|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,061.49 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna American Axle |
$1,568.11
|
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Advantage |
$1,688.73
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,688.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.35
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,061.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.35
|
|
|
DARBEPOETIN ALFA 100 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
IP
|
$2,225.56
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$979.25 |
| Max. Negotiated Rate |
$2,003.00 |
| Rate for Payer: Aetna American Axle |
$1,446.61
|
| Rate for Payer: Aetna American Axle |
$1,568.11
|
| Rate for Payer: Aetna Commercial |
$1,891.73
|
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,446.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Cash Price |
$1,780.45
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Advantage |
$1,688.73
|
| Rate for Payer: Cofinity Advantage |
$1,557.89
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Cofinity Commercial |
$1,913.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Healthscope Commercial |
$2,003.00
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,688.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,557.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,669.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,891.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,669.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.35
|
| Rate for Payer: PHP Commercial |
$1,891.73
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
| Rate for Payer: Priority Health SBD |
$1,402.10
|
| Rate for Payer: UMR Bronson Commercial |
$979.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,061.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,669.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.35
|
|
|
DARBEPOETIN ALFA 100 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna American Axle |
$1,568.11
|
| Rate for Payer: Aetna American Axle |
$1,446.61
|
| Rate for Payer: Aetna Commercial |
$1,891.73
|
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,446.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$1,780.45
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cash Price |
$1,780.45
|
| Rate for Payer: Cofinity Advantage |
$1,688.73
|
| Rate for Payer: Cofinity Advantage |
$1,557.89
|
| Rate for Payer: Cofinity Commercial |
$1,913.98
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$2,003.00
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,688.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,557.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,669.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.35
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,891.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.60
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,669.17
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$1,891.73
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$1,402.10
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$823.46
|
| Rate for Payer: UMR Bronson Commercial |
$892.61
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,669.17
|
|
|
DARBEPOETIN ALFA 10 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$267.64
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
161505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$240.88 |
| Rate for Payer: Aetna American Axle |
$173.97
|
| Rate for Payer: Aetna Commercial |
$227.49
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$214.11
|
| Rate for Payer: Cash Price |
$214.11
|
| Rate for Payer: Cofinity Advantage |
$187.35
|
| Rate for Payer: Cofinity Commercial |
$230.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$240.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.73
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.49
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.73
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$227.49
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$168.61
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$99.03
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.73
|
|
|
DARBEPOETIN ALFA 10 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$267.64
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
161505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.76 |
| Max. Negotiated Rate |
$240.88 |
| Rate for Payer: Aetna American Axle |
$173.97
|
| Rate for Payer: Aetna Commercial |
$227.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.97
|
| Rate for Payer: Cash Price |
$214.11
|
| Rate for Payer: Cofinity Advantage |
$187.35
|
| Rate for Payer: Cofinity Commercial |
$230.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.11
|
| Rate for Payer: Healthscope Commercial |
$240.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.73
|
| Rate for Payer: PHP Commercial |
$227.49
|
| Rate for Payer: Priority Health SBD |
$168.61
|
| Rate for Payer: UMR Bronson Commercial |
$117.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.73
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$3,618.71
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,592.23 |
| Max. Negotiated Rate |
$3,256.84 |
| Rate for Payer: Aetna American Axle |
$2,352.16
|
| Rate for Payer: Aetna Commercial |
$3,075.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,352.16
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cofinity Advantage |
$2,533.10
|
| Rate for Payer: Cofinity Commercial |
$3,112.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,894.97
|
| Rate for Payer: Healthscope Commercial |
$3,256.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,533.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,714.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,714.03
|
| Rate for Payer: PHP Commercial |
$3,075.90
|
| Rate for Payer: Priority Health SBD |
$2,279.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,592.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,714.03
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$3,618.71
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3,256.84 |
| Rate for Payer: Aetna American Axle |
$2,352.16
|
| Rate for Payer: Aetna Commercial |
$3,075.90
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,352.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cash Price |
$2,894.97
|
| Rate for Payer: Cofinity Advantage |
$2,533.10
|
| Rate for Payer: Cofinity Commercial |
$3,112.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,894.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$3,256.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,533.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,714.03
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.90
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,714.03
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$3,075.90
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$2,279.79
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,338.92
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,714.03
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$4,824.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna American Axle |
$3,136.20
|
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cofinity Advantage |
$3,377.45
|
| Rate for Payer: Cofinity Commercial |
$4,149.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,859.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$4,342.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,377.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,618.70
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,101.19
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,618.70
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$3,039.71
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,785.22
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,618.70
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$4,824.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,122.97 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna American Axle |
$3,136.20
|
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.20
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cofinity Advantage |
$3,377.45
|
| Rate for Payer: Cofinity Commercial |
$4,149.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,859.94
|
| Rate for Payer: Healthscope Commercial |
$4,342.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,377.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,618.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,101.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,618.70
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: Priority Health SBD |
$3,039.71
|
| Rate for Payer: UMR Bronson Commercial |
$2,122.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,618.70
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna American Axle |
$434.91
|
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Advantage |
$468.36
|
| Rate for Payer: Cofinity Commercial |
$575.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.27
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.82
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: Priority Health SBD |
$421.53
|
| Rate for Payer: UMR Bronson Commercial |
$294.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.82
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna American Axle |
$434.91
|
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Advantage |
$468.36
|
| Rate for Payer: Cofinity Commercial |
$575.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.82
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.73
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.82
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$421.53
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$247.56
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.82
|
|
|
DARBEPOETIN ALFA 25 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
IP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna American Axle |
$434.91
|
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Advantage |
$468.36
|
| Rate for Payer: Cofinity Commercial |
$575.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.27
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.82
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: Priority Health SBD |
$421.53
|
| Rate for Payer: UMR Bronson Commercial |
$294.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.82
|
|
|
DARBEPOETIN ALFA 25 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna American Axle |
$434.91
|
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Advantage |
$468.36
|
| Rate for Payer: Cofinity Commercial |
$575.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.82
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.73
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.82
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$421.53
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$247.56
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.82
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,587.38 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna American Axle |
$3,822.26
|
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,822.26
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cofinity Advantage |
$4,116.28
|
| Rate for Payer: Cofinity Commercial |
$5,057.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,704.32
|
| Rate for Payer: Healthscope Commercial |
$5,292.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,116.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,410.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,998.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,410.30
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: Priority Health SBD |
$3,704.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,587.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,410.30
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna American Axle |
$3,822.26
|
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,822.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cofinity Advantage |
$4,116.28
|
| Rate for Payer: Cofinity Commercial |
$5,057.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,704.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$5,292.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,116.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,410.30
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,998.34
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,410.30
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$3,704.65
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$2,175.75
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,410.30
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$964.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna American Axle |
$627.24
|
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cofinity Advantage |
$675.49
|
| Rate for Payer: Cofinity Commercial |
$829.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.74
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.24
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.74
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$607.94
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$357.05
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.74
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$964.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$424.60 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna American Axle |
$627.24
|
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.24
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cofinity Advantage |
$675.49
|
| Rate for Payer: Cofinity Commercial |
$829.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.99
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.74
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: Priority Health SBD |
$607.94
|
| Rate for Payer: UMR Bronson Commercial |
$424.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.74
|
|
|
DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$9,800.65
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$8,820.58 |
| Rate for Payer: Aetna American Axle |
$6,370.42
|
| Rate for Payer: Aetna Commercial |
$8,330.55
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,370.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cofinity Advantage |
$6,860.45
|
| Rate for Payer: Cofinity Commercial |
$8,428.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,840.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$8,820.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,860.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,350.49
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,330.55
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,350.49
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$8,330.55
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$6,174.41
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$3,626.24
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,350.49
|
|
|
DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$9,800.65
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,312.29 |
| Max. Negotiated Rate |
$8,820.58 |
| Rate for Payer: Aetna American Axle |
$6,370.42
|
| Rate for Payer: Aetna Commercial |
$8,330.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,370.42
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cofinity Advantage |
$6,860.45
|
| Rate for Payer: Cofinity Commercial |
$8,428.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,840.52
|
| Rate for Payer: Healthscope Commercial |
$8,820.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,860.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,350.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,330.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,350.49
|
| Rate for Payer: PHP Commercial |
$8,330.55
|
| Rate for Payer: Priority Health SBD |
$6,174.41
|
| Rate for Payer: UMR Bronson Commercial |
$4,312.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,350.49
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$1,447.49
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$636.90 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna American Axle |
$940.87
|
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.87
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cofinity Advantage |
$1,013.24
|
| Rate for Payer: Cofinity Commercial |
$1,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.99
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,013.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,085.62
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: Priority Health SBD |
$911.92
|
| Rate for Payer: UMR Bronson Commercial |
$636.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.62
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$1,447.49
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna American Axle |
$940.87
|
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cofinity Advantage |
$1,013.24
|
| Rate for Payer: Cofinity Commercial |
$1,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,013.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.62
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.37
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,085.62
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$911.92
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$535.57
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.62
|
|
|
DARBEPOETIN ALFA 60 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
IP
|
$1,447.49
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$636.90 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna American Axle |
$940.87
|
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.87
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cofinity Advantage |
$1,013.24
|
| Rate for Payer: Cofinity Commercial |
$1,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.99
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,013.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,085.62
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: Priority Health SBD |
$911.92
|
| Rate for Payer: UMR Bronson Commercial |
$636.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.62
|
|
|
DARBEPOETIN ALFA 60 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$1,447.49
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna American Axle |
$940.87
|
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cofinity Advantage |
$1,013.24
|
| Rate for Payer: Cofinity Commercial |
$1,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,013.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.62
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.37
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,085.62
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$911.92
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$535.57
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.62
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET
|
Facility
|
OP
|
$8,898.65
|
|
|
Service Code
|
NDC 59676057530
|
| Hospital Charge Code |
173955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,292.50 |
| Max. Negotiated Rate |
$8,008.78 |
| Rate for Payer: Aetna American Axle |
$5,784.12
|
| Rate for Payer: Aetna Commercial |
$7,563.85
|
| Rate for Payer: Aetna Medicare |
$4,449.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,784.12
|
| Rate for Payer: BCBS Complete |
$3,559.46
|
| Rate for Payer: Cash Price |
$7,118.92
|
| Rate for Payer: Cofinity Advantage |
$6,229.06
|
| Rate for Payer: Cofinity Commercial |
$7,652.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,118.92
|
| Rate for Payer: Healthscope Commercial |
$8,008.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,229.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,673.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,118.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,563.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,673.99
|
| Rate for Payer: PHP Commercial |
$7,563.85
|
| Rate for Payer: Priority Health SBD |
$5,606.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,784.12
|
| Rate for Payer: UHC Core |
$4,636.20
|
| Rate for Payer: UHC Exchange |
$3,497.17
|
| Rate for Payer: UMR Bronson Commercial |
$3,292.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,673.99
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET
|
Facility
|
IP
|
$8,898.65
|
|
|
Service Code
|
NDC 59676057530
|
| Hospital Charge Code |
173955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,915.41 |
| Max. Negotiated Rate |
$8,008.78 |
| Rate for Payer: Aetna American Axle |
$5,784.12
|
| Rate for Payer: Aetna Commercial |
$7,563.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,784.12
|
| Rate for Payer: Cash Price |
$7,118.92
|
| Rate for Payer: Cofinity Advantage |
$6,229.06
|
| Rate for Payer: Cofinity Commercial |
$7,652.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,118.92
|
| Rate for Payer: Healthscope Commercial |
$8,008.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,229.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,673.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,563.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,673.99
|
| Rate for Payer: PHP Commercial |
$7,563.85
|
| Rate for Payer: Priority Health SBD |
$5,606.15
|
| Rate for Payer: UMR Bronson Commercial |
$3,915.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,673.99
|
|
