|
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/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 |
$1.57 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna Commercial |
$319.46
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: ASR ASR |
$344.31
|
| Rate for Payer: ASR Commercial |
$344.31
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$290.68
|
| Rate for Payer: BCN Commercial |
$275.20
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| 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 |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Healthscope Whirlpool |
$344.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.93
|
| Rate for Payer: Mclaren Commercial |
$319.46
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.72
|
| Rate for Payer: Nomi Health Commercial |
$291.07
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.22
|
| Rate for Payer: PHP Medicaid |
$1.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.02
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$248.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Exchange |
$4.54
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP DNSP |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.57
|
| Rate for Payer: VA VA |
$2.93
|
|
|
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 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 |
$1.57 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna Commercial |
$319.46
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: ASR ASR |
$344.31
|
| Rate for Payer: ASR Commercial |
$344.31
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$290.68
|
| Rate for Payer: BCN Commercial |
$275.20
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| 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 |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$354.96
|
| Rate for Payer: Healthscope Whirlpool |
$344.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.93
|
| Rate for Payer: Mclaren Commercial |
$319.46
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.72
|
| Rate for Payer: Nomi Health Commercial |
$291.07
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.22
|
| Rate for Payer: PHP Medicaid |
$1.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.02
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$248.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Exchange |
$4.54
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP DNSP |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.57
|
| Rate for Payer: VA VA |
$2.93
|
|
|
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 |
$1.57 |
| Max. Negotiated Rate |
$3,839.65 |
| Rate for Payer: Aetna Commercial |
$3,455.68
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: ASR ASR |
$3,724.46
|
| Rate for Payer: ASR Commercial |
$3,724.46
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$3,144.29
|
| Rate for Payer: BCN Commercial |
$2,976.88
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| 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 |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$3,839.65
|
| Rate for Payer: Healthscope Whirlpool |
$3,724.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.93
|
| Rate for Payer: Mclaren Commercial |
$3,455.68
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| 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 |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.22
|
| Rate for Payer: PHP Medicaid |
$1.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,495.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,364.30
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,691.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,378.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Exchange |
$4.54
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP DNSP |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.57
|
| Rate for Payer: VA VA |
$2.93
|
|
|
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 |
$1.57 |
| Max. Negotiated Rate |
$567.95 |
| Rate for Payer: Aetna Commercial |
$511.15
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: ASR ASR |
$550.91
|
| Rate for Payer: ASR Commercial |
$550.91
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$465.09
|
| Rate for Payer: BCN Commercial |
$440.33
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| 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 |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$567.95
|
| Rate for Payer: Healthscope Whirlpool |
$550.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.93
|
| Rate for Payer: Mclaren Commercial |
$511.15
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.76
|
| Rate for Payer: Nomi Health Commercial |
$465.72
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.22
|
| Rate for Payer: PHP Medicaid |
$1.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.64
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$398.13
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Exchange |
$4.54
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP DNSP |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.57
|
| Rate for Payer: VA VA |
$2.93
|
|
|
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 |
$511.15
|
| 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 |
$511.15
|
| 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 |
$511.15
|
| 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 |
$511.15
|
| 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 |
$1.57 |
| Max. Negotiated Rate |
$567.95 |
| Rate for Payer: Aetna Commercial |
$511.15
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: ASR ASR |
$550.91
|
| Rate for Payer: ASR Commercial |
$550.91
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$465.09
|
| Rate for Payer: BCN Commercial |
$440.33
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| 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 |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$567.95
|
| Rate for Payer: Healthscope Whirlpool |
$550.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.93
|
| Rate for Payer: Mclaren Commercial |
$511.15
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.76
|
| Rate for Payer: Nomi Health Commercial |
$465.72
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.22
|
| Rate for Payer: PHP Medicaid |
$1.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.64
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$398.13
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Exchange |
$4.54
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP DNSP |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.57
|
| Rate for Payer: VA VA |
$2.93
|
|
|
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 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 |
$1.57 |
| Max. Negotiated Rate |
$6,399.42 |
| Rate for Payer: Aetna Commercial |
$5,759.48
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: ASR ASR |
$6,207.44
|
| Rate for Payer: ASR Commercial |
$6,207.44
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$5,240.49
|
| Rate for Payer: BCN Commercial |
$4,961.47
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| 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 |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$6,399.42
|
| Rate for Payer: Healthscope Whirlpool |
$6,207.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.93
|
| Rate for Payer: Mclaren Commercial |
$5,759.48
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| 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 |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.22
|
| Rate for Payer: PHP Medicaid |
$1.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,159.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,607.17
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$4,485.99
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,631.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Exchange |
$4.54
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP DNSP |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.57
|
| Rate for Payer: VA VA |
$2.93
|
|
|
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 |
$1.57 |
| Max. Negotiated Rate |
$851.93 |
| Rate for Payer: Aetna Commercial |
$766.74
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: ASR ASR |
$826.37
|
| Rate for Payer: ASR Commercial |
$826.37
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$697.65
|
| Rate for Payer: BCN Commercial |
$660.50
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| 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 |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$851.93
|
| Rate for Payer: Healthscope Whirlpool |
$826.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.93
|
| Rate for Payer: Mclaren Commercial |
$766.74
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.14
|
| Rate for Payer: Nomi Health Commercial |
$698.58
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.22
|
| Rate for Payer: PHP Medicaid |
$1.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$746.46
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$597.20
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$749.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Exchange |
$4.54
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP DNSP |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.57
|
| Rate for Payer: VA VA |
$2.93
|
|
|
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
|
OP
|
$851.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$851.93 |
| Rate for Payer: Aetna Commercial |
$766.74
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: ASR ASR |
$826.37
|
| Rate for Payer: ASR Commercial |
$826.37
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$697.65
|
| Rate for Payer: BCN Commercial |
$660.50
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| 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 |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$851.93
|
| Rate for Payer: Healthscope Whirlpool |
$826.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.93
|
| Rate for Payer: Mclaren Commercial |
$766.74
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.14
|
| Rate for Payer: Nomi Health Commercial |
$698.58
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.22
|
| Rate for Payer: PHP Medicaid |
$1.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$746.46
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$597.20
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$749.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Exchange |
$4.54
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP DNSP |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.57
|
| Rate for Payer: VA VA |
$2.93
|
|
|
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
|
|
|
DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$300.37
|
|
|
Service Code
|
CPT 97597
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$300.37 |
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
OP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.26 |
| Max. Negotiated Rate |
$150.65 |
| Rate for Payer: Aetna Commercial |
$135.59
|
| Rate for Payer: Aetna Medicare |
$75.33
|
| Rate for Payer: ASR ASR |
$146.13
|
| Rate for Payer: ASR Commercial |
$146.13
|
| Rate for Payer: BCBS Complete |
$60.26
|
| Rate for Payer: BCBS Trust/PPO |
$123.37
|
| Rate for Payer: BCN Commercial |
$116.80
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cofinity Commercial |
$141.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Healthscope Commercial |
$150.65
|
| Rate for Payer: Healthscope Whirlpool |
$146.13
|
| Rate for Payer: Mclaren Commercial |
$135.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Nomi Health Commercial |
$123.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.00
|
| Rate for Payer: Priority Health Narrow Network |
$105.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.57
|
|
|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
IP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.92 |
| Max. Negotiated Rate |
$150.65 |
| Rate for Payer: Aetna Commercial |
$135.59
|
| Rate for Payer: ASR ASR |
$146.13
|
| Rate for Payer: ASR Commercial |
$146.13
|
| Rate for Payer: BCBS Trust/PPO |
$122.76
|
| Rate for Payer: BCN Commercial |
$116.80
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cofinity Commercial |
$141.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Healthscope Commercial |
$150.65
|
| Rate for Payer: Healthscope Whirlpool |
$146.13
|
| Rate for Payer: Mclaren Commercial |
$135.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Nomi Health Commercial |
$123.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.57
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$53.53
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$53.53 |
| Rate for Payer: Aetna Commercial |
$48.18
|
| Rate for Payer: Aetna Medicare |
$26.77
|
| Rate for Payer: ASR ASR |
$51.92
|
| Rate for Payer: ASR Commercial |
$51.92
|
| Rate for Payer: BCBS Complete |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$43.84
|
| Rate for Payer: BCN Commercial |
$41.50
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$50.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.82
|
| Rate for Payer: Healthscope Commercial |
$53.53
|
| Rate for Payer: Healthscope Whirlpool |
$51.92
|
| Rate for Payer: Mclaren Commercial |
$48.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.50
|
| Rate for Payer: Nomi Health Commercial |
$43.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.90
|
| Rate for Payer: Priority Health Narrow Network |
$37.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.11
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$53.53
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$53.53 |
| Rate for Payer: Aetna Commercial |
$48.18
|
| Rate for Payer: ASR ASR |
$51.92
|
| Rate for Payer: ASR Commercial |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$43.62
|
| Rate for Payer: BCN Commercial |
$41.50
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$50.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.82
|
| Rate for Payer: Healthscope Commercial |
$53.53
|
| Rate for Payer: Healthscope Whirlpool |
$51.92
|
| Rate for Payer: Mclaren Commercial |
$48.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.50
|
| Rate for Payer: Nomi Health Commercial |
$43.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.11
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,547.07
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,905.60 |
| Max. Negotiated Rate |
$7,547.07 |
| Rate for Payer: Aetna Commercial |
$6,792.36
|
| Rate for Payer: ASR ASR |
$7,320.66
|
| Rate for Payer: ASR Commercial |
$7,320.66
|
| Rate for Payer: BCBS Trust/PPO |
$6,150.11
|
| Rate for Payer: BCN Commercial |
$5,851.24
|
| Rate for Payer: Cash Price |
$6,037.66
|
| Rate for Payer: Cofinity Commercial |
$7,094.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,037.66
|
| Rate for Payer: Healthscope Commercial |
$7,547.07
|
| Rate for Payer: Healthscope Whirlpool |
$7,320.66
|
| Rate for Payer: Mclaren Commercial |
$6,792.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,415.01
|
| Rate for Payer: Nomi Health Commercial |
$6,188.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,905.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,641.42
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,547.07
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$7,547.07 |
| Rate for Payer: Aetna Commercial |
$6,792.36
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.73
|
| Rate for Payer: ASR ASR |
$7,320.66
|
| Rate for Payer: ASR Commercial |
$7,320.66
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$6,180.30
|
| Rate for Payer: BCN Commercial |
$5,851.24
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$6,037.66
|
| Rate for Payer: Cash Price |
$6,037.66
|
| Rate for Payer: Cofinity Commercial |
$7,094.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,037.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$7,547.07
|
| Rate for Payer: Healthscope Whirlpool |
$7,320.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.38
|
| Rate for Payer: Mclaren Commercial |
$6,792.36
|
| Rate for Payer: Mclaren Medicaid |
$15.75
|
| Rate for Payer: Mclaren Medicare |
$29.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$16.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,415.01
|
| Rate for Payer: Nomi Health Commercial |
$6,188.60
|
| Rate for Payer: PACE Medicare |
$27.91
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Commercial |
$32.32
|
| Rate for Payer: PHP Medicaid |
$15.75
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,905.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,612.74
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: Priority Health Narrow Network |
$5,290.50
|
| Rate for Payer: Railroad Medicare Medicare |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,641.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Exchange |
$45.54
|
| Rate for Payer: UHC Medicare Advantage |
$29.38
|
| Rate for Payer: UHCCP DNSP |
$29.38
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: VA VA |
$29.38
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,315.49
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
105502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$5,315.49 |
| Rate for Payer: Aetna Commercial |
$4,783.94
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.73
|
| Rate for Payer: ASR ASR |
$5,156.03
|
| Rate for Payer: ASR Commercial |
$5,156.03
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$4,352.85
|
| Rate for Payer: BCN Commercial |
$4,121.10
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$4,252.39
|
| Rate for Payer: Cash Price |
$4,252.39
|
| Rate for Payer: Cofinity Commercial |
$4,996.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,252.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$5,315.49
|
| Rate for Payer: Healthscope Whirlpool |
$5,156.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.38
|
| Rate for Payer: Mclaren Commercial |
$4,783.94
|
| Rate for Payer: Mclaren Medicaid |
$15.75
|
| Rate for Payer: Mclaren Medicare |
$29.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$16.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,518.17
|
| Rate for Payer: Nomi Health Commercial |
$4,358.70
|
| Rate for Payer: PACE Medicare |
$27.91
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Commercial |
$32.32
|
| Rate for Payer: PHP Medicaid |
$15.75
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,455.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,657.43
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: Priority Health Narrow Network |
$3,726.16
|
| Rate for Payer: Railroad Medicare Medicare |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,677.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Exchange |
$45.54
|
| Rate for Payer: UHC Medicare Advantage |
$29.38
|
| Rate for Payer: UHCCP DNSP |
$29.38
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: VA VA |
$29.38
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,315.49
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
105502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,455.07 |
| Max. Negotiated Rate |
$5,315.49 |
| Rate for Payer: Aetna Commercial |
$4,783.94
|
| Rate for Payer: ASR ASR |
$5,156.03
|
| Rate for Payer: ASR Commercial |
$5,156.03
|
| Rate for Payer: BCBS Trust/PPO |
$4,331.59
|
| Rate for Payer: BCN Commercial |
$4,121.10
|
| Rate for Payer: Cash Price |
$4,252.39
|
| Rate for Payer: Cofinity Commercial |
$4,996.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,252.39
|
| Rate for Payer: Healthscope Commercial |
$5,315.49
|
| Rate for Payer: Healthscope Whirlpool |
$5,156.03
|
| Rate for Payer: Mclaren Commercial |
$4,783.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,518.17
|
| Rate for Payer: Nomi Health Commercial |
$4,358.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,455.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,677.63
|
|
