|
CLOZAPINE 100 MG TABLET
|
Facility
|
IP
|
$794.76
|
|
|
Service Code
|
NDC 00093777201
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$349.69 |
| Max. Negotiated Rate |
$715.28 |
| Rate for Payer: Aetna American Axle |
$516.59
|
| Rate for Payer: Aetna Commercial |
$675.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.59
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Cofinity Commercial |
$556.33
|
| Rate for Payer: Cofinity Commercial |
$683.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$556.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.81
|
| Rate for Payer: Healthscope Commercial |
$715.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$556.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$596.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.55
|
| Rate for Payer: PHP Commercial |
$675.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.59
|
| Rate for Payer: Priority Health SBD |
$500.70
|
| Rate for Payer: UMR Bronson Commercial |
$349.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$596.07
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 51079092201
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna American Axle |
$2.48
|
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.48
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: UMR Bronson Commercial |
$1.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
OP
|
$397.44
|
|
|
Service Code
|
NDC 00093435901
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$357.70 |
| Rate for Payer: Aetna American Axle |
$258.34
|
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare |
$198.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.34
|
| Rate for Payer: BCBS Complete |
$158.98
|
| Rate for Payer: Cash Price |
$317.95
|
| Rate for Payer: Cofinity Commercial |
$278.21
|
| Rate for Payer: Cofinity Commercial |
$341.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.95
|
| Rate for Payer: Healthscope Commercial |
$357.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.82
|
| Rate for Payer: PHP Commercial |
$337.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.34
|
| Rate for Payer: Priority Health SBD |
$250.39
|
| Rate for Payer: UMR Bronson Commercial |
$147.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.08
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
OP
|
$243.20
|
|
|
Service Code
|
NDC 00904708961
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.98 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna American Axle |
$158.08
|
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna Medicare |
$121.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.08
|
| Rate for Payer: BCBS Complete |
$97.28
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$170.24
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.24
|
| 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: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: Priority Health SBD |
$153.22
|
| Rate for Payer: UMR Bronson Commercial |
$89.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
OP
|
$298.30
|
|
|
Service Code
|
NDC 51079092120
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.37 |
| Max. Negotiated Rate |
$268.47 |
| Rate for Payer: Aetna American Axle |
$193.90
|
| Rate for Payer: Aetna Commercial |
$253.56
|
| Rate for Payer: Aetna Medicare |
$149.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.90
|
| Rate for Payer: BCBS Complete |
$119.32
|
| Rate for Payer: Cash Price |
$238.64
|
| Rate for Payer: Cofinity Commercial |
$208.81
|
| Rate for Payer: Cofinity Commercial |
$256.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.64
|
| Rate for Payer: Healthscope Commercial |
$268.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.56
|
| Rate for Payer: PHP Commercial |
$253.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.90
|
| Rate for Payer: Priority Health SBD |
$187.93
|
| Rate for Payer: UMR Bronson Commercial |
$110.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.72
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
IP
|
$397.44
|
|
|
Service Code
|
NDC 00093435901
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.87 |
| Max. Negotiated Rate |
$357.70 |
| Rate for Payer: Aetna American Axle |
$258.34
|
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.34
|
| Rate for Payer: Cash Price |
$317.95
|
| Rate for Payer: Cofinity Commercial |
$278.21
|
| Rate for Payer: Cofinity Commercial |
$341.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.95
|
| Rate for Payer: Healthscope Commercial |
$357.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.82
|
| Rate for Payer: PHP Commercial |
$337.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.34
|
| Rate for Payer: Priority Health SBD |
$250.39
|
| Rate for Payer: UMR Bronson Commercial |
$174.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.08
|
|
|
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 Commercial |
$170.24
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.24
|
| 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: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.08
|
| 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
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 51079092101
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna American Axle |
$1.94
|
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.24
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
NDC 51079092101
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna American Axle |
$1.94
|
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.24
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
IP
|
$298.30
|
|
|
Service Code
|
NDC 51079092120
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$268.47 |
| Rate for Payer: Aetna American Axle |
$193.90
|
| Rate for Payer: Aetna Commercial |
$253.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.90
|
| Rate for Payer: Cash Price |
$238.64
|
| Rate for Payer: Cofinity Commercial |
$208.81
|
| Rate for Payer: Cofinity Commercial |
$256.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.64
|
| Rate for Payer: Healthscope Commercial |
$268.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.56
|
| Rate for Payer: PHP Commercial |
$253.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.90
|
| Rate for Payer: Priority Health SBD |
$187.93
|
| Rate for Payer: UMR Bronson Commercial |
$131.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.72
|
|
|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 1,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
168017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 1,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
168017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 1,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
168017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.31
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS MAPPO |
$1.85
|
| Rate for Payer: BCN Medicare Advantage |
$1.85
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.85
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Mclaren Medicaid |
$0.99
|
| Rate for Payer: Mclaren Medicare |
$1.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.94
|
| Rate for Payer: Meridian Medicaid |
$1.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: PACE Medicare |
$1.76
|
| Rate for Payer: PACE SWMI |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: PHP Medicare Advantage |
$1.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health Medicare |
$1.85
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.85
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$1.85
|
| Rate for Payer: UHCCP Medicaid |
$0.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: VA VA |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 1,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
168017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 2,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
168018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 2,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
168018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.31
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS MAPPO |
$1.85
|
| Rate for Payer: BCN Medicare Advantage |
$1.85
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.85
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Mclaren Medicaid |
$0.99
|
| Rate for Payer: Mclaren Medicare |
$1.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.94
|
| Rate for Payer: Meridian Medicaid |
$1.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: PACE Medicare |
$1.76
|
| Rate for Payer: PACE SWMI |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: PHP Medicare Advantage |
$1.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health Medicare |
$1.85
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.85
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$1.85
|
| Rate for Payer: UHCCP Medicaid |
$0.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: VA VA |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 3,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
168019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.31
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS MAPPO |
$1.85
|
| Rate for Payer: BCN Medicare Advantage |
$1.85
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.85
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Mclaren Medicaid |
$0.99
|
| Rate for Payer: Mclaren Medicare |
$1.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.94
|
| Rate for Payer: Meridian Medicaid |
$1.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: PACE Medicare |
$1.76
|
| Rate for Payer: PACE SWMI |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: PHP Medicare Advantage |
$1.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health Medicare |
$1.85
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.85
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$1.85
|
| Rate for Payer: UHCCP Medicaid |
$0.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: VA VA |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 3,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
168019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
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 Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| 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: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| 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) 1000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| 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: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| 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 Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| 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: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| 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 |
$1.27 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| 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: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| 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 |
$1.27 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| 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: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| 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 Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| 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: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| 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) 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 Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| 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: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| 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
|
|
