|
CLOZAPINE 25 MG TABLET
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
NDC 51079092120
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna American Axle |
$176.60
|
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Advantage |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.78
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UMR Bronson Commercial |
$119.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
IP
|
$243.20
|
|
|
Service Code
|
NDC 00904708961
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.01 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna American Axle |
$158.08
|
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.08
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Advantage |
$170.24
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.40
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health SBD |
$153.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$4,683.40
|
|
|
Service Code
|
APR-DRG 6611
|
| Min. Negotiated Rate |
$4,460.38 |
| Max. Negotiated Rate |
$4,683.40 |
| Rate for Payer: BCBS Complete |
$4,683.40
|
| Rate for Payer: Mclaren Medicaid |
$4,460.38
|
| Rate for Payer: Meridian Medicaid |
$4,683.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,460.38
|
| Rate for Payer: UHC Medicaid |
$4,460.38
|
| Rate for Payer: UHCCP Medicaid |
$4,460.38
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$27,994.47
|
|
|
Service Code
|
APR-DRG 6614
|
| Min. Negotiated Rate |
$26,661.40 |
| Max. Negotiated Rate |
$27,994.47 |
| Rate for Payer: BCBS Complete |
$27,994.47
|
| Rate for Payer: Mclaren Medicaid |
$26,661.40
|
| Rate for Payer: Meridian Medicaid |
$27,994.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,661.40
|
| Rate for Payer: UHC Medicaid |
$26,661.40
|
| Rate for Payer: UHCCP Medicaid |
$26,661.40
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$7,789.32
|
|
|
Service Code
|
APR-DRG 6612
|
| Min. Negotiated Rate |
$7,418.40 |
| Max. Negotiated Rate |
$7,789.32 |
| Rate for Payer: BCBS Complete |
$7,789.32
|
| Rate for Payer: Mclaren Medicaid |
$7,418.40
|
| Rate for Payer: Meridian Medicaid |
$7,789.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,418.40
|
| Rate for Payer: UHC Medicaid |
$7,418.40
|
| Rate for Payer: UHCCP Medicaid |
$7,418.40
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$17,102.85
|
|
|
Service Code
|
APR-DRG 6613
|
| Min. Negotiated Rate |
$16,288.43 |
| Max. Negotiated Rate |
$17,102.85 |
| Rate for Payer: BCBS Complete |
$17,102.85
|
| Rate for Payer: Mclaren Medicaid |
$16,288.43
|
| Rate for Payer: Meridian Medicaid |
$17,102.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,288.43
|
| Rate for Payer: UHC Medicaid |
$16,288.43
|
| Rate for Payer: UHCCP Medicaid |
$16,288.43
|
|
|
COAGULATION DISORDERS
|
Facility
|
IP
|
$35,046.69
|
|
|
Service Code
|
MSDRG 813
|
| Min. Negotiated Rate |
$12,681.16 |
| Max. Negotiated Rate |
$35,046.69 |
| Rate for Payer: Aetna Medicare |
$13,882.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,685.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,685.74
|
| Rate for Payer: BCBS MAPPO |
$13,348.59
|
| Rate for Payer: BCBS Trust/PPO |
$35,046.69
|
| Rate for Payer: BCN Commercial |
$35,046.69
|
| Rate for Payer: BCN Medicare Advantage |
$13,348.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,348.59
|
| Rate for Payer: Mclaren Medicare |
$13,348.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,016.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,350.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,683.45
|
| Rate for Payer: Nomi Health Commercial |
$19,676.37
|
| Rate for Payer: PACE Medicare |
$12,681.16
|
| Rate for Payer: PACE SWMI |
$13,348.59
|
| Rate for Payer: PHP Medicare Advantage |
$13,348.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,591.10
|
| Rate for Payer: Priority Health Medicare |
$13,348.59
|
| Rate for Payer: Priority Health Tiered Network |
$19,672.88
|
| Rate for Payer: Railroad Medicare Medicare |
$13,348.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,862.39
|
| Rate for Payer: UHC Core |
$20,800.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,348.59
|
| Rate for Payer: UHC Exchange |
$16,987.27
|
| Rate for Payer: VA VA |
$13,348.59
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 1000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.17
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: BCBS MAPPO |
$1.74
|
| Rate for Payer: BCBS Trust/PPO |
$5.60
|
| Rate for Payer: BCN Commercial |
$5.60
|
| Rate for Payer: BCN Medicare Advantage |
$1.74
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Advantage |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Mclaren Medicaid |
$1.74
|
| Rate for Payer: Mclaren Medicare |
$1.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.83
|
| Rate for Payer: Meridian Medicaid |
$1.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.57
|
| Rate for Payer: PACE Medicare |
$1.65
|
| Rate for Payer: PACE SWMI |
$1.74
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: PHP Medicare Advantage |
$1.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.33
|
| Rate for Payer: Priority Health Medicare |
$1.74
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: Priority Health Tiered Network |
$4.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.87
|
| Rate for Payer: UHC Core |
$2.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.74
|
| Rate for Payer: UHC Exchange |
$2.87
|
| Rate for Payer: UHC Medicaid |
$0.91
|
| Rate for Payer: UHCCP Medicaid |
$0.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: VA VA |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 1000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Advantage |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.57
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 2,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Advantage |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.57
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 2,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.17
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: BCBS MAPPO |
$1.74
|
| Rate for Payer: BCBS Trust/PPO |
$5.60
|
| Rate for Payer: BCN Commercial |
$5.60
|
| Rate for Payer: BCN Medicare Advantage |
$1.74
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Advantage |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Mclaren Medicaid |
$1.74
|
| Rate for Payer: Mclaren Medicare |
$1.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.83
|
| Rate for Payer: Meridian Medicaid |
$1.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.57
|
| Rate for Payer: PACE Medicare |
$1.65
|
| Rate for Payer: PACE SWMI |
$1.74
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: PHP Medicare Advantage |
$1.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.33
|
| Rate for Payer: Priority Health Medicare |
$1.74
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: Priority Health Tiered Network |
$4.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.87
|
| Rate for Payer: UHC Core |
$2.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.74
|
| Rate for Payer: UHC Exchange |
$2.87
|
| Rate for Payer: UHC Medicaid |
$0.91
|
| Rate for Payer: UHCCP Medicaid |
$0.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: VA VA |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 250 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Advantage |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.57
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 250 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.17
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: BCBS MAPPO |
$1.74
|
| Rate for Payer: BCBS Trust/PPO |
$5.60
|
| Rate for Payer: BCN Commercial |
$5.60
|
| Rate for Payer: BCN Medicare Advantage |
$1.74
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Advantage |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Mclaren Medicaid |
$1.74
|
| Rate for Payer: Mclaren Medicare |
$1.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.83
|
| Rate for Payer: Meridian Medicaid |
$1.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.57
|
| Rate for Payer: PACE Medicare |
$1.65
|
| Rate for Payer: PACE SWMI |
$1.74
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: PHP Medicare Advantage |
$1.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.33
|
| Rate for Payer: Priority Health Medicare |
$1.74
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: Priority Health Tiered Network |
$4.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.87
|
| Rate for Payer: UHC Core |
$2.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.74
|
| Rate for Payer: UHC Exchange |
$2.87
|
| Rate for Payer: UHC Medicaid |
$0.91
|
| Rate for Payer: UHCCP Medicaid |
$0.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: VA VA |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 3,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.17
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: BCBS MAPPO |
$1.74
|
| Rate for Payer: BCBS Trust/PPO |
$5.60
|
| Rate for Payer: BCN Commercial |
$5.60
|
| Rate for Payer: BCN Medicare Advantage |
$1.74
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Advantage |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Mclaren Medicaid |
$1.74
|
| Rate for Payer: Mclaren Medicare |
$1.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.83
|
| Rate for Payer: Meridian Medicaid |
$1.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.57
|
| Rate for Payer: PACE Medicare |
$1.65
|
| Rate for Payer: PACE SWMI |
$1.74
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: PHP Medicare Advantage |
$1.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.33
|
| Rate for Payer: Priority Health Medicare |
$1.74
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: Priority Health Tiered Network |
$4.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.87
|
| Rate for Payer: UHC Core |
$2.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.74
|
| Rate for Payer: UHC Exchange |
$2.87
|
| Rate for Payer: UHC Medicaid |
$0.91
|
| Rate for Payer: UHCCP Medicaid |
$0.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: VA VA |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 3,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Advantage |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.57
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 500 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Advantage |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.57
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 500 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.17
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: BCBS MAPPO |
$1.74
|
| Rate for Payer: BCBS Trust/PPO |
$5.60
|
| Rate for Payer: BCN Commercial |
$5.60
|
| Rate for Payer: BCN Medicare Advantage |
$1.74
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Advantage |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Mclaren Medicaid |
$1.74
|
| Rate for Payer: Mclaren Medicare |
$1.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.83
|
| Rate for Payer: Meridian Medicaid |
$1.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.57
|
| Rate for Payer: PACE Medicare |
$1.65
|
| Rate for Payer: PACE SWMI |
$1.74
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: PHP Medicare Advantage |
$1.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.33
|
| Rate for Payer: Priority Health Medicare |
$1.74
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: Priority Health Tiered Network |
$4.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.87
|
| Rate for Payer: UHC Core |
$2.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.74
|
| Rate for Payer: UHC Exchange |
$2.87
|
| Rate for Payer: UHC Medicaid |
$0.91
|
| Rate for Payer: UHCCP Medicaid |
$0.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: VA VA |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,972.03
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$6,274.83 |
| Rate for Payer: Aetna American Axle |
$4,531.82
|
| Rate for Payer: Aetna Commercial |
$5,926.23
|
| Rate for Payer: Aetna Medicare |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,531.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.30
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: BCBS MAPPO |
$2.64
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: BCN Medicare Advantage |
$2.64
|
| Rate for Payer: Cash Price |
$5,577.62
|
| Rate for Payer: Cash Price |
$5,577.62
|
| Rate for Payer: Cofinity Advantage |
$4,880.42
|
| Rate for Payer: Cofinity Commercial |
$5,995.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,577.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$6,274.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,880.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,229.02
|
| Rate for Payer: Mclaren Medicaid |
$2.64
|
| Rate for Payer: Mclaren Medicare |
$2.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.77
|
| Rate for Payer: Meridian Medicaid |
$2.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,926.23
|
| Rate for Payer: Nomi Health Commercial |
$7.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,229.02
|
| Rate for Payer: PACE Medicare |
$2.51
|
| Rate for Payer: PACE SWMI |
$2.64
|
| Rate for Payer: PHP Commercial |
$5,926.23
|
| Rate for Payer: PHP Medicare Advantage |
$2.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.36
|
| Rate for Payer: Priority Health Medicare |
$2.64
|
| Rate for Payer: Priority Health SBD |
$4,392.38
|
| Rate for Payer: Priority Health Tiered Network |
$6.69
|
| Rate for Payer: Railroad Medicare Medicare |
$2.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.32
|
| Rate for Payer: UHC Core |
$4.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.64
|
| Rate for Payer: UHC Exchange |
$4.32
|
| Rate for Payer: UHC Medicaid |
$1.38
|
| Rate for Payer: UHCCP Medicaid |
$1.38
|
| Rate for Payer: UMR Bronson Commercial |
$2,579.65
|
| Rate for Payer: VA VA |
$2.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,229.02
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,972.03
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,067.69 |
| Max. Negotiated Rate |
$6,274.83 |
| Rate for Payer: Aetna American Axle |
$4,531.82
|
| Rate for Payer: Aetna Commercial |
$5,926.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,531.82
|
| Rate for Payer: Cash Price |
$5,577.62
|
| Rate for Payer: Cofinity Advantage |
$4,880.42
|
| Rate for Payer: Cofinity Commercial |
$5,995.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,577.62
|
| Rate for Payer: Healthscope Commercial |
$6,274.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,880.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,229.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,926.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,229.02
|
| Rate for Payer: PHP Commercial |
$5,926.23
|
| Rate for Payer: Priority Health SBD |
$4,392.38
|
| Rate for Payer: UMR Bronson Commercial |
$3,067.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,229.02
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$13,944.06
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$12,549.65 |
| Rate for Payer: Aetna American Axle |
$9,063.64
|
| Rate for Payer: Aetna Commercial |
$11,852.45
|
| Rate for Payer: Aetna Medicare |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,063.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.30
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: BCBS MAPPO |
$2.64
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: BCN Medicare Advantage |
$2.64
|
| Rate for Payer: Cash Price |
$11,155.25
|
| Rate for Payer: Cash Price |
$11,155.25
|
| Rate for Payer: Cofinity Advantage |
$9,760.84
|
| Rate for Payer: Cofinity Commercial |
$11,991.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,155.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$12,549.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,760.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,458.05
|
| Rate for Payer: Mclaren Medicaid |
$2.64
|
| Rate for Payer: Mclaren Medicare |
$2.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.77
|
| Rate for Payer: Meridian Medicaid |
$2.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,852.45
|
| Rate for Payer: Nomi Health Commercial |
$7.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,458.05
|
| Rate for Payer: PACE Medicare |
$2.51
|
| Rate for Payer: PACE SWMI |
$2.64
|
| Rate for Payer: PHP Commercial |
$11,852.45
|
| Rate for Payer: PHP Medicare Advantage |
$2.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.36
|
| Rate for Payer: Priority Health Medicare |
$2.64
|
| Rate for Payer: Priority Health SBD |
$8,784.76
|
| Rate for Payer: Priority Health Tiered Network |
$6.69
|
| Rate for Payer: Railroad Medicare Medicare |
$2.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.32
|
| Rate for Payer: UHC Core |
$4.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.64
|
| Rate for Payer: UHC Exchange |
$4.32
|
| Rate for Payer: UHC Medicaid |
$1.38
|
| Rate for Payer: UHCCP Medicaid |
$1.38
|
| Rate for Payer: UMR Bronson Commercial |
$5,159.30
|
| Rate for Payer: VA VA |
$2.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,458.05
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13,944.06
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,135.39 |
| Max. Negotiated Rate |
$12,549.65 |
| Rate for Payer: Aetna American Axle |
$9,063.64
|
| Rate for Payer: Aetna Commercial |
$11,852.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,063.64
|
| Rate for Payer: Cash Price |
$11,155.25
|
| Rate for Payer: Cofinity Advantage |
$9,760.84
|
| Rate for Payer: Cofinity Commercial |
$11,991.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,155.25
|
| Rate for Payer: Healthscope Commercial |
$12,549.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,760.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,458.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,852.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,458.05
|
| Rate for Payer: PHP Commercial |
$11,852.45
|
| Rate for Payer: Priority Health SBD |
$8,784.76
|
| Rate for Payer: UMR Bronson Commercial |
$6,135.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,458.05
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$34,860.15
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$31,374.13 |
| Rate for Payer: Aetna American Axle |
$22,659.10
|
| Rate for Payer: Aetna Commercial |
$29,631.13
|
| Rate for Payer: Aetna Medicare |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,659.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.30
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: BCBS MAPPO |
$2.64
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: BCN Medicare Advantage |
$2.64
|
| Rate for Payer: Cash Price |
$27,888.12
|
| Rate for Payer: Cash Price |
$27,888.12
|
| Rate for Payer: Cofinity Advantage |
$24,402.10
|
| Rate for Payer: Cofinity Commercial |
$29,979.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27,888.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$31,374.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24,402.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26,145.11
|
| Rate for Payer: Mclaren Medicaid |
$2.64
|
| Rate for Payer: Mclaren Medicare |
$2.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.77
|
| Rate for Payer: Meridian Medicaid |
$2.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,631.13
|
| Rate for Payer: Nomi Health Commercial |
$7.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26,145.11
|
| Rate for Payer: PACE Medicare |
$2.51
|
| Rate for Payer: PACE SWMI |
$2.64
|
| Rate for Payer: PHP Commercial |
$29,631.13
|
| Rate for Payer: PHP Medicare Advantage |
$2.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.36
|
| Rate for Payer: Priority Health Medicare |
$2.64
|
| Rate for Payer: Priority Health SBD |
$21,961.89
|
| Rate for Payer: Priority Health Tiered Network |
$6.69
|
| Rate for Payer: Railroad Medicare Medicare |
$2.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.32
|
| Rate for Payer: UHC Core |
$4.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.64
|
| Rate for Payer: UHC Exchange |
$4.32
|
| Rate for Payer: UHC Medicaid |
$1.38
|
| Rate for Payer: UHCCP Medicaid |
$1.38
|
| Rate for Payer: UMR Bronson Commercial |
$12,898.26
|
| Rate for Payer: VA VA |
$2.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26,145.11
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$34,860.15
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15,338.47 |
| Max. Negotiated Rate |
$31,374.13 |
| Rate for Payer: Aetna American Axle |
$22,659.10
|
| Rate for Payer: Aetna Commercial |
$29,631.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,659.10
|
| Rate for Payer: Cash Price |
$27,888.12
|
| Rate for Payer: Cofinity Advantage |
$24,402.10
|
| Rate for Payer: Cofinity Commercial |
$29,979.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27,888.12
|
| Rate for Payer: Healthscope Commercial |
$31,374.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24,402.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26,145.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,631.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26,145.11
|
| Rate for Payer: PHP Commercial |
$29,631.13
|
| Rate for Payer: Priority Health SBD |
$21,961.89
|
| Rate for Payer: UMR Bronson Commercial |
$15,338.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26,145.11
|
|
|
COAGULATION FACTOR X 250 (+/-) UNIT RANGE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.01
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
176429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$32.14 |
| Rate for Payer: Aetna American Axle |
$12.36
|
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.44
|
| Rate for Payer: BCBS Complete |
$5.46
|
| Rate for Payer: BCBS MAPPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$32.14
|
| Rate for Payer: BCN Commercial |
$32.14
|
| Rate for Payer: BCN Medicare Advantage |
$9.95
|
| Rate for Payer: Cash Price |
$15.21
|
| Rate for Payer: Cash Price |
$15.21
|
| Rate for Payer: Cofinity Advantage |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$16.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.95
|
| Rate for Payer: Healthscope Commercial |
$17.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.26
|
| Rate for Payer: Mclaren Medicaid |
$9.95
|
| Rate for Payer: Mclaren Medicare |
$9.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.45
|
| Rate for Payer: Meridian Medicaid |
$10.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.16
|
| Rate for Payer: Nomi Health Commercial |
$29.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.26
|
| Rate for Payer: PACE Medicare |
$9.45
|
| Rate for Payer: PACE SWMI |
$9.95
|
| Rate for Payer: PHP Commercial |
$16.16
|
| Rate for Payer: PHP Medicare Advantage |
$9.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30.82
|
| Rate for Payer: Priority Health Medicare |
$9.95
|
| Rate for Payer: Priority Health SBD |
$11.98
|
| Rate for Payer: Priority Health Tiered Network |
$24.66
|
| Rate for Payer: Railroad Medicare Medicare |
$9.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.37
|
| Rate for Payer: UHC Core |
$16.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.95
|
| Rate for Payer: UHC Exchange |
$16.37
|
| Rate for Payer: UHC Medicaid |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$5.20
|
| Rate for Payer: UMR Bronson Commercial |
$7.03
|
| Rate for Payer: VA VA |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.26
|
|
|
COAGULATION FACTOR X 250 (+/-) UNIT RANGE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.01
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
176429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$17.11 |
| Rate for Payer: Aetna American Axle |
$12.36
|
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.36
|
| Rate for Payer: Cash Price |
$15.21
|
| Rate for Payer: Cofinity Advantage |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$16.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.21
|
| Rate for Payer: Healthscope Commercial |
$17.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.26
|
| Rate for Payer: PHP Commercial |
$16.16
|
| Rate for Payer: Priority Health SBD |
$11.98
|
| Rate for Payer: UMR Bronson Commercial |
$8.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.26
|
|
