|
FILGRASTIM 480 MCG/1.6 ML INJECTION SOLUTION
|
Facility
|
OP
|
$2,194.70
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
112757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1,975.23 |
| Rate for Payer: Aetna American Axle |
$1,426.56
|
| Rate for Payer: Aetna Commercial |
$1,865.49
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,426.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.27
|
| Rate for Payer: BCBS Complete |
$0.56
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: Cash Price |
$1,755.76
|
| Rate for Payer: Cash Price |
$1,755.76
|
| Rate for Payer: Cofinity Advantage |
$1,536.29
|
| Rate for Payer: Cofinity Commercial |
$1,887.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,755.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$1,975.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,536.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,646.03
|
| Rate for Payer: Mclaren Medicaid |
$1.02
|
| Rate for Payer: Mclaren Medicare |
$1.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: Meridian Medicaid |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,865.49
|
| Rate for Payer: Nomi Health Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,646.03
|
| Rate for Payer: PACE Medicare |
$0.97
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PHP Commercial |
$1,865.49
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$1.02
|
| Rate for Payer: Priority Health SBD |
$1,382.66
|
| Rate for Payer: Priority Health Tiered Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.65
|
| Rate for Payer: UHC Core |
$1.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.02
|
| Rate for Payer: UHC Exchange |
$1.65
|
| Rate for Payer: UHC Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UMR Bronson Commercial |
$812.04
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,646.03
|
|
|
FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$485.96
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$437.36 |
| Rate for Payer: Aetna American Axle |
$315.87
|
| Rate for Payer: Aetna Commercial |
$413.07
|
| Rate for Payer: Aetna Medicare |
$0.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.35
|
| Rate for Payer: BCBS Complete |
$0.15
|
| Rate for Payer: BCBS MAPPO |
$0.28
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: BCN Medicare Advantage |
$0.28
|
| Rate for Payer: Cash Price |
$388.77
|
| Rate for Payer: Cash Price |
$388.77
|
| Rate for Payer: Cofinity Advantage |
$340.17
|
| Rate for Payer: Cofinity Commercial |
$417.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.28
|
| Rate for Payer: Healthscope Commercial |
$437.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.47
|
| Rate for Payer: Mclaren Medicaid |
$0.28
|
| Rate for Payer: Mclaren Medicare |
$0.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.29
|
| Rate for Payer: Meridian Medicaid |
$0.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.07
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.47
|
| Rate for Payer: PACE Medicare |
$0.27
|
| Rate for Payer: PACE SWMI |
$0.28
|
| Rate for Payer: PHP Commercial |
$413.07
|
| Rate for Payer: PHP Medicare Advantage |
$0.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.95
|
| Rate for Payer: Priority Health Medicare |
$0.28
|
| Rate for Payer: Priority Health SBD |
$306.15
|
| Rate for Payer: Priority Health Tiered Network |
$0.76
|
| Rate for Payer: Railroad Medicare Medicare |
$0.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.46
|
| Rate for Payer: UHC Core |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.28
|
| Rate for Payer: UHC Exchange |
$0.46
|
| Rate for Payer: UHC Medicaid |
$0.15
|
| Rate for Payer: UHCCP Medicaid |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$179.81
|
| Rate for Payer: VA VA |
$0.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.47
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$777.53
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$342.11 |
| Max. Negotiated Rate |
$699.78 |
| Rate for Payer: Aetna American Axle |
$505.39
|
| Rate for Payer: Aetna American Axle |
$505.40
|
| Rate for Payer: Aetna Commercial |
$660.90
|
| Rate for Payer: Aetna Commercial |
$660.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.40
|
| Rate for Payer: Cash Price |
$622.02
|
| Rate for Payer: Cash Price |
$622.03
|
| Rate for Payer: Cofinity Advantage |
$544.28
|
| Rate for Payer: Cofinity Advantage |
$544.27
|
| Rate for Payer: Cofinity Commercial |
$668.68
|
| Rate for Payer: Cofinity Commercial |
$668.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.03
|
| Rate for Payer: Healthscope Commercial |
$699.78
|
| Rate for Payer: Healthscope Commercial |
$699.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.15
|
| Rate for Payer: PHP Commercial |
$660.90
|
| Rate for Payer: PHP Commercial |
$660.91
|
| Rate for Payer: Priority Health SBD |
$489.85
|
| Rate for Payer: Priority Health SBD |
$489.84
|
| Rate for Payer: UMR Bronson Commercial |
$342.11
|
| Rate for Payer: UMR Bronson Commercial |
$342.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.15
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$777.54
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$699.79 |
| Rate for Payer: Aetna American Axle |
$505.40
|
| Rate for Payer: Aetna American Axle |
$505.39
|
| Rate for Payer: Aetna Commercial |
$660.90
|
| Rate for Payer: Aetna Commercial |
$660.91
|
| Rate for Payer: Aetna Medicare |
$0.29
|
| Rate for Payer: Aetna Medicare |
$0.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.35
|
| Rate for Payer: BCBS Complete |
$0.15
|
| Rate for Payer: BCBS Complete |
$0.15
|
| Rate for Payer: BCBS MAPPO |
$0.28
|
| Rate for Payer: BCBS MAPPO |
$0.28
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: BCN Medicare Advantage |
$0.28
|
| Rate for Payer: BCN Medicare Advantage |
$0.28
|
| Rate for Payer: Cash Price |
$622.02
|
| Rate for Payer: Cash Price |
$622.03
|
| Rate for Payer: Cash Price |
$622.03
|
| Rate for Payer: Cash Price |
$622.02
|
| Rate for Payer: Cofinity Advantage |
$544.28
|
| Rate for Payer: Cofinity Advantage |
$544.27
|
| Rate for Payer: Cofinity Commercial |
$668.68
|
| Rate for Payer: Cofinity Commercial |
$668.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.28
|
| Rate for Payer: Healthscope Commercial |
$699.78
|
| Rate for Payer: Healthscope Commercial |
$699.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.15
|
| Rate for Payer: Mclaren Medicaid |
$0.28
|
| Rate for Payer: Mclaren Medicaid |
$0.28
|
| Rate for Payer: Mclaren Medicare |
$0.28
|
| Rate for Payer: Mclaren Medicare |
$0.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.29
|
| Rate for Payer: Meridian Medicaid |
$0.29
|
| Rate for Payer: Meridian Medicaid |
$0.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.91
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.15
|
| Rate for Payer: PACE Medicare |
$0.27
|
| Rate for Payer: PACE Medicare |
$0.27
|
| Rate for Payer: PACE SWMI |
$0.28
|
| Rate for Payer: PACE SWMI |
$0.28
|
| Rate for Payer: PHP Commercial |
$660.90
|
| Rate for Payer: PHP Commercial |
$660.91
|
| Rate for Payer: PHP Medicare Advantage |
$0.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.95
|
| Rate for Payer: Priority Health Medicare |
$0.28
|
| Rate for Payer: Priority Health Medicare |
$0.28
|
| Rate for Payer: Priority Health SBD |
$489.84
|
| Rate for Payer: Priority Health SBD |
$489.85
|
| Rate for Payer: Priority Health Tiered Network |
$0.76
|
| Rate for Payer: Priority Health Tiered Network |
$0.76
|
| Rate for Payer: Railroad Medicare Medicare |
$0.28
|
| Rate for Payer: Railroad Medicare Medicare |
$0.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.46
|
| Rate for Payer: UHC Core |
$0.46
|
| Rate for Payer: UHC Core |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.28
|
| Rate for Payer: UHC Exchange |
$0.46
|
| Rate for Payer: UHC Exchange |
$0.46
|
| Rate for Payer: UHC Medicaid |
$0.15
|
| Rate for Payer: UHC Medicaid |
$0.15
|
| Rate for Payer: UHCCP Medicaid |
$0.15
|
| Rate for Payer: UHCCP Medicaid |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$287.69
|
| Rate for Payer: UMR Bronson Commercial |
$287.69
|
| Rate for Payer: VA VA |
$0.28
|
| Rate for Payer: VA VA |
$0.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.15
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$493.81
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$444.43 |
| Rate for Payer: Aetna American Axle |
$320.98
|
| Rate for Payer: Aetna Commercial |
$419.74
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.44
|
| Rate for Payer: BCBS Complete |
$0.19
|
| Rate for Payer: BCBS MAPPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.92
|
| Rate for Payer: BCN Commercial |
$0.92
|
| Rate for Payer: BCN Medicare Advantage |
$0.35
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cofinity Advantage |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.35
|
| Rate for Payer: Healthscope Commercial |
$444.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.36
|
| Rate for Payer: Mclaren Medicaid |
$0.35
|
| Rate for Payer: Mclaren Medicare |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.37
|
| Rate for Payer: Meridian Medicaid |
$0.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.74
|
| Rate for Payer: Nomi Health Commercial |
$1.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.36
|
| Rate for Payer: PACE Medicare |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.35
|
| Rate for Payer: PHP Commercial |
$419.74
|
| Rate for Payer: PHP Medicare Advantage |
$0.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.44
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: Priority Health SBD |
$311.10
|
| Rate for Payer: Priority Health Tiered Network |
$1.15
|
| Rate for Payer: Railroad Medicare Medicare |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Medicaid |
$0.18
|
| Rate for Payer: UHCCP Medicaid |
$0.18
|
| Rate for Payer: UMR Bronson Commercial |
$182.71
|
| Rate for Payer: VA VA |
$0.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.36
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$493.81
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.28 |
| Max. Negotiated Rate |
$444.43 |
| Rate for Payer: Aetna American Axle |
$320.98
|
| Rate for Payer: Aetna Commercial |
$419.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cofinity Advantage |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.05
|
| Rate for Payer: Healthscope Commercial |
$444.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.36
|
| Rate for Payer: PHP Commercial |
$419.74
|
| Rate for Payer: Priority Health SBD |
$311.10
|
| Rate for Payer: UMR Bronson Commercial |
$217.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.36
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
OP
|
$790.10
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$711.09 |
| Rate for Payer: Aetna American Axle |
$513.57
|
| Rate for Payer: Aetna American Axle |
$513.56
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Commercial |
$671.59
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.44
|
| Rate for Payer: BCBS Complete |
$0.19
|
| Rate for Payer: BCBS Complete |
$0.19
|
| Rate for Payer: BCBS MAPPO |
$0.35
|
| Rate for Payer: BCBS MAPPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.92
|
| Rate for Payer: BCBS Trust/PPO |
$0.92
|
| Rate for Payer: BCN Commercial |
$0.92
|
| Rate for Payer: BCN Commercial |
$0.92
|
| Rate for Payer: BCN Medicare Advantage |
$0.35
|
| Rate for Payer: BCN Medicare Advantage |
$0.35
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cofinity Advantage |
$553.07
|
| Rate for Payer: Cofinity Advantage |
$553.06
|
| Rate for Payer: Cofinity Commercial |
$679.48
|
| Rate for Payer: Cofinity Commercial |
$679.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.35
|
| Rate for Payer: Healthscope Commercial |
$711.08
|
| Rate for Payer: Healthscope Commercial |
$711.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.58
|
| Rate for Payer: Mclaren Medicaid |
$0.35
|
| Rate for Payer: Mclaren Medicaid |
$0.35
|
| Rate for Payer: Mclaren Medicare |
$0.35
|
| Rate for Payer: Mclaren Medicare |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.37
|
| Rate for Payer: Meridian Medicaid |
$0.37
|
| Rate for Payer: Meridian Medicaid |
$0.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.59
|
| Rate for Payer: Nomi Health Commercial |
$1.05
|
| Rate for Payer: Nomi Health Commercial |
$1.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$592.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$592.57
|
| Rate for Payer: PACE Medicare |
$0.33
|
| Rate for Payer: PACE Medicare |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.35
|
| Rate for Payer: PACE SWMI |
$0.35
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.59
|
| Rate for Payer: PHP Medicare Advantage |
$0.35
|
| Rate for Payer: PHP Medicare Advantage |
$0.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.44
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Priority Health Tiered Network |
$1.15
|
| Rate for Payer: Priority Health Tiered Network |
$1.15
|
| Rate for Payer: Railroad Medicare Medicare |
$0.35
|
| Rate for Payer: Railroad Medicare Medicare |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Medicaid |
$0.18
|
| Rate for Payer: UHC Medicaid |
$0.18
|
| Rate for Payer: UHCCP Medicaid |
$0.18
|
| Rate for Payer: UHCCP Medicaid |
$0.18
|
| Rate for Payer: UMR Bronson Commercial |
$292.33
|
| Rate for Payer: UMR Bronson Commercial |
$292.34
|
| Rate for Payer: VA VA |
$0.35
|
| Rate for Payer: VA VA |
$0.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.57
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
IP
|
$790.09
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$347.64 |
| Max. Negotiated Rate |
$711.08 |
| Rate for Payer: Aetna American Axle |
$513.56
|
| Rate for Payer: Aetna American Axle |
$513.57
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Commercial |
$671.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.57
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cofinity Advantage |
$553.07
|
| Rate for Payer: Cofinity Advantage |
$553.06
|
| Rate for Payer: Cofinity Commercial |
$679.49
|
| Rate for Payer: Cofinity Commercial |
$679.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.08
|
| Rate for Payer: Healthscope Commercial |
$711.08
|
| Rate for Payer: Healthscope Commercial |
$711.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$592.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$592.58
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.59
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: UMR Bronson Commercial |
$347.64
|
| Rate for Payer: UMR Bronson Commercial |
$347.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.58
|
|
|
FINASTERIDE 1 MG TABLET
|
Facility
|
OP
|
$51.47
|
|
|
Service Code
|
NDC 65862092730
|
| Hospital Charge Code |
22243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$46.32 |
| Rate for Payer: Aetna American Axle |
$33.46
|
| Rate for Payer: Aetna Commercial |
$43.75
|
| Rate for Payer: Aetna Medicare |
$25.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.46
|
| Rate for Payer: BCBS Complete |
$20.59
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: Cofinity Advantage |
$36.03
|
| Rate for Payer: Cofinity Commercial |
$44.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.18
|
| Rate for Payer: Healthscope Commercial |
$46.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.60
|
| Rate for Payer: PHP Commercial |
$43.75
|
| Rate for Payer: Priority Health SBD |
$32.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.46
|
| Rate for Payer: UHC Core |
$26.82
|
| Rate for Payer: UHC Exchange |
$20.23
|
| Rate for Payer: UMR Bronson Commercial |
$19.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.60
|
|
|
FINASTERIDE 1 MG TABLET
|
Facility
|
IP
|
$51.47
|
|
|
Service Code
|
NDC 65862092730
|
| Hospital Charge Code |
22243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.65 |
| Max. Negotiated Rate |
$46.32 |
| Rate for Payer: Aetna American Axle |
$33.46
|
| Rate for Payer: Aetna Commercial |
$43.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.46
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: Cofinity Advantage |
$36.03
|
| Rate for Payer: Cofinity Commercial |
$44.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.18
|
| Rate for Payer: Healthscope Commercial |
$46.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.60
|
| Rate for Payer: PHP Commercial |
$43.75
|
| Rate for Payer: Priority Health SBD |
$32.43
|
| Rate for Payer: UMR Bronson Commercial |
$22.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.60
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$4.42
|
|
|
Service Code
|
NDC 50268031411
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Aetna American Axle |
$2.87
|
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Aetna Medicare |
$2.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: BCBS Complete |
$1.77
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cofinity Advantage |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$3.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.31
|
| Rate for Payer: PHP Commercial |
$3.76
|
| Rate for Payer: Priority Health SBD |
$2.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.87
|
| Rate for Payer: UHC Core |
$2.30
|
| Rate for Payer: UHC Exchange |
$1.74
|
| Rate for Payer: UMR Bronson Commercial |
$1.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.31
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 16729009001
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Advantage |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$65.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$160.74
|
|
|
Service Code
|
NDC 16729009015
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.73 |
| Max. Negotiated Rate |
$144.67 |
| Rate for Payer: Aetna American Axle |
$104.48
|
| Rate for Payer: Aetna Commercial |
$136.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.48
|
| Rate for Payer: Cash Price |
$128.59
|
| Rate for Payer: Cofinity Advantage |
$112.52
|
| Rate for Payer: Cofinity Commercial |
$138.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.59
|
| Rate for Payer: Healthscope Commercial |
$144.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.56
|
| Rate for Payer: PHP Commercial |
$136.63
|
| Rate for Payer: Priority Health SBD |
$101.27
|
| Rate for Payer: UMR Bronson Commercial |
$70.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.56
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$133.25
|
|
|
Service Code
|
NDC 65862014990
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.30 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna American Axle |
$86.61
|
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Medicare |
$66.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.61
|
| Rate for Payer: BCBS Complete |
$53.30
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cofinity Advantage |
$93.28
|
| Rate for Payer: Cofinity Commercial |
$114.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.60
|
| Rate for Payer: Healthscope Commercial |
$119.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.94
|
| Rate for Payer: PHP Commercial |
$113.26
|
| Rate for Payer: Priority Health SBD |
$83.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.61
|
| Rate for Payer: UHC Core |
$69.42
|
| Rate for Payer: UHC Exchange |
$52.37
|
| Rate for Payer: UMR Bronson Commercial |
$49.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.94
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$200.45
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.17 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna American Axle |
$130.29
|
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna Medicare |
$100.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: BCBS Complete |
$80.18
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Advantage |
$140.31
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.34
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health SBD |
$126.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.29
|
| Rate for Payer: UHC Core |
$104.43
|
| Rate for Payer: UHC Exchange |
$78.78
|
| Rate for Payer: UMR Bronson Commercial |
$74.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
NDC 31722052530
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.30 |
| Max. Negotiated Rate |
$90.74 |
| Rate for Payer: Aetna American Axle |
$65.53
|
| Rate for Payer: Aetna Commercial |
$85.70
|
| Rate for Payer: Aetna Medicare |
$50.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.53
|
| Rate for Payer: BCBS Complete |
$40.33
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Advantage |
$70.57
|
| Rate for Payer: Cofinity Commercial |
$86.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$90.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PHP Commercial |
$85.70
|
| Rate for Payer: Priority Health SBD |
$63.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.53
|
| Rate for Payer: UHC Core |
$52.53
|
| Rate for Payer: UHC Exchange |
$39.62
|
| Rate for Payer: UMR Bronson Commercial |
$37.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.61
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$220.88
|
|
|
Service Code
|
NDC 50268031415
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.19 |
| Max. Negotiated Rate |
$198.79 |
| Rate for Payer: Aetna American Axle |
$143.57
|
| Rate for Payer: Aetna Commercial |
$187.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.57
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cofinity Advantage |
$154.62
|
| Rate for Payer: Cofinity Commercial |
$189.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.70
|
| Rate for Payer: Healthscope Commercial |
$198.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.66
|
| Rate for Payer: PHP Commercial |
$187.75
|
| Rate for Payer: Priority Health SBD |
$139.15
|
| Rate for Payer: UMR Bronson Commercial |
$97.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.66
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 16729009001
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna Medicare |
$74.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: BCBS Complete |
$59.22
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Advantage |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.23
|
| Rate for Payer: UHC Core |
$77.13
|
| Rate for Payer: UHC Exchange |
$58.18
|
| Rate for Payer: UMR Bronson Commercial |
$54.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$100.82
|
|
|
Service Code
|
NDC 31722052530
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.36 |
| Max. Negotiated Rate |
$90.74 |
| Rate for Payer: Aetna American Axle |
$65.53
|
| Rate for Payer: Aetna Commercial |
$85.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.53
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Advantage |
$70.57
|
| Rate for Payer: Cofinity Commercial |
$86.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$90.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PHP Commercial |
$85.70
|
| Rate for Payer: Priority Health SBD |
$63.52
|
| Rate for Payer: UMR Bronson Commercial |
$44.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.61
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$4.42
|
|
|
Service Code
|
NDC 50268031411
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Aetna American Axle |
$2.87
|
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cofinity Advantage |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$3.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.31
|
| Rate for Payer: PHP Commercial |
$3.76
|
| Rate for Payer: Priority Health SBD |
$2.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.31
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$220.88
|
|
|
Service Code
|
NDC 50268031415
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.73 |
| Max. Negotiated Rate |
$198.79 |
| Rate for Payer: Aetna American Axle |
$143.57
|
| Rate for Payer: Aetna Commercial |
$187.75
|
| Rate for Payer: Aetna Medicare |
$110.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.57
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cofinity Advantage |
$154.62
|
| Rate for Payer: Cofinity Commercial |
$189.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.70
|
| Rate for Payer: Healthscope Commercial |
$198.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.66
|
| Rate for Payer: PHP Commercial |
$187.75
|
| Rate for Payer: Priority Health SBD |
$139.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.57
|
| Rate for Payer: UHC Core |
$115.08
|
| Rate for Payer: UHC Exchange |
$86.81
|
| Rate for Payer: UMR Bronson Commercial |
$81.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.66
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna American Axle |
$130.29
|
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Advantage |
$140.31
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.34
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health SBD |
$126.28
|
| Rate for Payer: UMR Bronson Commercial |
$88.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$160.74
|
|
|
Service Code
|
NDC 16729009015
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.47 |
| Max. Negotiated Rate |
$144.67 |
| Rate for Payer: Aetna American Axle |
$104.48
|
| Rate for Payer: Aetna Commercial |
$136.63
|
| Rate for Payer: Aetna Medicare |
$80.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.48
|
| Rate for Payer: BCBS Complete |
$64.30
|
| Rate for Payer: Cash Price |
$128.59
|
| Rate for Payer: Cofinity Advantage |
$112.52
|
| Rate for Payer: Cofinity Commercial |
$138.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.59
|
| Rate for Payer: Healthscope Commercial |
$144.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.56
|
| Rate for Payer: PHP Commercial |
$136.63
|
| Rate for Payer: Priority Health SBD |
$101.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.48
|
| Rate for Payer: UHC Core |
$83.75
|
| Rate for Payer: UHC Exchange |
$63.17
|
| Rate for Payer: UMR Bronson Commercial |
$59.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.56
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$133.25
|
|
|
Service Code
|
NDC 65862014990
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna American Axle |
$86.61
|
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.61
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cofinity Advantage |
$93.28
|
| Rate for Payer: Cofinity Commercial |
$114.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.60
|
| Rate for Payer: Healthscope Commercial |
$119.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.94
|
| Rate for Payer: PHP Commercial |
$113.26
|
| Rate for Payer: Priority Health SBD |
$83.95
|
| Rate for Payer: UMR Bronson Commercial |
$58.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.94
|
|
|
FINE NEEDLE ASPIRATION BIOPSY, INCLUDING ULTRASOUND GUIDANCE; FIRST LESION
|
Facility
|
OP
|
$2,281.79
|
|
|
Service Code
|
CPT 10005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$126.90 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$879.35
|
| Rate for Payer: BCCCP Commercial |
$126.90
|
| Rate for Payer: BCN Commercial |
$879.35
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
