|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$292.65
|
|
|
Service Code
|
NDC 42023012306
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$219.48 |
| Max. Negotiated Rate |
$292.64 |
| Rate for Payer: Aetna Commercial |
$263.38
|
| Rate for Payer: ASR ASR |
$283.87
|
| Rate for Payer: BCBS Trust/PPO |
$240.32
|
| Rate for Payer: BCN Commercial |
$240.32
|
| Rate for Payer: Cash Price |
$234.12
|
| Rate for Payer: Cofinity Commercial |
$275.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.12
|
| Rate for Payer: Healthscope Commercial |
$283.87
|
| Rate for Payer: Healthscope Whirlpool |
$292.64
|
| Rate for Payer: Mclaren Commercial |
$263.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.75
|
| Rate for Payer: Nomi Health Commercial |
$239.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.53
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$292.65
|
|
|
Service Code
|
NDC 42023012306
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.28 |
| Max. Negotiated Rate |
$292.64 |
| Rate for Payer: Aetna Commercial |
$263.38
|
| Rate for Payer: Aetna Medicare |
$108.28
|
| Rate for Payer: ASR ASR |
$283.87
|
| Rate for Payer: BCBS Complete |
$117.06
|
| Rate for Payer: BCBS Trust/PPO |
$241.29
|
| Rate for Payer: BCN Commercial |
$241.29
|
| Rate for Payer: Cash Price |
$234.12
|
| Rate for Payer: Cofinity Commercial |
$275.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.12
|
| Rate for Payer: Healthscope Commercial |
$283.87
|
| Rate for Payer: Healthscope Whirlpool |
$292.64
|
| Rate for Payer: Mclaren Commercial |
$263.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.75
|
| Rate for Payer: Nomi Health Commercial |
$239.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$256.42
|
| Rate for Payer: Priority Health Narrow Network |
$205.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.53
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$1,692.20
|
|
|
Service Code
|
NDC 310621030
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,269.15 |
| Max. Negotiated Rate |
$1,692.19 |
| Rate for Payer: Aetna Commercial |
$1,522.98
|
| Rate for Payer: ASR ASR |
$1,641.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,389.63
|
| Rate for Payer: BCN Commercial |
$1,389.63
|
| Rate for Payer: Cash Price |
$1,353.76
|
| Rate for Payer: Cofinity Commercial |
$1,590.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,353.76
|
| Rate for Payer: Healthscope Commercial |
$1,641.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,692.19
|
| Rate for Payer: Mclaren Commercial |
$1,522.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,438.37
|
| Rate for Payer: Nomi Health Commercial |
$1,387.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,269.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,489.13
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
OP
|
$1,692.20
|
|
|
Service Code
|
NDC 310621030
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$626.11 |
| Max. Negotiated Rate |
$1,692.19 |
| Rate for Payer: Aetna Commercial |
$1,522.98
|
| Rate for Payer: Aetna Medicare |
$626.11
|
| Rate for Payer: ASR ASR |
$1,641.43
|
| Rate for Payer: BCBS Complete |
$676.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,395.21
|
| Rate for Payer: BCN Commercial |
$1,395.21
|
| Rate for Payer: Cash Price |
$1,353.76
|
| Rate for Payer: Cofinity Commercial |
$1,590.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,353.76
|
| Rate for Payer: Healthscope Commercial |
$1,641.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,692.19
|
| Rate for Payer: Mclaren Commercial |
$1,522.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,353.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,438.37
|
| Rate for Payer: Nomi Health Commercial |
$1,387.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,269.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,482.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,186.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,489.13
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$37.02
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.77 |
| Max. Negotiated Rate |
$37.02 |
| Rate for Payer: Aetna Commercial |
$33.32
|
| Rate for Payer: Aetna Commercial |
$83.81
|
| Rate for Payer: ASR ASR |
$90.32
|
| Rate for Payer: ASR ASR |
$35.91
|
| Rate for Payer: BCBS Trust/PPO |
$76.47
|
| Rate for Payer: BCBS Trust/PPO |
$30.40
|
| Rate for Payer: BCN Commercial |
$76.47
|
| Rate for Payer: BCN Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$74.49
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cofinity Commercial |
$34.80
|
| Rate for Payer: Cofinity Commercial |
$87.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.62
|
| Rate for Payer: Healthscope Commercial |
$35.91
|
| Rate for Payer: Healthscope Commercial |
$90.32
|
| Rate for Payer: Healthscope Whirlpool |
$93.12
|
| Rate for Payer: Healthscope Whirlpool |
$37.02
|
| Rate for Payer: Mclaren Commercial |
$83.81
|
| Rate for Payer: Mclaren Commercial |
$33.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.47
|
| Rate for Payer: Nomi Health Commercial |
$76.36
|
| Rate for Payer: Nomi Health Commercial |
$30.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.94
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$93.12
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$83.81
|
| Rate for Payer: Aetna Commercial |
$33.32
|
| Rate for Payer: Aetna Medicare |
$13.70
|
| Rate for Payer: Aetna Medicare |
$34.45
|
| Rate for Payer: ASR ASR |
$90.32
|
| Rate for Payer: ASR ASR |
$35.91
|
| Rate for Payer: BCBS Complete |
$14.81
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: BCBS Trust/PPO |
$76.77
|
| Rate for Payer: BCBS Trust/PPO |
$30.53
|
| Rate for Payer: BCN Commercial |
$30.53
|
| Rate for Payer: BCN Commercial |
$76.77
|
| Rate for Payer: Cash Price |
$74.49
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cash Price |
$74.49
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cofinity Commercial |
$34.80
|
| Rate for Payer: Cofinity Commercial |
$87.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.62
|
| Rate for Payer: Healthscope Commercial |
$90.32
|
| Rate for Payer: Healthscope Commercial |
$35.91
|
| Rate for Payer: Healthscope Whirlpool |
$93.12
|
| Rate for Payer: Healthscope Whirlpool |
$37.02
|
| Rate for Payer: Mclaren Commercial |
$83.81
|
| Rate for Payer: Mclaren Commercial |
$33.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Nomi Health Commercial |
$30.36
|
| Rate for Payer: Nomi Health Commercial |
$76.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.94
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$66.22
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$66.22 |
| Rate for Payer: Aetna Commercial |
$59.59
|
| Rate for Payer: Aetna Commercial |
$59.78
|
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Aetna Commercial |
$61.04
|
| Rate for Payer: Aetna Commercial |
$59.80
|
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Aetna Medicare |
$20.89
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: Aetna Medicare |
$19.74
|
| Rate for Payer: Aetna Medicare |
$24.58
|
| Rate for Payer: Aetna Medicare |
$24.58
|
| Rate for Payer: Aetna Medicare |
$25.09
|
| Rate for Payer: Aetna Medicare |
$19.91
|
| Rate for Payer: Aetna Medicare |
$47.80
|
| Rate for Payer: ASR ASR |
$64.23
|
| Rate for Payer: ASR ASR |
$54.78
|
| Rate for Payer: ASR ASR |
$51.76
|
| Rate for Payer: ASR ASR |
$125.31
|
| Rate for Payer: ASR ASR |
$52.19
|
| Rate for Payer: ASR ASR |
$65.78
|
| Rate for Payer: ASR ASR |
$64.45
|
| Rate for Payer: ASR ASR |
$64.43
|
| Rate for Payer: BCBS Complete |
$21.52
|
| Rate for Payer: BCBS Complete |
$22.59
|
| Rate for Payer: BCBS Complete |
$26.49
|
| Rate for Payer: BCBS Complete |
$26.58
|
| Rate for Payer: BCBS Complete |
$27.13
|
| Rate for Payer: BCBS Complete |
$21.34
|
| Rate for Payer: BCBS Complete |
$26.57
|
| Rate for Payer: BCBS Complete |
$51.67
|
| Rate for Payer: BCBS Trust/PPO |
$43.99
|
| Rate for Payer: BCBS Trust/PPO |
$106.51
|
| Rate for Payer: BCBS Trust/PPO |
$44.36
|
| Rate for Payer: BCBS Trust/PPO |
$55.92
|
| Rate for Payer: BCBS Trust/PPO |
$54.78
|
| Rate for Payer: BCBS Trust/PPO |
$54.60
|
| Rate for Payer: BCBS Trust/PPO |
$54.77
|
| Rate for Payer: BCBS Trust/PPO |
$46.56
|
| Rate for Payer: BCN Commercial |
$106.51
|
| Rate for Payer: BCN Commercial |
$54.60
|
| Rate for Payer: BCN Commercial |
$55.92
|
| Rate for Payer: BCN Commercial |
$44.36
|
| Rate for Payer: BCN Commercial |
$46.56
|
| Rate for Payer: BCN Commercial |
$43.99
|
| Rate for Payer: BCN Commercial |
$54.78
|
| Rate for Payer: BCN Commercial |
$54.77
|
| Rate for Payer: Cash Price |
$43.04
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$42.68
|
| Rate for Payer: Cash Price |
$42.68
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$43.04
|
| Rate for Payer: Cash Price |
$45.18
|
| Rate for Payer: Cash Price |
$45.18
|
| Rate for Payer: Cash Price |
$52.97
|
| Rate for Payer: Cash Price |
$52.97
|
| Rate for Payer: Cash Price |
$53.14
|
| Rate for Payer: Cash Price |
$53.14
|
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: Cash Price |
$54.25
|
| Rate for Payer: Cash Price |
$54.25
|
| Rate for Payer: Cofinity Commercial |
$50.57
|
| Rate for Payer: Cofinity Commercial |
$53.08
|
| Rate for Payer: Cofinity Commercial |
$62.44
|
| Rate for Payer: Cofinity Commercial |
$63.75
|
| Rate for Payer: Cofinity Commercial |
$62.45
|
| Rate for Payer: Cofinity Commercial |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$50.15
|
| Rate for Payer: Cofinity Commercial |
$121.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.97
|
| Rate for Payer: Healthscope Commercial |
$54.78
|
| Rate for Payer: Healthscope Commercial |
$65.78
|
| Rate for Payer: Healthscope Commercial |
$64.45
|
| Rate for Payer: Healthscope Commercial |
$52.19
|
| Rate for Payer: Healthscope Commercial |
$51.76
|
| Rate for Payer: Healthscope Commercial |
$125.31
|
| Rate for Payer: Healthscope Commercial |
$64.43
|
| Rate for Payer: Healthscope Commercial |
$64.23
|
| Rate for Payer: Healthscope Whirlpool |
$129.18
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$56.47
|
| Rate for Payer: Healthscope Whirlpool |
$66.22
|
| Rate for Payer: Healthscope Whirlpool |
$66.43
|
| Rate for Payer: Healthscope Whirlpool |
$53.36
|
| Rate for Payer: Healthscope Whirlpool |
$66.44
|
| Rate for Payer: Healthscope Whirlpool |
$53.80
|
| Rate for Payer: Mclaren Commercial |
$48.42
|
| Rate for Payer: Mclaren Commercial |
$50.82
|
| Rate for Payer: Mclaren Commercial |
$59.78
|
| Rate for Payer: Mclaren Commercial |
$59.80
|
| Rate for Payer: Mclaren Commercial |
$116.27
|
| Rate for Payer: Mclaren Commercial |
$48.02
|
| Rate for Payer: Mclaren Commercial |
$59.59
|
| Rate for Payer: Mclaren Commercial |
$61.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.81
|
| Rate for Payer: Nomi Health Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$55.61
|
| Rate for Payer: Nomi Health Commercial |
$44.12
|
| Rate for Payer: Nomi Health Commercial |
$46.31
|
| Rate for Payer: Nomi Health Commercial |
$43.75
|
| Rate for Payer: Nomi Health Commercial |
$54.47
|
| Rate for Payer: Nomi Health Commercial |
$54.48
|
| Rate for Payer: Nomi Health Commercial |
$54.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.45
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$66.44
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.83 |
| Max. Negotiated Rate |
$66.44 |
| Rate for Payer: Aetna Commercial |
$59.80
|
| Rate for Payer: Aetna Commercial |
$61.04
|
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Aetna Commercial |
$59.59
|
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Aetna Commercial |
$59.78
|
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: ASR ASR |
$52.19
|
| Rate for Payer: ASR ASR |
$64.45
|
| Rate for Payer: ASR ASR |
$64.23
|
| Rate for Payer: ASR ASR |
$65.78
|
| Rate for Payer: ASR ASR |
$51.76
|
| Rate for Payer: ASR ASR |
$54.78
|
| Rate for Payer: ASR ASR |
$125.31
|
| Rate for Payer: ASR ASR |
$64.43
|
| Rate for Payer: BCBS Trust/PPO |
$106.09
|
| Rate for Payer: BCBS Trust/PPO |
$43.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.38
|
| Rate for Payer: BCBS Trust/PPO |
$55.69
|
| Rate for Payer: BCBS Trust/PPO |
$54.56
|
| Rate for Payer: BCBS Trust/PPO |
$54.55
|
| Rate for Payer: BCBS Trust/PPO |
$44.18
|
| Rate for Payer: BCBS Trust/PPO |
$46.37
|
| Rate for Payer: BCN Commercial |
$43.82
|
| Rate for Payer: BCN Commercial |
$44.18
|
| Rate for Payer: BCN Commercial |
$55.69
|
| Rate for Payer: BCN Commercial |
$46.37
|
| Rate for Payer: BCN Commercial |
$54.38
|
| Rate for Payer: BCN Commercial |
$106.09
|
| Rate for Payer: BCN Commercial |
$54.55
|
| Rate for Payer: BCN Commercial |
$54.56
|
| Rate for Payer: Cash Price |
$52.97
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$43.04
|
| Rate for Payer: Cash Price |
$45.18
|
| Rate for Payer: Cash Price |
$42.68
|
| Rate for Payer: Cash Price |
$53.14
|
| Rate for Payer: Cash Price |
$54.25
|
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: Cofinity Commercial |
$62.44
|
| Rate for Payer: Cofinity Commercial |
$50.57
|
| Rate for Payer: Cofinity Commercial |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$53.08
|
| Rate for Payer: Cofinity Commercial |
$50.15
|
| Rate for Payer: Cofinity Commercial |
$63.75
|
| Rate for Payer: Cofinity Commercial |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$62.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.04
|
| Rate for Payer: Healthscope Commercial |
$64.23
|
| Rate for Payer: Healthscope Commercial |
$51.76
|
| Rate for Payer: Healthscope Commercial |
$52.19
|
| Rate for Payer: Healthscope Commercial |
$65.78
|
| Rate for Payer: Healthscope Commercial |
$64.45
|
| Rate for Payer: Healthscope Commercial |
$64.43
|
| Rate for Payer: Healthscope Commercial |
$125.31
|
| Rate for Payer: Healthscope Commercial |
$54.78
|
| Rate for Payer: Healthscope Whirlpool |
$53.80
|
| Rate for Payer: Healthscope Whirlpool |
$56.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.36
|
| Rate for Payer: Healthscope Whirlpool |
$66.22
|
| Rate for Payer: Healthscope Whirlpool |
$129.18
|
| Rate for Payer: Healthscope Whirlpool |
$66.43
|
| Rate for Payer: Healthscope Whirlpool |
$66.44
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$59.59
|
| Rate for Payer: Mclaren Commercial |
$61.04
|
| Rate for Payer: Mclaren Commercial |
$116.27
|
| Rate for Payer: Mclaren Commercial |
$48.02
|
| Rate for Payer: Mclaren Commercial |
$50.82
|
| Rate for Payer: Mclaren Commercial |
$59.80
|
| Rate for Payer: Mclaren Commercial |
$48.42
|
| Rate for Payer: Mclaren Commercial |
$59.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.65
|
| Rate for Payer: Nomi Health Commercial |
$54.30
|
| Rate for Payer: Nomi Health Commercial |
$55.61
|
| Rate for Payer: Nomi Health Commercial |
$54.47
|
| Rate for Payer: Nomi Health Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$46.31
|
| Rate for Payer: Nomi Health Commercial |
$43.75
|
| Rate for Payer: Nomi Health Commercial |
$44.12
|
| Rate for Payer: Nomi Health Commercial |
$54.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.45
|
|
|
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 |
$959.92 |
| 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: BCBS Trust/PPO |
$1,051.04
|
| Rate for Payer: BCN Commercial |
$1,051.04
|
| Rate for Payer: Cash Price |
$1,023.91
|
| Rate for Payer: Cofinity Commercial |
$1,203.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.91
|
| Rate for Payer: Healthscope Commercial |
$1,241.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,279.89
|
| Rate for Payer: Mclaren Commercial |
$1,151.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.90
|
| Rate for Payer: Nomi Health Commercial |
$1,049.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$959.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,126.30
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$1,279.89
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$1,279.89 |
| Rate for Payer: Aetna Commercial |
$1,151.90
|
| Rate for Payer: Aetna Medicare |
$3.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: ASR ASR |
$1,241.49
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.27
|
| Rate for Payer: BCN Commercial |
$1,055.27
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$1,023.91
|
| Rate for Payer: Cash Price |
$1,023.91
|
| Rate for Payer: Cofinity Commercial |
$1,203.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$1,241.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,279.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$1,151.90
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$1.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.90
|
| Rate for Payer: Nomi Health Commercial |
$1,049.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$959.92
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: PHP Medicaid |
$1.65
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health Narrow Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,126.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP DNSP |
$3.07
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
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 |
$959.92 |
| 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 |
$1,241.49
|
| Rate for Payer: ASR ASR |
$2,162.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,051.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,831.14
|
| Rate for Payer: BCN Commercial |
$1,051.04
|
| Rate for Payer: BCN Commercial |
$1,831.14
|
| Rate for Payer: Cash Price |
$1,783.87
|
| Rate for Payer: Cash Price |
$1,023.91
|
| Rate for Payer: Cofinity Commercial |
$2,096.04
|
| Rate for Payer: Cofinity Commercial |
$1,203.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,783.87
|
| Rate for Payer: Healthscope Commercial |
$1,241.49
|
| Rate for Payer: Healthscope Commercial |
$2,162.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,229.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,279.89
|
| Rate for Payer: Mclaren Commercial |
$2,006.85
|
| Rate for Payer: Mclaren Commercial |
$1,151.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,895.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.90
|
| Rate for Payer: Nomi Health Commercial |
$1,828.46
|
| Rate for Payer: Nomi Health Commercial |
$1,049.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$959.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,672.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,962.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,126.30
|
|
|
DARBEPOETIN ALFA 100 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$1,279.89
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| 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: Aetna Medicare |
$3.07
|
| Rate for Payer: Aetna Medicare |
$3.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: ASR ASR |
$1,241.49
|
| Rate for Payer: ASR ASR |
$2,162.94
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,838.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.27
|
| Rate for Payer: BCN Commercial |
$1,838.50
|
| Rate for Payer: BCN Commercial |
$1,055.27
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$1,023.91
|
| Rate for Payer: Cash Price |
$1,023.91
|
| Rate for Payer: Cash Price |
$1,783.87
|
| Rate for Payer: Cash Price |
$1,783.87
|
| Rate for Payer: Cofinity Commercial |
$1,203.09
|
| Rate for Payer: Cofinity Commercial |
$2,096.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,783.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$1,241.49
|
| Rate for Payer: Healthscope Commercial |
$2,162.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,279.89
|
| Rate for Payer: Healthscope Whirlpool |
$2,229.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$2,006.85
|
| Rate for Payer: Mclaren Commercial |
$1,151.90
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$1.69
|
| Rate for Payer: Meridian Medicaid |
$1.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,895.36
|
| Rate for Payer: Nomi Health Commercial |
$1,828.46
|
| Rate for Payer: Nomi Health Commercial |
$1,049.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$959.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,672.38
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: PHP Medicaid |
$1.65
|
| Rate for Payer: PHP Medicaid |
$1.65
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health Narrow Network |
$2.51
|
| Rate for Payer: Priority Health Narrow Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,962.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,126.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP DNSP |
$3.07
|
| Rate for Payer: UHCCP DNSP |
$3.07
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: VA VA |
$3.07
|
|
|
DARBEPOETIN ALFA 10 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$177.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
161505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Aetna Commercial |
$160.19
|
| Rate for Payer: Aetna Medicare |
$3.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: ASR ASR |
$172.65
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$146.75
|
| Rate for Payer: BCN Commercial |
$146.75
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$142.39
|
| Rate for Payer: Cash Price |
$142.39
|
| Rate for Payer: Cofinity Commercial |
$167.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$172.65
|
| Rate for Payer: Healthscope Whirlpool |
$177.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$160.19
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$1.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.29
|
| Rate for Payer: Nomi Health Commercial |
$145.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.49
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: PHP Medicaid |
$1.65
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health Narrow Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP DNSP |
$3.07
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
DARBEPOETIN ALFA 10 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$177.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
161505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.49 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Aetna Commercial |
$160.19
|
| Rate for Payer: ASR ASR |
$172.65
|
| Rate for Payer: BCBS Trust/PPO |
$146.17
|
| Rate for Payer: BCN Commercial |
$146.17
|
| Rate for Payer: Cash Price |
$142.39
|
| Rate for Payer: Cofinity Commercial |
$167.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.39
|
| Rate for Payer: Healthscope Commercial |
$172.65
|
| Rate for Payer: Healthscope Whirlpool |
$177.99
|
| Rate for Payer: Mclaren Commercial |
$160.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.29
|
| Rate for Payer: Nomi Health Commercial |
$145.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.63
|
|
|
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 |
$1.61 |
| Max. Negotiated Rate |
$1,919.83 |
| Rate for Payer: Aetna Commercial |
$1,727.85
|
| Rate for Payer: Aetna Medicare |
$3.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: ASR ASR |
$1,862.24
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.90
|
| Rate for Payer: BCN Commercial |
$1,582.90
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| 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 |
$1,535.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$1,862.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,919.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$1,727.85
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$1.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,631.86
|
| Rate for Payer: Nomi Health Commercial |
$1,574.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,439.87
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: PHP Medicaid |
$1.65
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health Narrow Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,689.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP DNSP |
$3.07
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
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 |
$1,439.87 |
| 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: BCBS Trust/PPO |
$1,576.57
|
| Rate for Payer: BCN Commercial |
$1,576.57
|
| Rate for Payer: Cash Price |
$1,535.87
|
| Rate for Payer: Cofinity Commercial |
$1,804.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,535.87
|
| Rate for Payer: Healthscope Commercial |
$1,862.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,919.83
|
| 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: Opus (Opus Packaging Group) HMA |
$1,439.87
|
| 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 |
$1.61 |
| Max. Negotiated Rate |
$2,559.78 |
| Rate for Payer: Aetna Commercial |
$2,303.80
|
| Rate for Payer: Aetna Medicare |
$3.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: ASR ASR |
$2,482.98
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,110.54
|
| Rate for Payer: BCN Commercial |
$2,110.54
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| 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 |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$2,482.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,559.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$2,303.80
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$1.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,175.81
|
| Rate for Payer: Nomi Health Commercial |
$2,099.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,919.83
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: PHP Medicaid |
$1.65
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health Narrow Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,252.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP DNSP |
$3.07
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
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 |
$1,919.83 |
| Max. Negotiated Rate |
$2,559.78 |
| Rate for Payer: Aetna Commercial |
$2,303.80
|
| Rate for Payer: ASR ASR |
$2,482.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,102.09
|
| Rate for Payer: BCN Commercial |
$2,102.09
|
| 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 |
$2,482.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,559.78
|
| 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: Opus (Opus Packaging Group) HMA |
$1,919.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,252.60
|
|
|
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 |
$1.61 |
| Max. Negotiated Rate |
$2,559.78 |
| Rate for Payer: Aetna Commercial |
$2,303.80
|
| Rate for Payer: Aetna Medicare |
$3.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: ASR ASR |
$2,482.98
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,110.54
|
| Rate for Payer: BCN Commercial |
$2,110.54
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| 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 |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$2,482.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,559.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$2,303.80
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$1.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,175.81
|
| Rate for Payer: Nomi Health Commercial |
$2,099.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,919.83
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: PHP Medicaid |
$1.65
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health Narrow Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,252.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP DNSP |
$3.07
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
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 |
$1,919.83 |
| Max. Negotiated Rate |
$2,559.78 |
| Rate for Payer: Aetna Commercial |
$2,303.80
|
| Rate for Payer: ASR ASR |
$2,482.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,102.09
|
| Rate for Payer: BCN Commercial |
$2,102.09
|
| 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 |
$2,482.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,559.78
|
| 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: Opus (Opus Packaging Group) HMA |
$1,919.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,252.60
|
|
|
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 |
$1.61 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna Commercial |
$319.47
|
| Rate for Payer: Aetna Medicare |
$3.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: ASR ASR |
$344.32
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$292.67
|
| Rate for Payer: BCN Commercial |
$292.67
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$283.97
|
| Rate for Payer: Cash Price |
$283.97
|
| Rate for Payer: Cofinity Commercial |
$333.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$344.32
|
| Rate for Payer: Healthscope Whirlpool |
$354.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$319.47
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$1.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.72
|
| Rate for Payer: Nomi Health Commercial |
$291.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.22
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: PHP Medicaid |
$1.65
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health Narrow Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP DNSP |
$3.07
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
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 |
$266.22 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna Commercial |
$319.47
|
| Rate for Payer: ASR ASR |
$344.32
|
| Rate for Payer: BCBS Trust/PPO |
$291.50
|
| Rate for Payer: BCN Commercial |
$291.50
|
| Rate for Payer: Cash Price |
$283.97
|
| Rate for Payer: Cofinity Commercial |
$333.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.97
|
| Rate for Payer: Healthscope Commercial |
$344.32
|
| Rate for Payer: Healthscope Whirlpool |
$354.96
|
| Rate for Payer: Mclaren Commercial |
$319.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.72
|
| Rate for Payer: Nomi Health Commercial |
$291.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.37
|
|
|
DARBEPOETIN ALFA 25 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$354.97
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna Commercial |
$319.47
|
| Rate for Payer: Aetna Medicare |
$3.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: ASR ASR |
$344.32
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$292.67
|
| Rate for Payer: BCN Commercial |
$292.67
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$283.97
|
| Rate for Payer: Cash Price |
$283.97
|
| Rate for Payer: Cofinity Commercial |
$333.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$344.32
|
| Rate for Payer: Healthscope Whirlpool |
$354.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$319.47
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$1.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.72
|
| Rate for Payer: Nomi Health Commercial |
$291.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.22
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: PHP Medicaid |
$1.65
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health Narrow Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP DNSP |
$3.07
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$3.07
|
|
|
DARBEPOETIN ALFA 25 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
IP
|
$354.97
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$266.22 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Aetna Commercial |
$319.47
|
| Rate for Payer: ASR ASR |
$344.32
|
| Rate for Payer: BCBS Trust/PPO |
$291.50
|
| Rate for Payer: BCN Commercial |
$291.50
|
| Rate for Payer: Cash Price |
$283.97
|
| Rate for Payer: Cofinity Commercial |
$333.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.97
|
| Rate for Payer: Healthscope Commercial |
$344.32
|
| Rate for Payer: Healthscope Whirlpool |
$354.96
|
| Rate for Payer: Mclaren Commercial |
$319.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.72
|
| Rate for Payer: Nomi Health Commercial |
$291.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.37
|
|
|
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 |
$2,879.74 |
| 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: BCBS Trust/PPO |
$3,153.12
|
| Rate for Payer: BCN Commercial |
$3,153.12
|
| 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 |
$3,724.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,839.65
|
| 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: Opus (Opus Packaging Group) HMA |
$2,879.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,378.89
|
|
