|
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
|
|
|
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 |
$425.96 |
| Max. Negotiated Rate |
$567.95 |
| Rate for Payer: Aetna Commercial |
$511.15
|
| Rate for Payer: ASR ASR |
$550.91
|
| Rate for Payer: BCBS Trust/PPO |
$466.40
|
| Rate for Payer: BCN Commercial |
$466.40
|
| 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 |
$550.91
|
| Rate for Payer: Healthscope Whirlpool |
$567.95
|
| 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: Opus (Opus Packaging Group) HMA |
$425.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.79
|
|
|
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 |
$1.61 |
| Max. Negotiated Rate |
$567.95 |
| Rate for Payer: Aetna Commercial |
$511.15
|
| 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 |
$550.91
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$468.27
|
| Rate for Payer: BCN Commercial |
$468.27
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| 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 |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$550.91
|
| Rate for Payer: Healthscope Whirlpool |
$567.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$511.15
|
| 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 |
$482.76
|
| Rate for Payer: Nomi Health Commercial |
$465.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.96
|
| 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 |
$499.79
|
| 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 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 |
$1.61 |
| Max. Negotiated Rate |
$567.95 |
| Rate for Payer: Aetna Commercial |
$511.15
|
| 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 |
$550.91
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$468.27
|
| Rate for Payer: BCN Commercial |
$468.27
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| 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 |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$550.91
|
| Rate for Payer: Healthscope Whirlpool |
$567.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$511.15
|
| 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 |
$482.75
|
| Rate for Payer: Nomi Health Commercial |
$465.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.96
|
| 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 |
$499.79
|
| 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 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 |
$425.96 |
| Max. Negotiated Rate |
$567.95 |
| Rate for Payer: Aetna Commercial |
$511.15
|
| Rate for Payer: ASR ASR |
$550.91
|
| Rate for Payer: BCBS Trust/PPO |
$466.40
|
| Rate for Payer: BCN Commercial |
$466.40
|
| 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 |
$550.91
|
| Rate for Payer: Healthscope Whirlpool |
$567.95
|
| Rate for Payer: Mclaren Commercial |
$511.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.75
|
| Rate for Payer: Nomi Health Commercial |
$465.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.79
|
|
|
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 |
$4,799.57 |
| 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: BCBS Trust/PPO |
$5,255.21
|
| Rate for Payer: BCN Commercial |
$5,255.21
|
| Rate for Payer: Cash Price |
$5,119.54
|
| Rate for Payer: Cofinity Commercial |
$6,015.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,119.54
|
| Rate for Payer: Healthscope Commercial |
$6,207.44
|
| Rate for Payer: Healthscope Whirlpool |
$6,399.42
|
| 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 |
$5,247.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,799.57
|
| 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 |
$1.61 |
| Max. Negotiated Rate |
$6,399.42 |
| Rate for Payer: Aetna Commercial |
$5,759.48
|
| 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 |
$6,207.44
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$5,276.33
|
| Rate for Payer: BCN Commercial |
$5,276.33
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$5,119.54
|
| Rate for Payer: Cash Price |
$5,119.54
|
| Rate for Payer: Cofinity Commercial |
$6,015.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,119.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$6,207.44
|
| Rate for Payer: Healthscope Whirlpool |
$6,399.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$5,759.48
|
| 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 |
$5,439.51
|
| Rate for Payer: Nomi Health Commercial |
$5,247.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,799.57
|
| 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 |
$5,631.49
|
| 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 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 |
$638.95 |
| Max. Negotiated Rate |
$851.93 |
| Rate for Payer: Aetna Commercial |
$766.74
|
| Rate for Payer: ASR ASR |
$826.37
|
| Rate for Payer: BCBS Trust/PPO |
$699.60
|
| Rate for Payer: BCN Commercial |
$699.60
|
| 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 |
$826.37
|
| Rate for Payer: Healthscope Whirlpool |
$851.93
|
| 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: Opus (Opus Packaging Group) HMA |
$638.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$749.70
|
|
|
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 |
$1.61 |
| Max. Negotiated Rate |
$851.93 |
| Rate for Payer: Aetna Commercial |
$766.74
|
| 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 |
$826.37
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$702.42
|
| Rate for Payer: BCN Commercial |
$702.42
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| 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 |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$826.37
|
| Rate for Payer: Healthscope Whirlpool |
$851.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$766.74
|
| 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 |
$724.14
|
| Rate for Payer: Nomi Health Commercial |
$698.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.95
|
| 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 |
$749.70
|
| 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 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 |
$1.61 |
| Max. Negotiated Rate |
$851.93 |
| Rate for Payer: Aetna Commercial |
$766.74
|
| 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 |
$826.37
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$702.42
|
| Rate for Payer: BCN Commercial |
$702.42
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| 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 |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$826.37
|
| Rate for Payer: Healthscope Whirlpool |
$851.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$766.74
|
| 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 |
$724.14
|
| Rate for Payer: Nomi Health Commercial |
$698.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.95
|
| 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 |
$749.70
|
| 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 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 |
$638.95 |
| Max. Negotiated Rate |
$851.93 |
| Rate for Payer: Aetna Commercial |
$766.74
|
| Rate for Payer: ASR ASR |
$826.37
|
| Rate for Payer: BCBS Trust/PPO |
$699.60
|
| Rate for Payer: BCN Commercial |
$699.60
|
| 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 |
$826.37
|
| Rate for Payer: Healthscope Whirlpool |
$851.93
|
| 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: Opus (Opus Packaging Group) HMA |
$638.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$749.70
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC
|
Facility
|
IP
|
$28,152.18
|
|
|
Service Code
|
MSDRG 744
|
| Min. Negotiated Rate |
$15,685.00 |
| Max. Negotiated Rate |
$28,152.18 |
| Rate for Payer: Aetna Medicare |
$16,510.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,638.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,638.16
|
| Rate for Payer: BCBS MAPPO |
$16,510.53
|
| Rate for Payer: BCN Medicare Advantage |
$16,510.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,510.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,510.53
|
| Rate for Payer: Mclaren Medicare |
$16,510.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,336.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,987.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,161.58
|
| Rate for Payer: PACE Medicare |
$15,685.00
|
| Rate for Payer: PACE SWMI |
$16,510.53
|
| Rate for Payer: PHP Commercial |
$18,161.58
|
| Rate for Payer: PHP Medicare Advantage |
$16,510.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28,152.18
|
| Rate for Payer: Priority Health Medicare |
$16,510.53
|
| Rate for Payer: Priority Health Narrow Network |
$22,521.74
|
| Rate for Payer: Railroad Medicare Medicare |
$16,510.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,510.53
|
| Rate for Payer: UHC Exchange |
$25,591.32
|
| Rate for Payer: UHCCP DNSP |
$16,510.53
|
| Rate for Payer: VA VA |
$16,510.53
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC
|
Facility
|
IP
|
$15,627.89
|
|
|
Service Code
|
MSDRG 745
|
| Min. Negotiated Rate |
$9,448.58 |
| Max. Negotiated Rate |
$15,627.89 |
| Rate for Payer: Aetna Medicare |
$9,945.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,432.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,432.34
|
| Rate for Payer: BCBS MAPPO |
$9,945.87
|
| Rate for Payer: BCN Medicare Advantage |
$9,945.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,945.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,945.87
|
| Rate for Payer: Mclaren Medicare |
$9,945.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,443.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,437.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,940.46
|
| Rate for Payer: PACE Medicare |
$9,448.58
|
| Rate for Payer: PACE SWMI |
$9,945.87
|
| Rate for Payer: PHP Commercial |
$10,940.46
|
| Rate for Payer: PHP Medicare Advantage |
$9,945.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,627.89
|
| Rate for Payer: Priority Health Medicare |
$9,945.87
|
| Rate for Payer: Priority Health Narrow Network |
$12,502.31
|
| Rate for Payer: Railroad Medicare Medicare |
$9,945.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,945.87
|
| Rate for Payer: UHC Exchange |
$15,416.10
|
| Rate for Payer: UHCCP DNSP |
$9,945.87
|
| Rate for Payer: VA VA |
$9,945.87
|
|
|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
OP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$150.65 |
| Rate for Payer: Aetna Commercial |
$135.58
|
| Rate for Payer: Aetna Medicare |
$55.74
|
| Rate for Payer: ASR ASR |
$146.13
|
| Rate for Payer: BCBS Complete |
$60.26
|
| Rate for Payer: BCBS Trust/PPO |
$124.21
|
| Rate for Payer: BCN Commercial |
$124.21
|
| Rate for Payer: Cash Price |
$120.52
|
| 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 |
$146.13
|
| Rate for Payer: Healthscope Whirlpool |
$150.65
|
| Rate for Payer: Mclaren Commercial |
$135.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Nomi Health Commercial |
$123.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.79
|
| Rate for Payer: Priority Health Narrow Network |
$7.03
|
| 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 |
$112.98 |
| Max. Negotiated Rate |
$150.65 |
| Rate for Payer: Aetna Commercial |
$135.58
|
| Rate for Payer: ASR ASR |
$146.13
|
| Rate for Payer: BCBS Trust/PPO |
$123.71
|
| Rate for Payer: BCN Commercial |
$123.71
|
| 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 |
$146.13
|
| Rate for Payer: Healthscope Whirlpool |
$150.65
|
| Rate for Payer: Mclaren Commercial |
$135.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Nomi Health Commercial |
$123.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.57
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$61.05
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna Commercial |
$54.95
|
| Rate for Payer: ASR ASR |
$59.22
|
| Rate for Payer: BCBS Trust/PPO |
$50.14
|
| Rate for Payer: BCN Commercial |
$50.14
|
| Rate for Payer: Cash Price |
$48.84
|
| Rate for Payer: Cofinity Commercial |
$57.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.84
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Healthscope Whirlpool |
$61.05
|
| Rate for Payer: Mclaren Commercial |
$54.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.90
|
| Rate for Payer: Nomi Health Commercial |
$50.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.73
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$61.05
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna Commercial |
$54.95
|
| Rate for Payer: Aetna Medicare |
$22.59
|
| Rate for Payer: ASR ASR |
$59.22
|
| Rate for Payer: BCBS Complete |
$24.42
|
| Rate for Payer: BCBS Trust/PPO |
$50.34
|
| Rate for Payer: BCN Commercial |
$50.34
|
| Rate for Payer: Cash Price |
$48.84
|
| Rate for Payer: Cash Price |
$48.84
|
| Rate for Payer: Cofinity Commercial |
$57.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.84
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Healthscope Whirlpool |
$61.05
|
| Rate for Payer: Mclaren Commercial |
$54.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.90
|
| Rate for Payer: Nomi Health Commercial |
$50.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.79
|
| Rate for Payer: Priority Health Narrow Network |
$7.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.73
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$18,257.46
|
|
|
Service Code
|
APR-DRG 1792
|
| Min. Negotiated Rate |
$16,506.93 |
| Max. Negotiated Rate |
$18,257.46 |
| Rate for Payer: BCBS Complete |
$18,257.46
|
| Rate for Payer: Mclaren Medicaid |
$17,388.06
|
| Rate for Payer: Meridian Medicaid |
$18,257.46
|
| Rate for Payer: PHP Medicaid |
$16,506.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,388.06
|
| Rate for Payer: UHC Medicaid |
$17,388.06
|
| Rate for Payer: UHCCP Medicaid |
$17,388.06
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$15,407.92
|
|
|
Service Code
|
APR-DRG 1791
|
| Min. Negotiated Rate |
$13,930.60 |
| Max. Negotiated Rate |
$15,407.92 |
| Rate for Payer: BCBS Complete |
$15,407.92
|
| Rate for Payer: Mclaren Medicaid |
$14,674.21
|
| Rate for Payer: Meridian Medicaid |
$15,407.92
|
| Rate for Payer: PHP Medicaid |
$13,930.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,674.21
|
| Rate for Payer: UHC Medicaid |
$14,674.21
|
| Rate for Payer: UHCCP Medicaid |
$14,674.21
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$22,573.46
|
|
|
Service Code
|
APR-DRG 1793
|
| Min. Negotiated Rate |
$20,409.11 |
| Max. Negotiated Rate |
$22,573.46 |
| Rate for Payer: BCBS Complete |
$22,573.46
|
| Rate for Payer: Mclaren Medicaid |
$21,498.54
|
| Rate for Payer: Meridian Medicaid |
$22,573.46
|
| Rate for Payer: PHP Medicaid |
$20,409.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,498.54
|
| Rate for Payer: UHC Medicaid |
$21,498.54
|
| Rate for Payer: UHCCP Medicaid |
$21,498.54
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$29,629.48
|
|
|
Service Code
|
APR-DRG 1794
|
| Min. Negotiated Rate |
$26,788.59 |
| Max. Negotiated Rate |
$29,629.48 |
| Rate for Payer: BCBS Complete |
$29,629.48
|
| Rate for Payer: Mclaren Medicaid |
$28,218.55
|
| Rate for Payer: Meridian Medicaid |
$29,629.48
|
| Rate for Payer: PHP Medicaid |
$26,788.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$28,218.55
|
| Rate for Payer: UHC Medicaid |
$28,218.55
|
| Rate for Payer: UHCCP Medicaid |
$28,218.55
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$9,114.83
|
|
|
Service Code
|
APR-DRG 0424
|
| Min. Negotiated Rate |
$8,240.90 |
| Max. Negotiated Rate |
$9,114.83 |
| Rate for Payer: BCBS Complete |
$9,114.83
|
| Rate for Payer: Mclaren Medicaid |
$8,680.79
|
| Rate for Payer: Meridian Medicaid |
$9,114.83
|
| Rate for Payer: PHP Medicaid |
$8,240.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,680.79
|
| Rate for Payer: UHC Medicaid |
$8,680.79
|
| Rate for Payer: UHCCP Medicaid |
$8,680.79
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$6,071.29
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$5,489.17 |
| Max. Negotiated Rate |
$6,071.29 |
| Rate for Payer: BCBS Complete |
$6,071.29
|
| Rate for Payer: Mclaren Medicaid |
$5,782.18
|
| Rate for Payer: Meridian Medicaid |
$6,071.29
|
| Rate for Payer: PHP Medicaid |
$5,489.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,782.18
|
| Rate for Payer: UHC Medicaid |
$5,782.18
|
| Rate for Payer: UHCCP Medicaid |
$5,782.18
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$8,775.33
|
|
|
Service Code
|
APR-DRG 0423
|
| Min. Negotiated Rate |
$7,933.95 |
| Max. Negotiated Rate |
$8,775.33 |
| Rate for Payer: BCBS Complete |
$8,775.33
|
| Rate for Payer: Mclaren Medicaid |
$8,357.46
|
| Rate for Payer: Meridian Medicaid |
$8,775.33
|
| Rate for Payer: PHP Medicaid |
$7,933.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,357.46
|
| Rate for Payer: UHC Medicaid |
$8,357.46
|
| Rate for Payer: UHCCP Medicaid |
$8,357.46
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$5,650.04
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$5,108.31 |
| Max. Negotiated Rate |
$5,650.04 |
| Rate for Payer: BCBS Complete |
$5,650.04
|
| Rate for Payer: Mclaren Medicaid |
$5,380.99
|
| Rate for Payer: Meridian Medicaid |
$5,650.04
|
| Rate for Payer: PHP Medicaid |
$5,108.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,380.99
|
| Rate for Payer: UHC Medicaid |
$5,380.99
|
| Rate for Payer: UHCCP Medicaid |
$5,380.99
|
|
