|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 4,000 (+/-) UNIT IV SOLUTION
|
Facility
OP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
161770
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.89
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$4.88
|
| Rate for Payer: BCN Medicare Advantage |
$1.51
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.51
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Mclaren Medicare |
$1.51
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.94
|
| Rate for Payer: PACE Medicare |
$1.44
|
| Rate for Payer: PACE SWMI |
$1.51
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.41
|
| Rate for Payer: Priority Health Medicare |
$1.51
|
| Rate for Payer: Priority Health Narrow Network |
$3.53
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.51
|
| Rate for Payer: UHC Medicare Advantage |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 4,000 (+/-) UNIT IV SOLUTION
|
Facility
IP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
161770
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,200 UNIT INTRAVENOUS SOLUTION
|
Facility
OP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.68
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$1.35
|
| Rate for Payer: BCBS Trust/PPO |
$4.35
|
| Rate for Payer: BCN Medicare Advantage |
$1.35
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.35
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Mclaren Medicaid |
$0.74
|
| Rate for Payer: Mclaren Medicare |
$1.35
|
| Rate for Payer: Meridian Medicaid |
$0.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.31
|
| Rate for Payer: PACE Medicare |
$1.28
|
| Rate for Payer: PACE SWMI |
$1.35
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$1.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.95
|
| Rate for Payer: Priority Health Medicare |
$1.35
|
| Rate for Payer: Priority Health Narrow Network |
$3.16
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.35
|
| Rate for Payer: UHC Medicare Advantage |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: VA VA |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,200 UNIT INTRAVENOUS SOLUTION
|
Facility
IP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 2,400 UNIT INTRAVENOUS SOLUTION
|
Facility
IP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 2,400 UNIT INTRAVENOUS SOLUTION
|
Facility
OP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.68
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$1.35
|
| Rate for Payer: BCBS Trust/PPO |
$4.35
|
| Rate for Payer: BCN Medicare Advantage |
$1.35
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.35
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Mclaren Medicaid |
$0.74
|
| Rate for Payer: Mclaren Medicare |
$1.35
|
| Rate for Payer: Meridian Medicaid |
$0.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.31
|
| Rate for Payer: PACE Medicare |
$1.28
|
| Rate for Payer: PACE SWMI |
$1.35
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$1.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.95
|
| Rate for Payer: Priority Health Medicare |
$1.35
|
| Rate for Payer: Priority Health Narrow Network |
$3.16
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.35
|
| Rate for Payer: UHC Medicare Advantage |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: VA VA |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 600 UNIT INTRAVENOUS SOLUTION
|
Facility
OP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.68
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$1.35
|
| Rate for Payer: BCBS Trust/PPO |
$4.35
|
| Rate for Payer: BCN Medicare Advantage |
$1.35
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.35
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Mclaren Medicaid |
$0.74
|
| Rate for Payer: Mclaren Medicare |
$1.35
|
| Rate for Payer: Meridian Medicaid |
$0.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.31
|
| Rate for Payer: PACE Medicare |
$1.28
|
| Rate for Payer: PACE SWMI |
$1.35
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$1.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.95
|
| Rate for Payer: Priority Health Medicare |
$1.35
|
| Rate for Payer: Priority Health Narrow Network |
$3.16
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.35
|
| Rate for Payer: UHC Medicare Advantage |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: VA VA |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 600 UNIT INTRAVENOUS SOLUTION
|
Facility
IP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 1,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna American Axle |
$1.81
|
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.23
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.37
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health SBD |
$1.76
|
| Rate for Payer: UMR Bronson Commercial |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.09
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 2,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna American Axle |
$1.81
|
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.23
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.37
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health SBD |
$1.76
|
| Rate for Payer: UMR Bronson Commercial |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.09
|
|
|
ANTIHEMOPHILIC FVIII, B-DOM TRUNCATED 250 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna American Axle |
$1.81
|
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.23
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.37
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health SBD |
$1.76
|
| Rate for Payer: UMR Bronson Commercial |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.09
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 3,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna American Axle |
$1.81
|
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.23
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.37
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health SBD |
$1.76
|
| Rate for Payer: UMR Bronson Commercial |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.09
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 500 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna American Axle |
$1.81
|
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.23
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.37
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health SBD |
$1.76
|
| Rate for Payer: UMR Bronson Commercial |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.09
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH,PEGYLATED 1,000(+/-) UNIT IV SOLUTION
|
Facility
OP
|
$5.38
|
|
|
Service Code
|
HCPCS J7207
|
| Hospital Charge Code |
176592
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$2.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS MAPPO |
$1.98
|
| Rate for Payer: BCBS Trust/PPO |
$6.38
|
| Rate for Payer: BCN Medicare Advantage |
$1.98
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$4.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$1.08
|
| Rate for Payer: Mclaren Medicare |
$1.98
|
| Rate for Payer: Meridian Medicaid |
$1.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.57
|
| Rate for Payer: PACE Medicare |
$1.88
|
| Rate for Payer: PACE SWMI |
$1.98
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$1.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.95
|
| Rate for Payer: Priority Health Medicare |
$1.98
|
| Rate for Payer: Priority Health Narrow Network |
$4.76
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.98
|
| Rate for Payer: UHC Medicare Advantage |
$2.04
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: VA VA |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH,PEGYLATED 1,500(+/-) UNIT IV SOLUTION
|
Facility
OP
|
$5.38
|
|
|
Service Code
|
HCPCS J7207
|
| Hospital Charge Code |
182080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$2.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS MAPPO |
$1.98
|
| Rate for Payer: BCBS Trust/PPO |
$6.38
|
| Rate for Payer: BCN Medicare Advantage |
$1.98
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$4.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$1.08
|
| Rate for Payer: Mclaren Medicare |
$1.98
|
| Rate for Payer: Meridian Medicaid |
$1.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.57
|
| Rate for Payer: PACE Medicare |
$1.88
|
| Rate for Payer: PACE SWMI |
$1.98
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$1.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.95
|
| Rate for Payer: Priority Health Medicare |
$1.98
|
| Rate for Payer: Priority Health Narrow Network |
$4.76
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.98
|
| Rate for Payer: UHC Medicare Advantage |
$2.04
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: VA VA |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH,PEGYLATED 2,000(+/-) UNIT IV SOLUTION
|
Facility
OP
|
$5.38
|
|
|
Service Code
|
HCPCS J7207
|
| Hospital Charge Code |
176593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$2.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS MAPPO |
$1.98
|
| Rate for Payer: BCBS Trust/PPO |
$6.38
|
| Rate for Payer: BCN Medicare Advantage |
$1.98
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$4.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$1.08
|
| Rate for Payer: Mclaren Medicare |
$1.98
|
| Rate for Payer: Meridian Medicaid |
$1.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.57
|
| Rate for Payer: PACE Medicare |
$1.88
|
| Rate for Payer: PACE SWMI |
$1.98
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$1.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.95
|
| Rate for Payer: Priority Health Medicare |
$1.98
|
| Rate for Payer: Priority Health Narrow Network |
$4.76
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.98
|
| Rate for Payer: UHC Medicare Advantage |
$2.04
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: VA VA |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH,PEGYLATED 2,000(+/-) UNIT IV SOLUTION
|
Facility
IP
|
$5.38
|
|
|
Service Code
|
HCPCS J7207
|
| Hospital Charge Code |
176593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Healthscope Commercial |
$4.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.57
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: UMR Bronson Commercial |
$2.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH,PEGYLATED 500 (+/-) UNIT IV SOLUTION
|
Facility
OP
|
$5.38
|
|
|
Service Code
|
HCPCS J7207
|
| Hospital Charge Code |
176591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$2.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS MAPPO |
$1.98
|
| Rate for Payer: BCBS Trust/PPO |
$6.38
|
| Rate for Payer: BCN Medicare Advantage |
$1.98
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$4.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$1.08
|
| Rate for Payer: Mclaren Medicare |
$1.98
|
| Rate for Payer: Meridian Medicaid |
$1.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.57
|
| Rate for Payer: PACE Medicare |
$1.88
|
| Rate for Payer: PACE SWMI |
$1.98
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$1.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.95
|
| Rate for Payer: Priority Health Medicare |
$1.98
|
| Rate for Payer: Priority Health Narrow Network |
$4.76
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.98
|
| Rate for Payer: UHC Medicare Advantage |
$2.04
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: VA VA |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 350 UNIT-650 UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
191212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.71
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.88
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
191213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.71
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.88
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
116307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.71
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.88
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
IP
|
$10.72
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
9116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna American Axle |
$6.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.97
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cofinity Commercial |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.58
|
| Rate for Payer: Healthscope Commercial |
$9.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.11
|
| Rate for Payer: PHP Commercial |
$9.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.50
|
| Rate for Payer: Priority Health SBD |
$6.75
|
| Rate for Payer: UMR Bronson Commercial |
$4.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.04
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$3,944.80
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
24585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,735.71 |
| Max. Negotiated Rate |
$3,550.32 |
| Rate for Payer: Aetna American Axle |
$2,564.12
|
| Rate for Payer: Aetna Commercial |
$3,353.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,564.12
|
| Rate for Payer: Cash Price |
$3,155.84
|
| Rate for Payer: Cofinity Commercial |
$2,761.36
|
| Rate for Payer: Cofinity Commercial |
$3,392.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,155.84
|
| Rate for Payer: Healthscope Commercial |
$3,550.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,761.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,958.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,353.08
|
| Rate for Payer: PHP Commercial |
$3,353.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,761.36
|
| Rate for Payer: Priority Health SBD |
$2,485.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,735.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,958.60
|
|
|
ANTI-THYMO IMMUNE GLOBULIN (ATGAM) 5 MCG/0.1 ML TEST DOSE
|
Facility
IP
|
$22.54
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
169802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$20.29 |
| Rate for Payer: Aetna American Axle |
$14.65
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cofinity Commercial |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.16
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.78
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: UMR Bronson Commercial |
$9.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.90
|
|
|
ANTIVENIN CROTALIDAE (EQUINE) SOLUTION FOR INJECTION
|
Facility
IP
|
$3,775.65
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
188592
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,661.29 |
| Max. Negotiated Rate |
$3,398.08 |
| Rate for Payer: Aetna American Axle |
$2,454.17
|
| Rate for Payer: Aetna Commercial |
$3,209.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,454.17
|
| Rate for Payer: Cash Price |
$3,020.52
|
| Rate for Payer: Cofinity Commercial |
$2,642.96
|
| Rate for Payer: Cofinity Commercial |
$3,247.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,020.52
|
| Rate for Payer: Healthscope Commercial |
$3,398.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,642.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,831.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,209.30
|
| Rate for Payer: PHP Commercial |
$3,209.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,642.96
|
| Rate for Payer: Priority Health SBD |
$2,378.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,661.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,831.74
|
|
