|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$183.19
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$164.87 |
| Rate for Payer: Aetna American Axle |
$119.07
|
| Rate for Payer: Aetna Commercial |
$155.71
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$24.63
|
| Rate for Payer: BCN Commercial |
$24.63
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$146.55
|
| Rate for Payer: Cash Price |
$146.55
|
| Rate for Payer: Cofinity Advantage |
$128.23
|
| Rate for Payer: Cofinity Commercial |
$157.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$164.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.39
|
| Rate for Payer: Mclaren Medicaid |
$7.31
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.71
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.39
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$155.71
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.96
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health SBD |
$115.41
|
| Rate for Payer: Priority Health Tiered Network |
$21.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC Core |
$12.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$12.77
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: UMR Bronson Commercial |
$67.78
|
| Rate for Payer: VA VA |
$7.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.39
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,801.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
24513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$792.46 |
| Max. Negotiated Rate |
$1,620.94 |
| Rate for Payer: Aetna American Axle |
$1,170.68
|
| Rate for Payer: Aetna Commercial |
$1,530.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.68
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cofinity Advantage |
$1,260.73
|
| Rate for Payer: Cofinity Commercial |
$1,548.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,440.84
|
| Rate for Payer: Healthscope Commercial |
$1,620.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,260.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,350.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,530.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.79
|
| Rate for Payer: PHP Commercial |
$1,530.89
|
| Rate for Payer: Priority Health SBD |
$1,134.66
|
| Rate for Payer: UMR Bronson Commercial |
$792.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,350.79
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,801.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
24513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$1,620.94 |
| Rate for Payer: Aetna American Axle |
$1,170.68
|
| Rate for Payer: Aetna Commercial |
$1,530.89
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$24.63
|
| Rate for Payer: BCN Commercial |
$24.63
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cash Price |
$1,440.84
|
| Rate for Payer: Cofinity Advantage |
$1,260.73
|
| Rate for Payer: Cofinity Commercial |
$1,548.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,440.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$1,620.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,260.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,350.79
|
| Rate for Payer: Mclaren Medicaid |
$7.31
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,530.89
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.79
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$1,530.89
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.96
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health SBD |
$1,134.66
|
| Rate for Payer: Priority Health Tiered Network |
$21.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC Core |
$12.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$12.77
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: UMR Bronson Commercial |
$666.39
|
| Rate for Payer: VA VA |
$7.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,350.79
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$366.32
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.18 |
| Max. Negotiated Rate |
$329.69 |
| Rate for Payer: Aetna American Axle |
$238.11
|
| Rate for Payer: Aetna Commercial |
$311.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.11
|
| Rate for Payer: Cash Price |
$293.06
|
| Rate for Payer: Cofinity Advantage |
$256.42
|
| Rate for Payer: Cofinity Commercial |
$315.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.06
|
| Rate for Payer: Healthscope Commercial |
$329.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.74
|
| Rate for Payer: PHP Commercial |
$311.37
|
| Rate for Payer: Priority Health SBD |
$230.78
|
| Rate for Payer: UMR Bronson Commercial |
$161.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.74
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$227.26
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$204.53 |
| Rate for Payer: Aetna American Axle |
$147.72
|
| Rate for Payer: Aetna American Axle |
$238.11
|
| Rate for Payer: Aetna Commercial |
$193.17
|
| Rate for Payer: Aetna Commercial |
$311.37
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$24.63
|
| Rate for Payer: BCN Commercial |
$24.63
|
| Rate for Payer: BCN Commercial |
$24.63
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$293.06
|
| Rate for Payer: Cash Price |
$181.81
|
| Rate for Payer: Cash Price |
$181.81
|
| Rate for Payer: Cash Price |
$293.06
|
| Rate for Payer: Cofinity Advantage |
$256.42
|
| Rate for Payer: Cofinity Advantage |
$159.08
|
| Rate for Payer: Cofinity Commercial |
$195.44
|
| Rate for Payer: Cofinity Commercial |
$315.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$204.53
|
| Rate for Payer: Healthscope Commercial |
$329.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.44
|
| Rate for Payer: Mclaren Medicaid |
$7.31
|
| Rate for Payer: Mclaren Medicaid |
$7.31
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.17
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.74
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$193.17
|
| Rate for Payer: PHP Commercial |
$311.37
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.96
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health SBD |
$230.78
|
| Rate for Payer: Priority Health SBD |
$143.17
|
| Rate for Payer: Priority Health Tiered Network |
$21.57
|
| Rate for Payer: Priority Health Tiered Network |
$21.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC Core |
$12.77
|
| Rate for Payer: UHC Core |
$12.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$12.77
|
| Rate for Payer: UHC Exchange |
$12.77
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: UMR Bronson Commercial |
$84.09
|
| Rate for Payer: UMR Bronson Commercial |
$135.54
|
| Rate for Payer: VA VA |
$7.31
|
| Rate for Payer: VA VA |
$7.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.74
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$333.28
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$299.95 |
| Rate for Payer: Aetna American Axle |
$216.63
|
| Rate for Payer: Aetna Commercial |
$283.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.63
|
| Rate for Payer: Cash Price |
$266.62
|
| Rate for Payer: Cofinity Advantage |
$233.30
|
| Rate for Payer: Cofinity Commercial |
$286.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.62
|
| Rate for Payer: Healthscope Commercial |
$299.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.96
|
| Rate for Payer: PHP Commercial |
$283.29
|
| Rate for Payer: Priority Health SBD |
$209.97
|
| Rate for Payer: UMR Bronson Commercial |
$146.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.96
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$333.28
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$299.95 |
| Rate for Payer: Aetna American Axle |
$216.63
|
| Rate for Payer: Aetna Commercial |
$283.29
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$23.55
|
| Rate for Payer: BCN Commercial |
$23.55
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$266.62
|
| Rate for Payer: Cash Price |
$266.62
|
| Rate for Payer: Cofinity Advantage |
$233.30
|
| Rate for Payer: Cofinity Commercial |
$286.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$299.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.96
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.29
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.96
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$283.29
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.77
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$209.97
|
| Rate for Payer: Priority Health Tiered Network |
$19.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.49
|
| Rate for Payer: UHC Core |
$12.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: UMR Bronson Commercial |
$123.31
|
| Rate for Payer: VA VA |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.96
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$666.56
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
195677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$293.29 |
| Max. Negotiated Rate |
$599.90 |
| Rate for Payer: Aetna American Axle |
$433.26
|
| Rate for Payer: Aetna Commercial |
$566.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.26
|
| Rate for Payer: Cash Price |
$533.25
|
| Rate for Payer: Cofinity Advantage |
$466.59
|
| Rate for Payer: Cofinity Commercial |
$573.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.25
|
| Rate for Payer: Healthscope Commercial |
$599.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$466.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$499.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$499.92
|
| Rate for Payer: PHP Commercial |
$566.58
|
| Rate for Payer: Priority Health SBD |
$419.93
|
| Rate for Payer: UMR Bronson Commercial |
$293.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$499.92
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$666.56
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
195677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$599.90 |
| Rate for Payer: Aetna American Axle |
$433.26
|
| Rate for Payer: Aetna Commercial |
$566.58
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$23.55
|
| Rate for Payer: BCN Commercial |
$23.55
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$533.25
|
| Rate for Payer: Cash Price |
$533.25
|
| Rate for Payer: Cofinity Advantage |
$466.59
|
| Rate for Payer: Cofinity Commercial |
$573.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$599.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$466.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$499.92
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.58
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$499.92
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$566.58
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.77
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$419.93
|
| Rate for Payer: Priority Health Tiered Network |
$19.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.49
|
| Rate for Payer: UHC Core |
$12.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: UMR Bronson Commercial |
$246.63
|
| Rate for Payer: VA VA |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$499.92
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$83.56
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.77 |
| Max. Negotiated Rate |
$75.20 |
| Rate for Payer: Aetna American Axle |
$54.31
|
| Rate for Payer: Aetna Commercial |
$71.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.31
|
| Rate for Payer: Cash Price |
$66.85
|
| Rate for Payer: Cofinity Advantage |
$58.49
|
| Rate for Payer: Cofinity Commercial |
$71.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.85
|
| Rate for Payer: Healthscope Commercial |
$75.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.67
|
| Rate for Payer: PHP Commercial |
$71.03
|
| Rate for Payer: Priority Health SBD |
$52.64
|
| Rate for Payer: UMR Bronson Commercial |
$36.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.67
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$83.56
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$75.20 |
| Rate for Payer: Aetna American Axle |
$54.31
|
| Rate for Payer: Aetna Commercial |
$71.03
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$23.55
|
| Rate for Payer: BCN Commercial |
$23.55
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$66.85
|
| Rate for Payer: Cash Price |
$66.85
|
| Rate for Payer: Cofinity Advantage |
$58.49
|
| Rate for Payer: Cofinity Commercial |
$71.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$75.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.67
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.03
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.67
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$71.03
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.77
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$52.64
|
| Rate for Payer: Priority Health Tiered Network |
$19.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.49
|
| Rate for Payer: UHC Core |
$12.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: UMR Bronson Commercial |
$30.92
|
| Rate for Payer: VA VA |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.67
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$125.33
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.15 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Aetna American Axle |
$81.46
|
| Rate for Payer: Aetna Commercial |
$106.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.46
|
| Rate for Payer: Cash Price |
$100.26
|
| Rate for Payer: Cofinity Advantage |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$107.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.26
|
| Rate for Payer: Healthscope Commercial |
$112.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.00
|
| Rate for Payer: PHP Commercial |
$106.53
|
| Rate for Payer: Priority Health SBD |
$78.96
|
| Rate for Payer: UMR Bronson Commercial |
$55.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.00
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$125.33
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Aetna American Axle |
$81.46
|
| Rate for Payer: Aetna Commercial |
$106.53
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$23.55
|
| Rate for Payer: BCN Commercial |
$23.55
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$100.26
|
| Rate for Payer: Cash Price |
$100.26
|
| Rate for Payer: Cofinity Advantage |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$107.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$112.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.00
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.53
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.00
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$106.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.77
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$78.96
|
| Rate for Payer: Priority Health Tiered Network |
$19.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.49
|
| Rate for Payer: UHC Core |
$12.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: UMR Bronson Commercial |
$46.37
|
| Rate for Payer: VA VA |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.00
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,201.67
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$528.73 |
| Max. Negotiated Rate |
$1,081.50 |
| Rate for Payer: Aetna American Axle |
$781.09
|
| Rate for Payer: Aetna Commercial |
$1,021.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.09
|
| Rate for Payer: Cash Price |
$961.34
|
| Rate for Payer: Cofinity Advantage |
$841.17
|
| Rate for Payer: Cofinity Commercial |
$1,033.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.34
|
| Rate for Payer: Healthscope Commercial |
$1,081.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$841.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$901.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$901.25
|
| Rate for Payer: PHP Commercial |
$1,021.42
|
| Rate for Payer: Priority Health SBD |
$757.05
|
| Rate for Payer: UMR Bronson Commercial |
$528.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$901.25
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,201.67
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$1,081.50 |
| Rate for Payer: Aetna American Axle |
$781.09
|
| Rate for Payer: Aetna Commercial |
$1,021.42
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$23.55
|
| Rate for Payer: BCN Commercial |
$23.55
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$961.34
|
| Rate for Payer: Cash Price |
$961.34
|
| Rate for Payer: Cofinity Advantage |
$841.17
|
| Rate for Payer: Cofinity Commercial |
$1,033.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$1,081.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$841.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$901.25
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.42
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$901.25
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$1,021.42
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.77
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$757.05
|
| Rate for Payer: Priority Health Tiered Network |
$19.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.49
|
| Rate for Payer: UHC Core |
$12.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: UMR Bronson Commercial |
$444.62
|
| Rate for Payer: VA VA |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$901.25
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$167.11
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$150.40 |
| Rate for Payer: Aetna American Axle |
$108.62
|
| Rate for Payer: Aetna Commercial |
$142.04
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$23.55
|
| Rate for Payer: BCN Commercial |
$23.55
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$133.69
|
| Rate for Payer: Cash Price |
$133.69
|
| Rate for Payer: Cofinity Advantage |
$116.98
|
| Rate for Payer: Cofinity Commercial |
$143.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$150.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.33
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.04
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.33
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$142.04
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.77
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$105.28
|
| Rate for Payer: Priority Health Tiered Network |
$19.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.49
|
| Rate for Payer: UHC Core |
$12.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.88
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: UMR Bronson Commercial |
$61.83
|
| Rate for Payer: VA VA |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.33
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$167.11
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.53 |
| Max. Negotiated Rate |
$150.40 |
| Rate for Payer: Aetna American Axle |
$108.62
|
| Rate for Payer: Aetna Commercial |
$142.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.62
|
| Rate for Payer: Cash Price |
$133.69
|
| Rate for Payer: Cofinity Advantage |
$116.98
|
| Rate for Payer: Cofinity Commercial |
$143.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.69
|
| Rate for Payer: Healthscope Commercial |
$150.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.33
|
| Rate for Payer: PHP Commercial |
$142.04
|
| Rate for Payer: Priority Health SBD |
$105.28
|
| Rate for Payer: UMR Bronson Commercial |
$73.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.33
|
|
|
EPOPROSTENOL 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$130.85
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
162203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.82 |
| Max. Negotiated Rate |
$117.77 |
| Rate for Payer: Aetna American Axle |
$85.05
|
| Rate for Payer: Aetna American Axle |
$69.46
|
| Rate for Payer: Aetna American Axle |
$59.23
|
| Rate for Payer: Aetna Commercial |
$111.22
|
| Rate for Payer: Aetna Commercial |
$77.46
|
| Rate for Payer: Aetna Commercial |
$90.83
|
| Rate for Payer: Aetna Medicare |
$65.42
|
| Rate for Payer: Aetna Medicare |
$53.43
|
| Rate for Payer: Aetna Medicare |
$45.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.23
|
| Rate for Payer: BCBS Complete |
$42.74
|
| Rate for Payer: BCBS Complete |
$52.34
|
| Rate for Payer: BCBS Complete |
$36.45
|
| Rate for Payer: BCBS Trust/PPO |
$50.73
|
| Rate for Payer: BCBS Trust/PPO |
$50.73
|
| Rate for Payer: BCBS Trust/PPO |
$50.73
|
| Rate for Payer: BCN Commercial |
$50.73
|
| Rate for Payer: BCN Commercial |
$50.73
|
| Rate for Payer: BCN Commercial |
$50.73
|
| Rate for Payer: Cash Price |
$85.49
|
| Rate for Payer: Cash Price |
$85.49
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cofinity Advantage |
$63.79
|
| Rate for Payer: Cofinity Advantage |
$91.59
|
| Rate for Payer: Cofinity Advantage |
$74.80
|
| Rate for Payer: Cofinity Commercial |
$91.90
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Cofinity Commercial |
$78.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.68
|
| Rate for Payer: Healthscope Commercial |
$96.17
|
| Rate for Payer: Healthscope Commercial |
$117.77
|
| Rate for Payer: Healthscope Commercial |
$82.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.35
|
| Rate for Payer: PHP Commercial |
$111.22
|
| Rate for Payer: PHP Commercial |
$90.83
|
| Rate for Payer: PHP Commercial |
$77.46
|
| Rate for Payer: Priority Health SBD |
$67.32
|
| Rate for Payer: Priority Health SBD |
$57.41
|
| Rate for Payer: Priority Health SBD |
$82.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.82
|
| Rate for Payer: UHC Core |
$25.82
|
| Rate for Payer: UHC Core |
$25.82
|
| Rate for Payer: UHC Core |
$25.82
|
| Rate for Payer: UHC Exchange |
$25.82
|
| Rate for Payer: UHC Exchange |
$25.82
|
| Rate for Payer: UHC Exchange |
$25.82
|
| Rate for Payer: UMR Bronson Commercial |
$33.72
|
| Rate for Payer: UMR Bronson Commercial |
$39.54
|
| Rate for Payer: UMR Bronson Commercial |
$48.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.35
|
|
|
EPOPROSTENOL 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$106.86
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
162203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$96.17 |
| Rate for Payer: Aetna American Axle |
$69.46
|
| Rate for Payer: Aetna American Axle |
$59.23
|
| Rate for Payer: Aetna American Axle |
$85.05
|
| Rate for Payer: Aetna Commercial |
$111.22
|
| Rate for Payer: Aetna Commercial |
$90.83
|
| Rate for Payer: Aetna Commercial |
$77.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.05
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cash Price |
$85.49
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cofinity Advantage |
$63.79
|
| Rate for Payer: Cofinity Advantage |
$74.80
|
| Rate for Payer: Cofinity Advantage |
$91.59
|
| Rate for Payer: Cofinity Commercial |
$78.37
|
| Rate for Payer: Cofinity Commercial |
$91.90
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.90
|
| Rate for Payer: Healthscope Commercial |
$117.77
|
| Rate for Payer: Healthscope Commercial |
$82.02
|
| Rate for Payer: Healthscope Commercial |
$96.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.35
|
| Rate for Payer: PHP Commercial |
$111.22
|
| Rate for Payer: PHP Commercial |
$90.83
|
| Rate for Payer: PHP Commercial |
$77.46
|
| Rate for Payer: Priority Health SBD |
$67.32
|
| Rate for Payer: Priority Health SBD |
$82.44
|
| Rate for Payer: Priority Health SBD |
$57.41
|
| Rate for Payer: UMR Bronson Commercial |
$47.02
|
| Rate for Payer: UMR Bronson Commercial |
$40.10
|
| Rate for Payer: UMR Bronson Commercial |
$57.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.35
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$121.40
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
155384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.82 |
| Max. Negotiated Rate |
$109.26 |
| Rate for Payer: Aetna American Axle |
$78.91
|
| Rate for Payer: Aetna American Axle |
$130.14
|
| Rate for Payer: Aetna Commercial |
$103.19
|
| Rate for Payer: Aetna Commercial |
$170.19
|
| Rate for Payer: Aetna Medicare |
$60.70
|
| Rate for Payer: Aetna Medicare |
$100.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.14
|
| Rate for Payer: BCBS Complete |
$80.09
|
| Rate for Payer: BCBS Complete |
$48.56
|
| Rate for Payer: BCBS Trust/PPO |
$50.73
|
| Rate for Payer: BCBS Trust/PPO |
$50.73
|
| Rate for Payer: BCN Commercial |
$50.73
|
| Rate for Payer: BCN Commercial |
$50.73
|
| Rate for Payer: Cash Price |
$97.12
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cash Price |
$97.12
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Advantage |
$84.98
|
| Rate for Payer: Cofinity Advantage |
$140.15
|
| Rate for Payer: Cofinity Commercial |
$104.40
|
| Rate for Payer: Cofinity Commercial |
$172.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.18
|
| Rate for Payer: Healthscope Commercial |
$109.26
|
| Rate for Payer: Healthscope Commercial |
$180.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.05
|
| Rate for Payer: PHP Commercial |
$103.19
|
| Rate for Payer: PHP Commercial |
$170.19
|
| Rate for Payer: Priority Health SBD |
$76.48
|
| Rate for Payer: Priority Health SBD |
$126.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.82
|
| Rate for Payer: UHC Core |
$25.82
|
| Rate for Payer: UHC Core |
$25.82
|
| Rate for Payer: UHC Exchange |
$25.82
|
| Rate for Payer: UHC Exchange |
$25.82
|
| Rate for Payer: UMR Bronson Commercial |
$44.92
|
| Rate for Payer: UMR Bronson Commercial |
$74.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.16
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$121.40
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
155384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.42 |
| Max. Negotiated Rate |
$109.26 |
| Rate for Payer: Aetna American Axle |
$78.91
|
| Rate for Payer: Aetna American Axle |
$130.14
|
| Rate for Payer: Aetna Commercial |
$103.19
|
| Rate for Payer: Aetna Commercial |
$170.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.14
|
| Rate for Payer: Cash Price |
$97.12
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Advantage |
$140.15
|
| Rate for Payer: Cofinity Advantage |
$84.98
|
| Rate for Payer: Cofinity Commercial |
$172.19
|
| Rate for Payer: Cofinity Commercial |
$104.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.18
|
| Rate for Payer: Healthscope Commercial |
$109.26
|
| Rate for Payer: Healthscope Commercial |
$180.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.16
|
| Rate for Payer: PHP Commercial |
$103.19
|
| Rate for Payer: PHP Commercial |
$170.19
|
| Rate for Payer: Priority Health SBD |
$126.14
|
| Rate for Payer: Priority Health SBD |
$76.48
|
| Rate for Payer: UMR Bronson Commercial |
$53.42
|
| Rate for Payer: UMR Bronson Commercial |
$88.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.16
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$126.72
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
15897
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.82 |
| Max. Negotiated Rate |
$114.05 |
| Rate for Payer: Aetna American Axle |
$82.37
|
| Rate for Payer: Aetna Commercial |
$107.71
|
| Rate for Payer: Aetna Medicare |
$63.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.37
|
| Rate for Payer: BCBS Complete |
$50.69
|
| Rate for Payer: BCBS Trust/PPO |
$50.73
|
| Rate for Payer: BCN Commercial |
$50.73
|
| Rate for Payer: Cash Price |
$101.38
|
| Rate for Payer: Cash Price |
$101.38
|
| Rate for Payer: Cofinity Advantage |
$88.70
|
| Rate for Payer: Cofinity Commercial |
$108.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.38
|
| Rate for Payer: Healthscope Commercial |
$114.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.04
|
| Rate for Payer: PHP Commercial |
$107.71
|
| Rate for Payer: Priority Health SBD |
$79.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.82
|
| Rate for Payer: UHC Core |
$25.82
|
| Rate for Payer: UHC Exchange |
$25.82
|
| Rate for Payer: UMR Bronson Commercial |
$46.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.04
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$126.72
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
15897
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.76 |
| Max. Negotiated Rate |
$114.05 |
| Rate for Payer: Aetna American Axle |
$82.37
|
| Rate for Payer: Aetna Commercial |
$107.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.37
|
| Rate for Payer: Cash Price |
$101.38
|
| Rate for Payer: Cofinity Advantage |
$88.70
|
| Rate for Payer: Cofinity Commercial |
$108.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.38
|
| Rate for Payer: Healthscope Commercial |
$114.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.04
|
| Rate for Payer: PHP Commercial |
$107.71
|
| Rate for Payer: Priority Health SBD |
$79.83
|
| Rate for Payer: UMR Bronson Commercial |
$55.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.04
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$267.73
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.80 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna American Axle |
$174.02
|
| Rate for Payer: Aetna American Axle |
$170.40
|
| Rate for Payer: Aetna American Axle |
$347.29
|
| Rate for Payer: Aetna American Axle |
$132.70
|
| Rate for Payer: Aetna American Axle |
$698.55
|
| Rate for Payer: Aetna Commercial |
$913.50
|
| Rate for Payer: Aetna Commercial |
$222.84
|
| Rate for Payer: Aetna Commercial |
$227.57
|
| Rate for Payer: Aetna Commercial |
$454.15
|
| Rate for Payer: Aetna Commercial |
$173.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.29
|
| Rate for Payer: Cash Price |
$209.73
|
| Rate for Payer: Cash Price |
$163.33
|
| Rate for Payer: Cash Price |
$427.43
|
| Rate for Payer: Cash Price |
$214.18
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cofinity Advantage |
$752.29
|
| Rate for Payer: Cofinity Advantage |
$374.00
|
| Rate for Payer: Cofinity Advantage |
$142.91
|
| Rate for Payer: Cofinity Advantage |
$187.41
|
| Rate for Payer: Cofinity Advantage |
$183.51
|
| Rate for Payer: Cofinity Commercial |
$459.49
|
| Rate for Payer: Cofinity Commercial |
$924.24
|
| Rate for Payer: Cofinity Commercial |
$175.58
|
| Rate for Payer: Cofinity Commercial |
$225.46
|
| Rate for Payer: Cofinity Commercial |
$230.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$859.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.43
|
| Rate for Payer: Healthscope Commercial |
$967.23
|
| Rate for Payer: Healthscope Commercial |
$183.74
|
| Rate for Payer: Healthscope Commercial |
$235.94
|
| Rate for Payer: Healthscope Commercial |
$240.96
|
| Rate for Payer: Healthscope Commercial |
$480.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$752.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$806.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$913.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$806.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$400.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.80
|
| Rate for Payer: PHP Commercial |
$222.84
|
| Rate for Payer: PHP Commercial |
$913.50
|
| Rate for Payer: PHP Commercial |
$227.57
|
| Rate for Payer: PHP Commercial |
$454.15
|
| Rate for Payer: PHP Commercial |
$173.54
|
| Rate for Payer: Priority Health SBD |
$168.67
|
| Rate for Payer: Priority Health SBD |
$336.60
|
| Rate for Payer: Priority Health SBD |
$128.62
|
| Rate for Payer: Priority Health SBD |
$677.06
|
| Rate for Payer: Priority Health SBD |
$165.16
|
| Rate for Payer: UMR Bronson Commercial |
$89.83
|
| Rate for Payer: UMR Bronson Commercial |
$235.09
|
| Rate for Payer: UMR Bronson Commercial |
$115.35
|
| Rate for Payer: UMR Bronson Commercial |
$472.87
|
| Rate for Payer: UMR Bronson Commercial |
$117.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$806.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.12
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,074.70
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$967.23 |
| Rate for Payer: Aetna American Axle |
$698.55
|
| Rate for Payer: Aetna American Axle |
$170.40
|
| Rate for Payer: Aetna American Axle |
$347.29
|
| Rate for Payer: Aetna American Axle |
$174.02
|
| Rate for Payer: Aetna American Axle |
$132.70
|
| Rate for Payer: Aetna Commercial |
$454.15
|
| Rate for Payer: Aetna Commercial |
$913.50
|
| Rate for Payer: Aetna Commercial |
$222.84
|
| Rate for Payer: Aetna Commercial |
$173.54
|
| Rate for Payer: Aetna Commercial |
$227.57
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$56.65
|
| Rate for Payer: BCBS Trust/PPO |
$56.65
|
| Rate for Payer: BCBS Trust/PPO |
$56.65
|
| Rate for Payer: BCBS Trust/PPO |
$56.65
|
| Rate for Payer: BCBS Trust/PPO |
$56.65
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cash Price |
$427.43
|
| Rate for Payer: Cash Price |
$214.18
|
| Rate for Payer: Cash Price |
$163.33
|
| Rate for Payer: Cash Price |
$427.43
|
| Rate for Payer: Cash Price |
$214.18
|
| Rate for Payer: Cash Price |
$209.73
|
| Rate for Payer: Cash Price |
$209.73
|
| Rate for Payer: Cash Price |
$163.33
|
| Rate for Payer: Cofinity Advantage |
$752.29
|
| Rate for Payer: Cofinity Advantage |
$183.51
|
| Rate for Payer: Cofinity Advantage |
$374.00
|
| Rate for Payer: Cofinity Advantage |
$187.41
|
| Rate for Payer: Cofinity Advantage |
$142.91
|
| Rate for Payer: Cofinity Commercial |
$230.25
|
| Rate for Payer: Cofinity Commercial |
$924.24
|
| Rate for Payer: Cofinity Commercial |
$459.49
|
| Rate for Payer: Cofinity Commercial |
$225.46
|
| Rate for Payer: Cofinity Commercial |
$175.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$859.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$480.86
|
| Rate for Payer: Healthscope Commercial |
$967.23
|
| Rate for Payer: Healthscope Commercial |
$240.96
|
| Rate for Payer: Healthscope Commercial |
$235.94
|
| Rate for Payer: Healthscope Commercial |
$183.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$752.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$806.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.72
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$913.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.15
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$400.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$806.02
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PHP Commercial |
$227.57
|
| Rate for Payer: PHP Commercial |
$222.84
|
| Rate for Payer: PHP Commercial |
$913.50
|
| Rate for Payer: PHP Commercial |
$173.54
|
| Rate for Payer: PHP Commercial |
$454.15
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health SBD |
$168.67
|
| Rate for Payer: Priority Health SBD |
$165.16
|
| Rate for Payer: Priority Health SBD |
$128.62
|
| Rate for Payer: Priority Health SBD |
$336.60
|
| Rate for Payer: Priority Health SBD |
$677.06
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UMR Bronson Commercial |
$97.00
|
| Rate for Payer: UMR Bronson Commercial |
$197.69
|
| Rate for Payer: UMR Bronson Commercial |
$99.06
|
| Rate for Payer: UMR Bronson Commercial |
$397.64
|
| Rate for Payer: UMR Bronson Commercial |
$75.54
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$806.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.72
|
|
