|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$1,279.89
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$831.93 |
| Max. Negotiated Rate |
$1,279.89 |
| Rate for Payer: Aetna Commercial |
$1,151.90
|
| Rate for Payer: ASR ASR |
$1,241.49
|
| Rate for Payer: ASR Commercial |
$1,241.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.98
|
| Rate for Payer: BCN Commercial |
$992.30
|
| Rate for Payer: Cash Price |
$1,023.91
|
| Rate for Payer: Cofinity Commercial |
$1,203.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.91
|
| Rate for Payer: Healthscope Commercial |
$1,279.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,241.49
|
| Rate for Payer: Mclaren Commercial |
$1,151.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.91
|
| Rate for Payer: Nomi Health Commercial |
$1,049.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,126.30
|
|
|
DARBEPOETIN ALFA 100 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
IP
|
$1,279.89
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$831.93 |
| Max. Negotiated Rate |
$1,279.89 |
| Rate for Payer: Aetna Commercial |
$1,151.90
|
| Rate for Payer: Aetna Commercial |
$2,006.85
|
| Rate for Payer: ASR ASR |
$2,162.94
|
| Rate for Payer: ASR ASR |
$1,241.49
|
| Rate for Payer: ASR Commercial |
$2,162.94
|
| Rate for Payer: ASR Commercial |
$1,241.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,817.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.98
|
| Rate for Payer: BCN Commercial |
$1,728.79
|
| Rate for Payer: BCN Commercial |
$992.30
|
| Rate for Payer: Cash Price |
$1,023.91
|
| Rate for Payer: Cash Price |
$1,783.87
|
| Rate for Payer: Cofinity Commercial |
$2,096.04
|
| Rate for Payer: Cofinity Commercial |
$1,203.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,783.86
|
| Rate for Payer: Healthscope Commercial |
$1,279.89
|
| Rate for Payer: Healthscope Commercial |
$2,229.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,162.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,241.49
|
| Rate for Payer: Mclaren Commercial |
$1,151.90
|
| Rate for Payer: Mclaren Commercial |
$2,006.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,895.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.91
|
| Rate for Payer: Nomi Health Commercial |
$1,828.46
|
| Rate for Payer: Nomi Health Commercial |
$1,049.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,449.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,126.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,962.25
|
|
|
DARBEPOETIN ALFA 100 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$2,229.83
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2,229.83 |
| Rate for Payer: Aetna Commercial |
$2,006.85
|
| Rate for Payer: Aetna Commercial |
$1,151.90
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$2,162.94
|
| Rate for Payer: ASR ASR |
$1,241.49
|
| Rate for Payer: ASR Commercial |
$1,241.49
|
| Rate for Payer: ASR Commercial |
$2,162.94
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,826.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.10
|
| Rate for Payer: BCN Commercial |
$992.30
|
| Rate for Payer: BCN Commercial |
$1,728.79
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$1,783.87
|
| Rate for Payer: Cash Price |
$1,023.91
|
| Rate for Payer: Cash Price |
$1,783.87
|
| Rate for Payer: Cash Price |
$1,023.91
|
| Rate for Payer: Cofinity Commercial |
$1,203.10
|
| Rate for Payer: Cofinity Commercial |
$2,096.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,783.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$1,279.89
|
| Rate for Payer: Healthscope Commercial |
$2,229.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,241.49
|
| Rate for Payer: Healthscope Whirlpool |
$2,162.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Mclaren Commercial |
$1,151.90
|
| Rate for Payer: Mclaren Commercial |
$2,006.85
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,895.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.91
|
| Rate for Payer: Nomi Health Commercial |
$1,828.46
|
| Rate for Payer: Nomi Health Commercial |
$1,049.51
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,449.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,126.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,962.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: VA VA |
$2.97
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$1,919.83
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$1,919.83 |
| Rate for Payer: Aetna Commercial |
$1,727.85
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$1,862.24
|
| Rate for Payer: ASR Commercial |
$1,862.24
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.15
|
| Rate for Payer: BCN Commercial |
$1,488.44
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$1,535.87
|
| Rate for Payer: Cash Price |
$1,535.87
|
| Rate for Payer: Cofinity Commercial |
$1,804.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,535.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$1,919.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,862.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Mclaren Commercial |
$1,727.85
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,631.86
|
| Rate for Payer: Nomi Health Commercial |
$1,574.26
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,247.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,689.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$1,919.83
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,247.89 |
| Max. Negotiated Rate |
$1,919.83 |
| Rate for Payer: Aetna Commercial |
$1,727.85
|
| Rate for Payer: ASR ASR |
$1,862.24
|
| Rate for Payer: ASR Commercial |
$1,862.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,564.47
|
| Rate for Payer: BCN Commercial |
$1,488.44
|
| Rate for Payer: Cash Price |
$1,535.87
|
| Rate for Payer: Cofinity Commercial |
$1,804.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,535.86
|
| Rate for Payer: Healthscope Commercial |
$1,919.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,862.24
|
| Rate for Payer: Mclaren Commercial |
$1,727.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,631.86
|
| Rate for Payer: Nomi Health Commercial |
$1,574.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,247.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,689.45
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$2,559.78
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2,559.78 |
| Rate for Payer: Aetna Commercial |
$2,303.80
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$2,482.99
|
| Rate for Payer: ASR Commercial |
$2,482.99
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,096.20
|
| Rate for Payer: BCN Commercial |
$1,984.60
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$2,047.82
|
| Rate for Payer: Cash Price |
$2,047.82
|
| Rate for Payer: Cofinity Commercial |
$2,406.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,047.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$2,559.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,482.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Mclaren Commercial |
$2,303.80
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,175.81
|
| Rate for Payer: Nomi Health Commercial |
$2,099.02
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,663.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,252.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$2,559.78
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,663.86 |
| Max. Negotiated Rate |
$2,559.78 |
| Rate for Payer: Aetna Commercial |
$2,303.80
|
| Rate for Payer: ASR ASR |
$2,482.99
|
| Rate for Payer: ASR Commercial |
$2,482.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,085.96
|
| Rate for Payer: BCN Commercial |
$1,984.60
|
| Rate for Payer: Cash Price |
$2,047.82
|
| Rate for Payer: Cofinity Commercial |
$2,406.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,047.82
|
| Rate for Payer: Healthscope Commercial |
$2,559.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,482.99
|
| Rate for Payer: Mclaren Commercial |
$2,303.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,175.81
|
| Rate for Payer: Nomi Health Commercial |
$2,099.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,663.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,252.61
|
|
|
DARBEPOETIN ALFA 200 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
IP
|
$2,559.78
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116661
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,663.86 |
| Max. Negotiated Rate |
$2,559.78 |
| Rate for Payer: Aetna Commercial |
$2,303.80
|
| Rate for Payer: ASR ASR |
$2,482.99
|
| Rate for Payer: ASR Commercial |
$2,482.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,085.96
|
| Rate for Payer: BCN Commercial |
$1,984.60
|
| Rate for Payer: Cash Price |
$2,047.82
|
| Rate for Payer: Cofinity Commercial |
$2,406.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,047.82
|
| Rate for Payer: Healthscope Commercial |
$2,559.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,482.99
|
| Rate for Payer: Mclaren Commercial |
$2,303.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,175.81
|
| Rate for Payer: Nomi Health Commercial |
$2,099.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,663.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,252.61
|
|
|
DARBEPOETIN ALFA 200 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$2,559.78
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116661
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2,559.78 |
| Rate for Payer: Aetna Commercial |
$2,303.80
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$2,482.99
|
| Rate for Payer: ASR Commercial |
$2,482.99
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,096.20
|
| Rate for Payer: BCN Commercial |
$1,984.60
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$2,047.82
|
| Rate for Payer: Cash Price |
$2,047.82
|
| Rate for Payer: Cofinity Commercial |
$2,406.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,047.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$2,559.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,482.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Mclaren Commercial |
$2,303.80
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,175.81
|
| Rate for Payer: Nomi Health Commercial |
$2,099.02
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,663.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,252.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$354.96
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna Commercial |
$319.46
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$344.31
|
| Rate for Payer: ASR Commercial |
$344.31
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$290.68
|
| Rate for Payer: BCN Commercial |
$275.20
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$283.97
|
| Rate for Payer: Cash Price |
$283.97
|
| Rate for Payer: Cofinity Commercial |
$333.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Healthscope Whirlpool |
$344.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Mclaren Commercial |
$319.46
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.72
|
| Rate for Payer: Nomi Health Commercial |
$291.07
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$354.96
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.72 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna Commercial |
$319.46
|
| Rate for Payer: ASR ASR |
$344.31
|
| Rate for Payer: ASR Commercial |
$344.31
|
| Rate for Payer: BCBS Trust/PPO |
$289.26
|
| Rate for Payer: BCN Commercial |
$275.20
|
| Rate for Payer: Cash Price |
$283.97
|
| Rate for Payer: Cofinity Commercial |
$333.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.97
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Healthscope Whirlpool |
$344.31
|
| Rate for Payer: Mclaren Commercial |
$319.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.72
|
| Rate for Payer: Nomi Health Commercial |
$291.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.36
|
|
|
DARBEPOETIN ALFA 25 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$354.96
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna Commercial |
$319.46
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$344.31
|
| Rate for Payer: ASR Commercial |
$344.31
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$290.68
|
| Rate for Payer: BCN Commercial |
$275.20
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$283.97
|
| Rate for Payer: Cash Price |
$283.97
|
| Rate for Payer: Cofinity Commercial |
$333.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Healthscope Whirlpool |
$344.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Mclaren Commercial |
$319.46
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.72
|
| Rate for Payer: Nomi Health Commercial |
$291.07
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 25 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
IP
|
$354.96
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.72 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna Commercial |
$319.46
|
| Rate for Payer: ASR ASR |
$344.31
|
| Rate for Payer: ASR Commercial |
$344.31
|
| Rate for Payer: BCBS Trust/PPO |
$289.26
|
| Rate for Payer: BCN Commercial |
$275.20
|
| Rate for Payer: Cash Price |
$283.97
|
| Rate for Payer: Cofinity Commercial |
$333.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.97
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Healthscope Whirlpool |
$344.31
|
| Rate for Payer: Mclaren Commercial |
$319.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.72
|
| Rate for Payer: Nomi Health Commercial |
$291.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.36
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$3,839.65
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,495.77 |
| Max. Negotiated Rate |
$3,839.65 |
| Rate for Payer: Aetna Commercial |
$3,455.68
|
| Rate for Payer: ASR ASR |
$3,724.46
|
| Rate for Payer: ASR Commercial |
$3,724.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,128.93
|
| Rate for Payer: BCN Commercial |
$2,976.88
|
| Rate for Payer: Cash Price |
$3,071.72
|
| Rate for Payer: Cofinity Commercial |
$3,609.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,071.72
|
| Rate for Payer: Healthscope Commercial |
$3,839.65
|
| Rate for Payer: Healthscope Whirlpool |
$3,724.46
|
| Rate for Payer: Mclaren Commercial |
$3,455.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,263.70
|
| Rate for Payer: Nomi Health Commercial |
$3,148.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,495.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,378.89
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$3,839.65
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3,839.65 |
| Rate for Payer: Aetna Commercial |
$3,455.68
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$3,724.46
|
| Rate for Payer: ASR Commercial |
$3,724.46
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$3,144.29
|
| Rate for Payer: BCN Commercial |
$2,976.88
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$3,071.72
|
| Rate for Payer: Cash Price |
$3,071.72
|
| Rate for Payer: Cofinity Commercial |
$3,609.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,071.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3,839.65
|
| Rate for Payer: Healthscope Whirlpool |
$3,724.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Mclaren Commercial |
$3,455.68
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,263.70
|
| Rate for Payer: Nomi Health Commercial |
$3,148.51
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,495.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,378.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$567.95
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$567.95 |
| Rate for Payer: Aetna Commercial |
$511.16
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$550.91
|
| Rate for Payer: ASR Commercial |
$550.91
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$465.09
|
| Rate for Payer: BCN Commercial |
$440.33
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$454.36
|
| Rate for Payer: Cash Price |
$454.36
|
| Rate for Payer: Cofinity Commercial |
$533.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$567.95
|
| Rate for Payer: Healthscope Whirlpool |
$550.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Mclaren Commercial |
$511.16
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.76
|
| Rate for Payer: Nomi Health Commercial |
$465.72
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$567.95
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$369.17 |
| Max. Negotiated Rate |
$567.95 |
| Rate for Payer: Aetna Commercial |
$511.16
|
| Rate for Payer: ASR ASR |
$550.91
|
| Rate for Payer: ASR Commercial |
$550.91
|
| Rate for Payer: BCBS Trust/PPO |
$462.82
|
| Rate for Payer: BCN Commercial |
$440.33
|
| Rate for Payer: Cash Price |
$454.36
|
| Rate for Payer: Cofinity Commercial |
$533.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.36
|
| Rate for Payer: Healthscope Commercial |
$567.95
|
| Rate for Payer: Healthscope Whirlpool |
$550.91
|
| Rate for Payer: Mclaren Commercial |
$511.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.76
|
| Rate for Payer: Nomi Health Commercial |
$465.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.80
|
|
|
DARBEPOETIN ALFA 40 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
IP
|
$567.95
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$369.17 |
| Max. Negotiated Rate |
$567.95 |
| Rate for Payer: Aetna Commercial |
$511.16
|
| Rate for Payer: ASR ASR |
$550.91
|
| Rate for Payer: ASR Commercial |
$550.91
|
| Rate for Payer: BCBS Trust/PPO |
$462.82
|
| Rate for Payer: BCN Commercial |
$440.33
|
| Rate for Payer: Cash Price |
$454.36
|
| Rate for Payer: Cofinity Commercial |
$533.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.36
|
| Rate for Payer: Healthscope Commercial |
$567.95
|
| Rate for Payer: Healthscope Whirlpool |
$550.91
|
| Rate for Payer: Mclaren Commercial |
$511.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.76
|
| Rate for Payer: Nomi Health Commercial |
$465.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.80
|
|
|
DARBEPOETIN ALFA 40 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$567.95
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$567.95 |
| Rate for Payer: Aetna Commercial |
$511.16
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$550.91
|
| Rate for Payer: ASR Commercial |
$550.91
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$465.09
|
| Rate for Payer: BCN Commercial |
$440.33
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$454.36
|
| Rate for Payer: Cash Price |
$454.36
|
| Rate for Payer: Cofinity Commercial |
$533.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$567.95
|
| Rate for Payer: Healthscope Whirlpool |
$550.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Mclaren Commercial |
$511.16
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.76
|
| Rate for Payer: Nomi Health Commercial |
$465.72
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$6,399.42
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6,399.42 |
| Rate for Payer: Aetna Commercial |
$5,759.48
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$6,207.44
|
| Rate for Payer: ASR Commercial |
$6,207.44
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$5,240.49
|
| Rate for Payer: BCN Commercial |
$4,961.47
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$5,119.54
|
| Rate for Payer: Cash Price |
$5,119.54
|
| Rate for Payer: Cofinity Commercial |
$6,015.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,119.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$6,399.42
|
| Rate for Payer: Healthscope Whirlpool |
$6,207.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Mclaren Commercial |
$5,759.48
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,439.51
|
| Rate for Payer: Nomi Health Commercial |
$5,247.52
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,159.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,631.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$6,399.42
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,159.62 |
| Max. Negotiated Rate |
$6,399.42 |
| Rate for Payer: Aetna Commercial |
$5,759.48
|
| Rate for Payer: ASR ASR |
$6,207.44
|
| Rate for Payer: ASR Commercial |
$6,207.44
|
| Rate for Payer: BCBS Trust/PPO |
$5,214.89
|
| Rate for Payer: BCN Commercial |
$4,961.47
|
| Rate for Payer: Cash Price |
$5,119.54
|
| Rate for Payer: Cofinity Commercial |
$6,015.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,119.54
|
| Rate for Payer: Healthscope Commercial |
$6,399.42
|
| Rate for Payer: Healthscope Whirlpool |
$6,207.44
|
| Rate for Payer: Mclaren Commercial |
$5,759.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,439.51
|
| Rate for Payer: Nomi Health Commercial |
$5,247.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,159.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,631.49
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$851.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$851.93 |
| Rate for Payer: Aetna Commercial |
$766.74
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$826.37
|
| Rate for Payer: ASR Commercial |
$826.37
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$697.65
|
| Rate for Payer: BCN Commercial |
$660.50
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$681.54
|
| Rate for Payer: Cash Price |
$681.54
|
| Rate for Payer: Cofinity Commercial |
$800.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$681.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$851.93
|
| Rate for Payer: Healthscope Whirlpool |
$826.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Mclaren Commercial |
$766.74
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.14
|
| Rate for Payer: Nomi Health Commercial |
$698.58
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$749.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: VA VA |
$2.97
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$851.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$553.75 |
| Max. Negotiated Rate |
$851.93 |
| Rate for Payer: Aetna Commercial |
$766.74
|
| Rate for Payer: ASR ASR |
$826.37
|
| Rate for Payer: ASR Commercial |
$826.37
|
| Rate for Payer: BCBS Trust/PPO |
$694.24
|
| Rate for Payer: BCN Commercial |
$660.50
|
| Rate for Payer: Cash Price |
$681.54
|
| Rate for Payer: Cofinity Commercial |
$800.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$681.54
|
| Rate for Payer: Healthscope Commercial |
$851.93
|
| Rate for Payer: Healthscope Whirlpool |
$826.37
|
| Rate for Payer: Mclaren Commercial |
$766.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.14
|
| Rate for Payer: Nomi Health Commercial |
$698.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$749.70
|
|
|
DARBEPOETIN ALFA 60 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
IP
|
$851.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$553.75 |
| Max. Negotiated Rate |
$851.93 |
| Rate for Payer: Aetna Commercial |
$766.74
|
| Rate for Payer: ASR ASR |
$826.37
|
| Rate for Payer: ASR Commercial |
$826.37
|
| Rate for Payer: BCBS Trust/PPO |
$694.24
|
| Rate for Payer: BCN Commercial |
$660.50
|
| Rate for Payer: Cash Price |
$681.54
|
| Rate for Payer: Cofinity Commercial |
$800.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$681.54
|
| Rate for Payer: Healthscope Commercial |
$851.93
|
| Rate for Payer: Healthscope Whirlpool |
$826.37
|
| Rate for Payer: Mclaren Commercial |
$766.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.14
|
| Rate for Payer: Nomi Health Commercial |
$698.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$749.70
|
|
|
DARBEPOETIN ALFA 60 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$851.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$851.93 |
| Rate for Payer: Aetna Commercial |
$766.74
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$826.37
|
| Rate for Payer: ASR Commercial |
$826.37
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$697.65
|
| Rate for Payer: BCN Commercial |
$660.50
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$681.54
|
| Rate for Payer: Cash Price |
$681.54
|
| Rate for Payer: Cofinity Commercial |
$800.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$681.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$851.93
|
| Rate for Payer: Healthscope Whirlpool |
$826.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.97
|
| Rate for Payer: Mclaren Commercial |
$766.74
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.14
|
| Rate for Payer: Nomi Health Commercial |
$698.58
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: PHP Medicaid |
$1.59
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$749.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP DNSP |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.59
|
| Rate for Payer: VA VA |
$2.97
|
|
