid |
$4.28
|
| Rate for Payer: Mclaren Medicare |
$7.82
|
| Rate for Payer: Meridian Medicaid |
$4.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.49
|
| Rate for Payer: PACE Medicare |
$7.43
|
| Rate for Payer: PACE SWMI |
$7.82
|
| Rate for Payer: PHP Commercial |
$276.49
|
| Rate for Payer: PHP Medicare Advantage |
$7.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.30
|
| Rate for Payer: Priority Health Medicare |
$7.82
|
| Rate for Payer: Priority Health Narrow Network |
$17.04
|
| Rate for Payer: Priority Health SBD |
$204.93
|
| Rate for Payer: Railroad Medicare Medicare |
$7.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.82
|
| Rate for Payer: UHC Medicare Advantage |
$8.06
|
| Rate for Payer: UMR Bronson Commercial |
$120.35
|
| Rate for Payer: VA VA |
$7.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.96
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$325.28
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.12 |
| Max. Negotiated Rate |
$292.75 |
| Rate for Payer: Aetna American Axle |
$211.43
|
| Rate for Payer: Aetna Commercial |
$276.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.43
|
| Rate for Payer: Cash Price |
$260.22
|
| Rate for Payer: Cofinity Commercial |
$227.70
|
| Rate for Payer: Cofinity Commercial |
$279.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.22
|
| Rate for Payer: Healthscope Commercial |
$292.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.49
|
| Rate for Payer: PHP Commercial |
$276.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.70
|
| Rate for Payer: Priority Health SBD |
$204.93
|
| Rate for Payer: UMR Bronson Commercial |
$143.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.96
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$81.55
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$73.40 |
| Rate for Payer: Aetna American Axle |
$53.01
|
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna Medicare |
$8.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.78
|
| Rate for Payer: BCBS Complete |
$4.49
|
| Rate for Payer: BCBS MAPPO |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$24.49
|
| Rate for Payer: BCN Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Commercial |
$57.08
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$73.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.16
|
| Rate for Payer: Mclaren Medicaid |
$4.28
|
| Rate for Payer: Mclaren Medicare |
$7.82
|
| Rate for Payer: Meridian Medicaid |
$4.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.32
|
| Rate for Payer: PACE Medicare |
$7.43
|
| Rate for Payer: PACE SWMI |
$7.82
|
| Rate for Payer: PHP Commercial |
$69.32
|
| Rate for Payer: PHP Medicare Advantage |
$7.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.30
|
| Rate for Payer: Priority Health Medicare |
$7.82
|
| Rate for Payer: Priority Health Narrow Network |
$17.04
|
| Rate for Payer: Priority Health SBD |
$51.38
|
| Rate for Payer: Railroad Medicare Medicare |
$7.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.82
|
| Rate for Payer: UHC Medicare Advantage |
$8.06
|
| Rate for Payer: UMR Bronson Commercial |
$30.17
|
| Rate for Payer: VA VA |
$7.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.16
|
|
