|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
NDC 6936716620
|
| Hospital Charge Code |
3077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna American Axle |
$128.70
|
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.70
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$170.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.40
|
| Rate for Payer: Healthscope Commercial |
$178.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.30
|
| Rate for Payer: PHP Commercial |
$168.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.60
|
| Rate for Payer: Priority Health SBD |
$124.74
|
| Rate for Payer: UMR Bronson Commercial |
$87.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.50
|
|
|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$970.67
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna American Axle |
$630.94
|
| Rate for Payer: Aetna American Axle |
$802.78
|
| Rate for Payer: Aetna Commercial |
$1,049.79
|
| Rate for Payer: Aetna Commercial |
$825.07
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$1.14
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: Cash Price |
$776.54
|
| Rate for Payer: Cash Price |
$988.04
|
| Rate for Payer: Cash Price |
$776.54
|
| Rate for Payer: Cash Price |
$988.04
|
| Rate for Payer: Cofinity Commercial |
$679.47
|
| Rate for Payer: Cofinity Commercial |
$834.78
|
| Rate for Payer: Cofinity Commercial |
$1,062.14
|
| Rate for Payer: Cofinity Commercial |
$864.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Healthscope Commercial |
$873.60
|
| Rate for Payer: Healthscope Commercial |
$1,111.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$864.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$679.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$926.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.00
|
| Rate for Payer: Mclaren Medicaid |
$0.20
|
| Rate for Payer: Mclaren Medicaid |
$0.20
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Meridian Medicaid |
$0.21
|
| Rate for Payer: Meridian Medicaid |
$0.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$825.07
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PHP Commercial |
$1,049.79
|
| Rate for Payer: PHP Commercial |
$825.07
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.49
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Narrow Network |
$1.19
|
| Rate for Payer: Priority Health Narrow Network |
$1.19
|
| Rate for Payer: Priority Health SBD |
$611.52
|
| Rate for Payer: Priority Health SBD |
$778.08
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: UMR Bronson Commercial |
$456.97
|
| Rate for Payer: UMR Bronson Commercial |
$359.15
|
| Rate for Payer: VA VA |
$0.36
|
| Rate for Payer: VA VA |
$0.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$926.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.00
|
|
|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,235.05
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$543.42 |
| Max. Negotiated Rate |
$1,111.54 |
| Rate for Payer: Aetna American Axle |
$802.78
|
| Rate for Payer: Aetna Commercial |
$1,049.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.78
|
| Rate for Payer: Cash Price |
$988.04
|
| Rate for Payer: Cofinity Commercial |
$1,062.14
|
| Rate for Payer: Cofinity Commercial |
$864.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.04
|
| Rate for Payer: Healthscope Commercial |
$1,111.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$864.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$926.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.79
|
| Rate for Payer: PHP Commercial |
$1,049.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.54
|
| Rate for Payer: Priority Health SBD |
$778.08
|
| Rate for Payer: UMR Bronson Commercial |
$543.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$926.29
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 59025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.46 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$184.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: BCBS Complete |
$101.74
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$190.49
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Mclaren Medicaid |
$96.88
|
| Rate for Payer: Mclaren Medicare |
$177.12
|
| Rate for Payer: Meridian Medicaid |
$101.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: PACE Medicare |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$557.61
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$446.09
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.31
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.12
|
| Rate for Payer: UHC Exchange |
$48.46
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: VA VA |
$177.12
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$14,788.42
|
|
|
Service Code
|
MS-DRG 864
|
| Min. Negotiated Rate |
$6,949.48 |
| Max. Negotiated Rate |
$14,788.42 |
| Rate for Payer: Aetna Medicare |
$7,607.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,144.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,144.05
|
| Rate for Payer: BCBS MAPPO |
$7,315.24
|
| Rate for Payer: BCBS Trust/PPO |
$14,788.42
|
| Rate for Payer: BCN Medicare Advantage |
$7,315.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,315.24
|
| Rate for Payer: Mclaren Medicare |
$7,315.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,681.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,412.53
|
| Rate for Payer: PACE Medicare |
$6,949.48
|
| Rate for Payer: PACE SWMI |
$7,315.24
|
| Rate for Payer: PHP Medicare Advantage |
$7,315.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,668.11
|
| Rate for Payer: Priority Health Medicare |
$7,315.24
|
| Rate for Payer: Priority Health Narrow Network |
$10,134.49
|
| Rate for Payer: Railroad Medicare Medicare |
$7,315.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,466.23
|
| Rate for Payer: UHC Core |
$11,042.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,315.24
|
| Rate for Payer: UHC Exchange |
$8,778.56
|
| Rate for Payer: UHC Medicare Advantage |
$7,534.70
|
| Rate for Payer: VA VA |
$7,315.24
|
|
|
FIBERSOURCE HN BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018555
|
| Hospital Charge Code |
161567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018555
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 4390018588
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIBERSOURCE HN CYCLIC FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 4390018588
|
| Hospital Charge Code |
200077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIBERSOURCE HN INTERMITTENT FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 4390018588
|
| Hospital Charge Code |
200076
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIDAXOMICIN 200 MG TABLET
|
Facility
|
IP
|
$8,398.12
|
|
|
Service Code
|
NDC 52015-080-01
|
| Hospital Charge Code |
152861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,695.17 |
| Max. Negotiated Rate |
$7,558.31 |
| Rate for Payer: Aetna American Axle |
$5,458.78
|
| Rate for Payer: Aetna Commercial |
$7,138.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,458.78
|
| Rate for Payer: Cash Price |
$6,718.50
|
| Rate for Payer: Cofinity Commercial |
$5,878.68
|
| Rate for Payer: Cofinity Commercial |
$7,222.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,718.50
|
| Rate for Payer: Healthscope Commercial |
$7,558.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,878.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,298.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,138.40
|
| Rate for Payer: PHP Commercial |
$7,138.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,878.68
|
| Rate for Payer: Priority Health SBD |
$5,290.82
|
| Rate for Payer: UMR Bronson Commercial |
$3,695.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,298.59
|
|
|
FILGRASTIM 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$1,040.13
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
28863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$936.12 |
| Rate for Payer: Aetna American Axle |
$676.08
|
| Rate for Payer: Aetna American Axle |
$676.08
|
| Rate for Payer: Aetna Commercial |
$884.10
|
| Rate for Payer: Aetna Commercial |
$884.11
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.23
|
| Rate for Payer: BCBS Complete |
$0.57
|
| Rate for Payer: BCBS Complete |
$0.57
|
| Rate for Payer: BCBS MAPPO |
$0.99
|
| Rate for Payer: BCBS MAPPO |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCN Medicare Advantage |
$0.99
|
| Rate for Payer: BCN Medicare Advantage |
$0.99
|
| Rate for Payer: Cash Price |
$832.10
|
| Rate for Payer: Cash Price |
$832.10
|
| Rate for Payer: Cash Price |
$832.10
|
| Rate for Payer: Cash Price |
$832.10
|
| Rate for Payer: Cofinity Commercial |
$894.50
|
| Rate for Payer: Cofinity Commercial |
$728.09
|
| Rate for Payer: Cofinity Commercial |
$894.51
|
| Rate for Payer: Cofinity Commercial |
$728.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.99
|
| Rate for Payer: Healthscope Commercial |
$936.11
|
| Rate for Payer: Healthscope Commercial |
$936.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.10
|
| Rate for Payer: Mclaren Medicaid |
$0.54
|
| Rate for Payer: Mclaren Medicaid |
$0.54
|
| Rate for Payer: Mclaren Medicare |
$0.99
|
| Rate for Payer: Mclaren Medicare |
$0.99
|
| Rate for Payer: Meridian Medicaid |
$0.57
|
| Rate for Payer: Meridian Medicaid |
$0.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$884.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$884.11
|
| Rate for Payer: PACE Medicare |
$0.94
|
| Rate for Payer: PACE Medicare |
$0.94
|
| Rate for Payer: PACE SWMI |
$0.99
|
| Rate for Payer: PACE SWMI |
$0.99
|
| Rate for Payer: PHP Commercial |
$884.10
|
| Rate for Payer: PHP Commercial |
$884.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.99
|
| Rate for Payer: PHP Medicare Advantage |
$0.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.90
|
| Rate for Payer: Priority Health Medicare |
$0.99
|
| Rate for Payer: Priority Health Medicare |
$0.99
|
| Rate for Payer: Priority Health Narrow Network |
$2.32
|
| Rate for Payer: Priority Health Narrow Network |
$2.32
|
| Rate for Payer: Priority Health SBD |
$655.28
|
| Rate for Payer: Priority Health SBD |
$655.28
|
| Rate for Payer: Railroad Medicare Medicare |
$0.99
|
| Rate for Payer: Railroad Medicare Medicare |
$0.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.99
|
| Rate for Payer: UHC Medicare Advantage |
$1.01
|
| Rate for Payer: UHC Medicare Advantage |
$1.01
|
| Rate for Payer: UMR Bronson Commercial |
$384.84
|
| Rate for Payer: UMR Bronson Commercial |
$384.85
|
| Rate for Payer: VA VA |
$0.99
|
| Rate for Payer: VA VA |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.09
|
|
|
FILGRASTIM 300 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,456.62
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
10036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1,310.96 |
| Rate for Payer: Aetna American Axle |
$946.80
|
| Rate for Payer: Aetna Commercial |
$1,238.13
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.23
|
| Rate for Payer: BCBS Complete |
$0.57
|
| Rate for Payer: BCBS MAPPO |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCN Medicare Advantage |
$0.99
|
| Rate for Payer: Cash Price |
$1,165.30
|
| Rate for Payer: Cash Price |
$1,165.30
|
| Rate for Payer: Cofinity Commercial |
$1,019.63
|
| Rate for Payer: Cofinity Commercial |
$1,252.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,165.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.99
|
| Rate for Payer: Healthscope Commercial |
$1,310.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,019.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,092.46
|
| Rate for Payer: Mclaren Medicaid |
$0.54
|
| Rate for Payer: Mclaren Medicare |
$0.99
|
| Rate for Payer: Meridian Medicaid |
$0.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,238.13
|
| Rate for Payer: PACE Medicare |
$0.94
|
| Rate for Payer: PACE SWMI |
$0.99
|
| Rate for Payer: PHP Commercial |
$1,238.13
|
| Rate for Payer: PHP Medicare Advantage |
$0.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.90
|
| Rate for Payer: Priority Health Medicare |
$0.99
|
| Rate for Payer: Priority Health Narrow Network |
$2.32
|
| Rate for Payer: Priority Health SBD |
$917.67
|
| Rate for Payer: Railroad Medicare Medicare |
$0.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.99
|
| Rate for Payer: UHC Medicare Advantage |
$1.01
|
| Rate for Payer: UMR Bronson Commercial |
$538.95
|
| Rate for Payer: VA VA |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,092.46
|
|
|
FILGRASTIM 300 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,456.62
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
10036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$640.91 |
| Max. Negotiated Rate |
$1,310.96 |
| Rate for Payer: Aetna American Axle |
$946.80
|
| Rate for Payer: Aetna Commercial |
$1,238.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.80
|
| Rate for Payer: Cash Price |
$1,165.30
|
| Rate for Payer: Cofinity Commercial |
$1,019.63
|
| Rate for Payer: Cofinity Commercial |
$1,252.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,165.30
|
| Rate for Payer: Healthscope Commercial |
$1,310.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,019.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,092.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,238.13
|
| Rate for Payer: PHP Commercial |
$1,238.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.63
|
| Rate for Payer: Priority Health SBD |
$917.67
|
| Rate for Payer: UMR Bronson Commercial |
$640.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,092.46
|
|
|
FILGRASTIM 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
OP
|
$1,656.42
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
112198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1,490.78 |
| Rate for Payer: Aetna American Axle |
$1,076.67
|
| Rate for Payer: Aetna Commercial |
$1,407.96
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,076.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.23
|
| Rate for Payer: BCBS Complete |
$0.57
|
| Rate for Payer: BCBS MAPPO |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCN Medicare Advantage |
$0.99
|
| Rate for Payer: Cash Price |
$1,325.14
|
| Rate for Payer: Cash Price |
$1,325.14
|
| Rate for Payer: Cofinity Commercial |
$1,159.49
|
| Rate for Payer: Cofinity Commercial |
$1,424.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.99
|
| Rate for Payer: Healthscope Commercial |
$1,490.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,159.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,242.32
|
| Rate for Payer: Mclaren Medicaid |
$0.54
|
| Rate for Payer: Mclaren Medicare |
$0.99
|
| Rate for Payer: Meridian Medicaid |
$0.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,407.96
|
| Rate for Payer: PACE Medicare |
$0.94
|
| Rate for Payer: PACE SWMI |
$0.99
|
| Rate for Payer: PHP Commercial |
$1,407.96
|
| Rate for Payer: PHP Medicare Advantage |
$0.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,159.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.90
|
| Rate for Payer: Priority Health Medicare |
$0.99
|
| Rate for Payer: Priority Health Narrow Network |
$2.32
|
| Rate for Payer: Priority Health SBD |
$1,043.54
|
| Rate for Payer: Railroad Medicare Medicare |
$0.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.99
|
| Rate for Payer: UHC Medicare Advantage |
$1.01
|
| Rate for Payer: UMR Bronson Commercial |
$612.88
|
| Rate for Payer: VA VA |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,242.32
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJECTION SOLUTION
|
Facility
|
OP
|
$2,192.50
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
112757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1,973.25 |
| Rate for Payer: Aetna American Axle |
$1,425.12
|
| Rate for Payer: Aetna Commercial |
$1,863.62
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.23
|
| Rate for Payer: BCBS Complete |
$0.57
|
| Rate for Payer: BCBS MAPPO |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCN Medicare Advantage |
$0.99
|
| Rate for Payer: Cash Price |
$1,754.00
|
| Rate for Payer: Cash Price |
$1,754.00
|
| Rate for Payer: Cofinity Commercial |
$1,534.75
|
| Rate for Payer: Cofinity Commercial |
$1,885.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,754.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.99
|
| Rate for Payer: Healthscope Commercial |
$1,973.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,534.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,644.38
|
| Rate for Payer: Mclaren Medicaid |
$0.54
|
| Rate for Payer: Mclaren Medicare |
$0.99
|
| Rate for Payer: Meridian Medicaid |
$0.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,863.62
|
| Rate for Payer: PACE Medicare |
$0.94
|
| Rate for Payer: PACE SWMI |
$0.99
|
| Rate for Payer: PHP Commercial |
$1,863.62
|
| Rate for Payer: PHP Medicare Advantage |
$0.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.90
|
| Rate for Payer: Priority Health Medicare |
$0.99
|
| Rate for Payer: Priority Health Narrow Network |
$2.32
|
| Rate for Payer: Priority Health SBD |
$1,381.28
|
| Rate for Payer: Railroad Medicare Medicare |
$0.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.99
|
| Rate for Payer: UHC Medicare Advantage |
$1.01
|
| Rate for Payer: UMR Bronson Commercial |
$811.22
|
| Rate for Payer: VA VA |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,644.38
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJECTION SOLUTION
|
Facility
|
IP
|
$2,192.50
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
112757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$964.70 |
| Max. Negotiated Rate |
$1,973.25 |
| Rate for Payer: Aetna American Axle |
$1,425.12
|
| Rate for Payer: Aetna Commercial |
$1,863.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.12
|
| Rate for Payer: Cash Price |
$1,754.00
|
| Rate for Payer: Cofinity Commercial |
$1,534.75
|
| Rate for Payer: Cofinity Commercial |
$1,885.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,754.00
|
| Rate for Payer: Healthscope Commercial |
$1,973.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,534.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,644.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,863.62
|
| Rate for Payer: PHP Commercial |
$1,863.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.75
|
| Rate for Payer: Priority Health SBD |
$1,381.28
|
| Rate for Payer: UMR Bronson Commercial |
$964.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,644.38
|
|
|
FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$295.94
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$266.35 |
| Rate for Payer: Aetna American Axle |
$192.36
|
| Rate for Payer: Aetna American Axle |
$192.35
|
| Rate for Payer: Aetna Commercial |
$251.54
|
| Rate for Payer: Aetna Commercial |
$251.55
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$0.73
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: Cash Price |
$236.75
|
| Rate for Payer: Cash Price |
$236.75
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$254.51
|
| Rate for Payer: Cofinity Commercial |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$254.50
|
| Rate for Payer: Cofinity Commercial |
$207.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.29
|
| Rate for Payer: Healthscope Commercial |
$266.35
|
| Rate for Payer: Healthscope Commercial |
$266.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.96
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.55
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PHP Commercial |
$251.55
|
| Rate for Payer: PHP Commercial |
$251.54
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.70
|
| Rate for Payer: Priority Health Narrow Network |
$0.70
|
| Rate for Payer: Priority Health SBD |
$186.44
|
| Rate for Payer: Priority Health SBD |
$186.44
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UMR Bronson Commercial |
$109.50
|
| Rate for Payer: UMR Bronson Commercial |
$109.49
|
| Rate for Payer: VA VA |
$0.29
|
| Rate for Payer: VA VA |
$0.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.96
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$473.50
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$208.34 |
| Max. Negotiated Rate |
$426.15 |
| Rate for Payer: Aetna American Axle |
$307.78
|
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.78
|
| Rate for Payer: Cash Price |
$378.80
|
| Rate for Payer: Cofinity Commercial |
$331.45
|
| Rate for Payer: Cofinity Commercial |
$407.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.80
|
| Rate for Payer: Healthscope Commercial |
$426.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.48
|
| Rate for Payer: PHP Commercial |
$402.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.45
|
| Rate for Payer: Priority Health SBD |
$298.30
|
| Rate for Payer: UMR Bronson Commercial |
$208.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.12
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$473.50
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$426.15 |
| Rate for Payer: Aetna American Axle |
$307.78
|
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.73
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: Cash Price |
$378.80
|
| Rate for Payer: Cash Price |
$378.80
|
| Rate for Payer: Cofinity Commercial |
$331.45
|
| Rate for Payer: Cofinity Commercial |
$407.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.29
|
| Rate for Payer: Healthscope Commercial |
$426.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.12
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.48
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PHP Commercial |
$402.48
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.70
|
| Rate for Payer: Priority Health SBD |
$298.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UMR Bronson Commercial |
$175.20
|
| Rate for Payer: VA VA |
$0.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.12
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$493.81
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.28 |
| Max. Negotiated Rate |
$444.43 |
| Rate for Payer: Aetna American Axle |
$320.98
|
| Rate for Payer: Aetna Commercial |
$419.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.05
|
| Rate for Payer: Healthscope Commercial |
$444.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.74
|
| Rate for Payer: PHP Commercial |
$419.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.67
|
| Rate for Payer: Priority Health SBD |
$311.10
|
| Rate for Payer: UMR Bronson Commercial |
$217.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.36
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$493.81
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$444.43 |
| Rate for Payer: Aetna American Axle |
$320.98
|
| Rate for Payer: Aetna Commercial |
$419.74
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.40
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS MAPPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.82
|
| Rate for Payer: BCN Medicare Advantage |
$0.32
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.32
|
| Rate for Payer: Healthscope Commercial |
$444.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.36
|
| Rate for Payer: Mclaren Medicaid |
$0.17
|
| Rate for Payer: Mclaren Medicare |
$0.32
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.74
|
| Rate for Payer: PACE Medicare |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.32
|
| Rate for Payer: PHP Commercial |
$419.74
|
| Rate for Payer: PHP Medicare Advantage |
$0.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.49
|
| Rate for Payer: Priority Health Medicare |
$0.32
|
| Rate for Payer: Priority Health Narrow Network |
$0.39
|
| Rate for Payer: Priority Health SBD |
$311.10
|
| Rate for Payer: Railroad Medicare Medicare |
$0.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.32
|
| Rate for Payer: UHC Medicare Advantage |
$0.33
|
| Rate for Payer: UMR Bronson Commercial |
$182.71
|
| Rate for Payer: VA VA |
$0.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.36
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
IP
|
$790.09
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$347.64 |
| Max. Negotiated Rate |
$711.08 |
| Rate for Payer: Aetna American Axle |
$513.56
|
| Rate for Payer: Aetna American Axle |
$513.56
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cofinity Commercial |
$679.49
|
| Rate for Payer: Cofinity Commercial |
$679.48
|
| Rate for Payer: Cofinity Commercial |
$553.06
|
| Rate for Payer: Cofinity Commercial |
$553.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.07
|
| Rate for Payer: Healthscope Commercial |
$711.09
|
| Rate for Payer: Healthscope Commercial |
$711.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.07
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: UMR Bronson Commercial |
$347.64
|
| Rate for Payer: UMR Bronson Commercial |
$347.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.58
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
OP
|
$790.09
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$711.08 |
| Rate for Payer: Aetna American Axle |
$513.56
|
| Rate for Payer: Aetna American Axle |
$513.56
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.40
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS MAPPO |
$0.32
|
| Rate for Payer: BCBS MAPPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$0.82
|
| Rate for Payer: BCN Medicare Advantage |
$0.32
|
| Rate for Payer: BCN Medicare Advantage |
$0.32
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cofinity Commercial |
$553.06
|
| Rate for Payer: Cofinity Commercial |
$553.07
|
| Rate for Payer: Cofinity Commercial |
$679.49
|
| Rate for Payer: Cofinity Commercial |
$679.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.32
|
| Rate for Payer: Healthscope Commercial |
$711.09
|
| Rate for Payer: Healthscope Commercial |
$711.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.58
|
| Rate for Payer: Mclaren Medicaid |
$0.17
|
| Rate for Payer: Mclaren Medicaid |
$0.17
|
| Rate for Payer: Mclaren Medicare |
$0.32
|
| Rate for Payer: Mclaren Medicare |
$0.32
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.58
|
| Rate for Payer: PACE Medicare |
$0.30
|
| Rate for Payer: PACE Medicare |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.32
|
| Rate for Payer: PACE SWMI |
$0.32
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.32
|
| Rate for Payer: PHP Medicare Advantage |
$0.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.49
|
| Rate for Payer: Priority Health Medicare |
$0.32
|
| Rate for Payer: Priority Health Medicare |
$0.32
|
| Rate for Payer: Priority Health Narrow Network |
$0.39
|
| Rate for Payer: Priority Health Narrow Network |
$0.39
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Railroad Medicare Medicare |
$0.32
|
| Rate for Payer: Railroad Medicare Medicare |
$0.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.32
|
| Rate for Payer: UHC Medicare Advantage |
$0.33
|
| Rate for Payer: UHC Medicare Advantage |
$0.33
|
| Rate for Payer: UMR Bronson Commercial |
$292.33
|
| Rate for Payer: UMR Bronson Commercial |
$292.34
|
| Rate for Payer: VA VA |
$0.32
|
| Rate for Payer: VA VA |
$0.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.58
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 0904-6830-06
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.27 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna American Axle |
$125.97
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.73
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.66
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$85.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
