|
FIBERSOURCE HN INTERMITTENT FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
200076
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIDAXOMICIN 200 MG TABLET
|
Facility
|
OP
|
$8,776.11
|
|
|
Service Code
|
NDC 52015008001
|
| Hospital Charge Code |
152861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,247.16 |
| Max. Negotiated Rate |
$7,898.50 |
| Rate for Payer: Aetna American Axle |
$5,704.47
|
| Rate for Payer: Aetna Commercial |
$7,459.69
|
| Rate for Payer: Aetna Medicare |
$4,388.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,704.47
|
| Rate for Payer: BCBS Complete |
$3,510.44
|
| Rate for Payer: Cash Price |
$7,020.89
|
| Rate for Payer: Cofinity Commercial |
$6,143.28
|
| Rate for Payer: Cofinity Commercial |
$7,547.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,143.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,020.89
|
| Rate for Payer: Healthscope Commercial |
$7,898.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,143.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,582.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,459.69
|
| Rate for Payer: PHP Commercial |
$7,459.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,704.47
|
| Rate for Payer: Priority Health SBD |
$5,528.95
|
| Rate for Payer: UMR Bronson Commercial |
$3,247.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,582.08
|
|
|
FIDAXOMICIN 200 MG TABLET
|
Facility
|
IP
|
$8,776.11
|
|
|
Service Code
|
NDC 52015008001
|
| Hospital Charge Code |
152861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,861.49 |
| Max. Negotiated Rate |
$7,898.50 |
| Rate for Payer: Aetna American Axle |
$5,704.47
|
| Rate for Payer: Aetna Commercial |
$7,459.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,704.47
|
| Rate for Payer: Cash Price |
$7,020.89
|
| Rate for Payer: Cofinity Commercial |
$6,143.28
|
| Rate for Payer: Cofinity Commercial |
$7,547.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,143.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,020.89
|
| Rate for Payer: Healthscope Commercial |
$7,898.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,143.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,582.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,459.69
|
| Rate for Payer: PHP Commercial |
$7,459.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,704.47
|
| Rate for Payer: Priority Health SBD |
$5,528.95
|
| Rate for Payer: UMR Bronson Commercial |
$3,861.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,582.08
|
|
|
FILGRASTIM 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$1,040.12
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
28863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$936.11 |
| Rate for Payer: PHP Commercial |
$884.10
|
| Rate for Payer: PHP Commercial |
$884.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.98
|
| Rate for Payer: PHP Medicare Advantage |
$0.98
|
| Rate for Payer: Aetna American Axle |
$676.08
|
| Rate for Payer: Aetna American Axle |
$676.08
|
| Rate for Payer: Aetna Commercial |
$884.11
|
| Rate for Payer: Aetna Commercial |
$884.10
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.22
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$0.98
|
| Rate for Payer: BCBS MAPPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: BCN Medicare Advantage |
$0.98
|
| Rate for Payer: BCN Medicare Advantage |
$0.98
|
| Rate for Payer: Cash Price |
$832.10
|
| Rate for Payer: Cash Price |
$832.10
|
| Rate for Payer: Cash Price |
$832.10
|
| Rate for Payer: Cash Price |
$832.10
|
| Rate for Payer: Cofinity Commercial |
$728.09
|
| Rate for Payer: Cofinity Commercial |
$728.08
|
| Rate for Payer: Cofinity Commercial |
$894.50
|
| Rate for Payer: Cofinity Commercial |
$894.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$728.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$728.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.98
|
| Rate for Payer: Healthscope Commercial |
$936.11
|
| Rate for Payer: Healthscope Commercial |
$936.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.10
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicare |
$0.98
|
| Rate for Payer: Mclaren Medicare |
$0.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.11
|
| Rate for Payer: Nomi Health Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$2.94
|
| Rate for Payer: PACE Medicare |
$0.93
|
| Rate for Payer: PACE Medicare |
$0.93
|
| Rate for Payer: PACE SWMI |
$0.98
|
| Rate for Payer: PACE SWMI |
$0.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.87
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$2.30
|
| Rate for Payer: Priority Health Narrow Network |
$2.30
|
| Rate for Payer: Priority Health SBD |
$655.28
|
| Rate for Payer: Priority Health SBD |
$655.28
|
| Rate for Payer: Railroad Medicare Medicare |
$0.98
|
| Rate for Payer: Railroad Medicare Medicare |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.98
|
| Rate for Payer: UHC Exchange |
$1.87
|
| Rate for Payer: UHC Exchange |
$1.87
|
| Rate for Payer: UHC Medicare Advantage |
$0.98
|
| Rate for Payer: UHC Medicare Advantage |
$0.98
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UMR Bronson Commercial |
$384.84
|
| Rate for Payer: UMR Bronson Commercial |
$384.85
|
| Rate for Payer: VA VA |
$0.98
|
| Rate for Payer: VA VA |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.10
|
|
|
FILGRASTIM 300 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,456.62
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
10036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1,310.96 |
| Rate for Payer: Aetna American Axle |
$946.80
|
| Rate for Payer: Aetna Commercial |
$1,238.13
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.22
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: BCN Medicare Advantage |
$0.98
|
| Rate for Payer: Cash Price |
$1,165.30
|
| Rate for Payer: Cash Price |
$1,165.30
|
| Rate for Payer: Cofinity Commercial |
$1,252.69
|
| Rate for Payer: Cofinity Commercial |
$1,019.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,019.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,165.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.98
|
| Rate for Payer: Healthscope Commercial |
$1,310.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,019.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,092.46
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicare |
$0.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,238.13
|
| Rate for Payer: Nomi Health Commercial |
$2.94
|
| Rate for Payer: PACE Medicare |
$0.93
|
| Rate for Payer: PACE SWMI |
$0.98
|
| Rate for Payer: PHP Commercial |
$1,238.13
|
| Rate for Payer: PHP Medicare Advantage |
$0.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$946.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.87
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$2.30
|
| Rate for Payer: Priority Health SBD |
$917.67
|
| Rate for Payer: Railroad Medicare Medicare |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.98
|
| Rate for Payer: UHC Exchange |
$1.87
|
| Rate for Payer: UHC Medicare Advantage |
$0.98
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UMR Bronson Commercial |
$538.95
|
| Rate for Payer: VA VA |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,092.46
|
|
|
FILGRASTIM 300 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,456.62
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
10036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$640.91 |
| Max. Negotiated Rate |
$1,310.96 |
| Rate for Payer: Aetna American Axle |
$946.80
|
| Rate for Payer: Aetna Commercial |
$1,238.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.80
|
| Rate for Payer: Cash Price |
$1,165.30
|
| Rate for Payer: Cofinity Commercial |
$1,019.63
|
| Rate for Payer: Cofinity Commercial |
$1,252.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,019.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,165.30
|
| Rate for Payer: Healthscope Commercial |
$1,310.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,019.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,092.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,238.13
|
| Rate for Payer: PHP Commercial |
$1,238.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$946.80
|
| Rate for Payer: Priority Health SBD |
$917.67
|
| Rate for Payer: UMR Bronson Commercial |
$640.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,092.46
|
|
|
FILGRASTIM 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
OP
|
$1,656.42
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
112198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1,490.78 |
| Rate for Payer: Aetna American Axle |
$1,076.67
|
| Rate for Payer: Aetna Commercial |
$1,407.96
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,076.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.22
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: BCN Medicare Advantage |
$0.98
|
| Rate for Payer: Cash Price |
$1,325.14
|
| Rate for Payer: Cash Price |
$1,325.14
|
| Rate for Payer: Cofinity Commercial |
$1,424.52
|
| Rate for Payer: Cofinity Commercial |
$1,159.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,159.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.98
|
| Rate for Payer: Healthscope Commercial |
$1,490.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,159.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,242.32
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicare |
$0.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,407.96
|
| Rate for Payer: Nomi Health Commercial |
$2.94
|
| Rate for Payer: PACE Medicare |
$0.93
|
| Rate for Payer: PACE SWMI |
$0.98
|
| Rate for Payer: PHP Commercial |
$1,407.96
|
| Rate for Payer: PHP Medicare Advantage |
$0.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,076.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.87
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$2.30
|
| Rate for Payer: Priority Health SBD |
$1,043.54
|
| Rate for Payer: Railroad Medicare Medicare |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.98
|
| Rate for Payer: UHC Exchange |
$1.87
|
| Rate for Payer: UHC Medicare Advantage |
$0.98
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UMR Bronson Commercial |
$612.88
|
| Rate for Payer: VA VA |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,242.32
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJECTION SOLUTION
|
Facility
|
OP
|
$2,192.50
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
112757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1,973.25 |
| Rate for Payer: Aetna American Axle |
$1,425.12
|
| Rate for Payer: Aetna Commercial |
$1,863.62
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.22
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: BCN Medicare Advantage |
$0.98
|
| Rate for Payer: Cash Price |
$1,754.00
|
| Rate for Payer: Cash Price |
$1,754.00
|
| Rate for Payer: Cofinity Commercial |
$1,885.55
|
| Rate for Payer: Cofinity Commercial |
$1,534.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,534.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,754.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.98
|
| Rate for Payer: Healthscope Commercial |
$1,973.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,534.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,644.38
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicare |
$0.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,863.62
|
| Rate for Payer: Nomi Health Commercial |
$2.94
|
| Rate for Payer: PACE Medicare |
$0.93
|
| Rate for Payer: PACE SWMI |
$0.98
|
| Rate for Payer: PHP Commercial |
$1,863.62
|
| Rate for Payer: PHP Medicare Advantage |
$0.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,425.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.87
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$2.30
|
| Rate for Payer: Priority Health SBD |
$1,381.28
|
| Rate for Payer: Railroad Medicare Medicare |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.98
|
| Rate for Payer: UHC Exchange |
$1.87
|
| Rate for Payer: UHC Medicare Advantage |
$0.98
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UMR Bronson Commercial |
$811.22
|
| Rate for Payer: VA VA |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,644.38
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJECTION SOLUTION
|
Facility
|
IP
|
$2,192.50
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
112757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$964.70 |
| Max. Negotiated Rate |
$1,973.25 |
| Rate for Payer: Aetna American Axle |
$1,425.12
|
| Rate for Payer: Aetna Commercial |
$1,863.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.12
|
| Rate for Payer: Cash Price |
$1,754.00
|
| Rate for Payer: Cofinity Commercial |
$1,534.75
|
| Rate for Payer: Cofinity Commercial |
$1,885.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,534.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,754.00
|
| Rate for Payer: Healthscope Commercial |
$1,973.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,534.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,644.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,863.62
|
| Rate for Payer: PHP Commercial |
$1,863.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,425.12
|
| Rate for Payer: Priority Health SBD |
$1,381.28
|
| Rate for Payer: UMR Bronson Commercial |
$964.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,644.38
|
|
|
FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$485.96
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| 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 |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.74
|
| Rate for Payer: BCN Commercial |
$0.74
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: Cash Price |
$388.77
|
| Rate for Payer: Cash Price |
$388.77
|
| Rate for Payer: Cofinity Commercial |
$417.93
|
| Rate for Payer: Cofinity Commercial |
$340.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$340.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.29
|
| 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 |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.30
|
| Rate for Payer: Meridian Medicaid |
$0.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.07
|
| Rate for Payer: Nomi Health Commercial |
$0.87
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PHP Commercial |
$413.07
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: Priority Health SBD |
$306.15
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Exchange |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.29
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$179.81
|
| Rate for Payer: VA VA |
$0.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.47
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$777.53
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| 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 |
$660.91
|
| Rate for Payer: Aetna Commercial |
$660.90
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| 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 |
$0.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.36
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS MAPPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.74
|
| Rate for Payer: BCN Commercial |
$0.74
|
| Rate for Payer: BCN Commercial |
$0.74
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: BCN Medicare Advantage |
$0.29
|
| Rate for Payer: Cash Price |
$622.03
|
| Rate for Payer: Cash Price |
$622.02
|
| Rate for Payer: Cash Price |
$622.03
|
| Rate for Payer: Cash Price |
$622.02
|
| Rate for Payer: Cofinity Commercial |
$544.28
|
| Rate for Payer: Cofinity Commercial |
$544.27
|
| Rate for Payer: Cofinity Commercial |
$668.68
|
| Rate for Payer: Cofinity Commercial |
$668.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.28
|
| 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 |
$0.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.29
|
| 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 |
$583.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Mclaren Medicare |
$0.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.30
|
| Rate for Payer: Meridian Medicaid |
$0.16
|
| Rate for Payer: Meridian Medicaid |
$0.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.91
|
| Rate for Payer: Nomi Health Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.87
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE Medicare |
$0.28
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PACE SWMI |
$0.29
|
| Rate for Payer: PHP Commercial |
$660.90
|
| Rate for Payer: PHP Commercial |
$660.91
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: PHP Medicare Advantage |
$0.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health Medicare |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: Priority Health SBD |
$489.84
|
| Rate for Payer: Priority Health SBD |
$489.85
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: Railroad Medicare Medicare |
$0.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.29
|
| Rate for Payer: UHC Exchange |
$0.55
|
| Rate for Payer: UHC Exchange |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.29
|
| Rate for Payer: UHC Medicare Advantage |
$0.29
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$287.69
|
| Rate for Payer: UMR Bronson Commercial |
$287.69
|
| Rate for Payer: VA VA |
$0.29
|
| Rate for Payer: VA VA |
$0.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.16
|
|
|
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 Commercial |
$668.68
|
| Rate for Payer: Cofinity Commercial |
$544.28
|
| Rate for Payer: Cofinity Commercial |
$544.27
|
| Rate for Payer: Cofinity Commercial |
$668.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.28
|
| 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 |
$544.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.90
|
| Rate for Payer: PHP Commercial |
$660.91
|
| Rate for Payer: PHP Commercial |
$660.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.40
|
| Rate for Payer: Priority Health SBD |
$489.84
|
| Rate for Payer: Priority Health SBD |
$489.85
|
| 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 |
$583.16
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$493.81
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.28 |
| Max. Negotiated Rate |
$444.43 |
| Rate for Payer: Aetna American Axle |
$320.98
|
| Rate for Payer: Aetna Commercial |
$419.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.67
|
| 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: PHP Commercial |
$419.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.98
|
| Rate for Payer: Priority Health SBD |
$311.10
|
| Rate for Payer: UMR Bronson Commercial |
$217.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.36
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$493.81
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| 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 |
$0.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS Trust/PPO |
$0.95
|
| Rate for Payer: BCN Commercial |
$0.95
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cash Price |
$395.05
|
| Rate for Payer: Cofinity Commercial |
$424.68
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| 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 |
$0.19
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: Meridian Medicaid |
$0.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.74
|
| Rate for Payer: Nomi Health Commercial |
$1.08
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PHP Commercial |
$419.74
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.05
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Narrow Network |
$0.84
|
| Rate for Payer: Priority Health SBD |
$311.10
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Exchange |
$0.69
|
| Rate for Payer: UHC Medicare Advantage |
$0.36
|
| Rate for Payer: UHCCP Medicaid |
$0.19
|
| Rate for Payer: UMR Bronson Commercial |
$182.71
|
| Rate for Payer: VA VA |
$0.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.36
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
IP
|
$790.09
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$347.64 |
| Max. Negotiated Rate |
$711.08 |
| Rate for Payer: Aetna American Axle |
$513.56
|
| Rate for Payer: Aetna American Axle |
$513.56
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cofinity Commercial |
$679.49
|
| Rate for Payer: Cofinity Commercial |
$553.07
|
| Rate for Payer: Cofinity Commercial |
$553.06
|
| Rate for Payer: Cofinity Commercial |
$679.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$553.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$553.07
|
| 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 |
$553.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.56
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: UMR Bronson Commercial |
$347.64
|
| Rate for Payer: UMR Bronson Commercial |
$347.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.58
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
OP
|
$790.09
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$711.08 |
| Rate for Payer: Aetna American Axle |
$513.56
|
| Rate for Payer: Aetna American Axle |
$513.56
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Commercial |
$671.58
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS Trust/PPO |
$0.95
|
| Rate for Payer: BCBS Trust/PPO |
$0.95
|
| Rate for Payer: BCN Commercial |
$0.95
|
| Rate for Payer: BCN Commercial |
$0.95
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cash Price |
$632.08
|
| Rate for Payer: Cash Price |
$632.07
|
| Rate for Payer: Cofinity Commercial |
$553.07
|
| Rate for Payer: Cofinity Commercial |
$553.06
|
| Rate for Payer: Cofinity Commercial |
$679.48
|
| Rate for Payer: Cofinity Commercial |
$679.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$553.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$553.07
|
| 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 |
$0.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| 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 |
$0.19
|
| Rate for Payer: Mclaren Medicaid |
$0.19
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: Meridian Medicaid |
$0.20
|
| Rate for Payer: Meridian Medicaid |
$0.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.58
|
| Rate for Payer: Nomi Health Commercial |
$1.08
|
| Rate for Payer: Nomi Health Commercial |
$1.08
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Commercial |
$671.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.05
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Narrow Network |
$0.84
|
| Rate for Payer: Priority Health Narrow Network |
$0.84
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Priority Health SBD |
$497.76
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Exchange |
$0.69
|
| Rate for Payer: UHC Exchange |
$0.69
|
| Rate for Payer: UHC Medicare Advantage |
$0.36
|
| Rate for Payer: UHC Medicare Advantage |
$0.36
|
| Rate for Payer: UHCCP Medicaid |
$0.19
|
| Rate for Payer: UHCCP Medicaid |
$0.19
|
| Rate for Payer: UMR Bronson Commercial |
$292.33
|
| Rate for Payer: UMR Bronson Commercial |
$292.34
|
| Rate for Payer: VA VA |
$0.36
|
| Rate for Payer: VA VA |
$0.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.58
|
|
|
FILLETED FINGER OR TOE FLAP, INCLUDING PREPARATION OF RECIPIENT SITE
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$647.23 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.09
|
| Rate for Payer: BCN Commercial |
$2,108.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$711.95
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$647.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$181.89
|
|
|
Service Code
|
NDC 65862014990
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.03 |
| Max. Negotiated Rate |
$163.70 |
| Rate for Payer: Aetna American Axle |
$118.23
|
| Rate for Payer: Aetna Commercial |
$154.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.23
|
| Rate for Payer: Cash Price |
$145.51
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Commercial |
$156.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.51
|
| Rate for Payer: Healthscope Commercial |
$163.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.61
|
| Rate for Payer: PHP Commercial |
$154.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.23
|
| Rate for Payer: Priority Health SBD |
$114.59
|
| Rate for Payer: UMR Bronson Commercial |
$80.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.42
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$181.89
|
|
|
Service Code
|
NDC 65862014990
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.30 |
| Max. Negotiated Rate |
$163.70 |
| Rate for Payer: Aetna American Axle |
$118.23
|
| Rate for Payer: Aetna Commercial |
$154.61
|
| Rate for Payer: Aetna Medicare |
$90.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.23
|
| Rate for Payer: BCBS Complete |
$72.76
|
| Rate for Payer: Cash Price |
$145.51
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Commercial |
$156.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.51
|
| Rate for Payer: Healthscope Commercial |
$163.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.61
|
| Rate for Payer: PHP Commercial |
$154.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.23
|
| Rate for Payer: Priority Health SBD |
$114.59
|
| Rate for Payer: UMR Bronson Commercial |
$67.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.42
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$215.18
|
|
|
Service Code
|
NDC 50268031415
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$193.66 |
| Rate for Payer: Aetna American Axle |
$139.87
|
| Rate for Payer: Aetna Commercial |
$182.90
|
| Rate for Payer: Aetna Medicare |
$107.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.87
|
| Rate for Payer: BCBS Complete |
$86.07
|
| Rate for Payer: Cash Price |
$172.14
|
| Rate for Payer: Cofinity Commercial |
$150.63
|
| Rate for Payer: Cofinity Commercial |
$185.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.14
|
| Rate for Payer: Healthscope Commercial |
$193.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.90
|
| Rate for Payer: PHP Commercial |
$182.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.87
|
| Rate for Payer: Priority Health SBD |
$135.56
|
| Rate for Payer: UMR Bronson Commercial |
$79.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.38
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$215.18
|
|
|
Service Code
|
NDC 50268031415
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.68 |
| Max. Negotiated Rate |
$193.66 |
| Rate for Payer: Aetna American Axle |
$139.87
|
| Rate for Payer: Aetna Commercial |
$182.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.87
|
| Rate for Payer: Cash Price |
$172.14
|
| Rate for Payer: Cofinity Commercial |
$150.63
|
| Rate for Payer: Cofinity Commercial |
$185.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.14
|
| Rate for Payer: Healthscope Commercial |
$193.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.90
|
| Rate for Payer: PHP Commercial |
$182.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.87
|
| Rate for Payer: Priority Health SBD |
$135.56
|
| Rate for Payer: UMR Bronson Commercial |
$94.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.38
|
|
|
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 |
$133.24 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna Medicare |
$74.02
|
| 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 Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| 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: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$54.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 50268031411
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna American Axle |
$2.80
|
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna Medicare |
$2.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.11 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna American Axle |
$127.20
|
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UMR Bronson Commercial |
$86.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
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 |
$133.24 |
| 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 Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| 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: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| 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
|
|
