|
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
|
|
|
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
|
|
|
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 |
$5.52 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.30
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS MAPPO |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$4.98
|
| Rate for Payer: BCN Commercial |
$4.98
|
| Rate for Payer: BCN Medicare Advantage |
$1.84
|
| 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 |
$1.84
|
| 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 |
$1.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.93
|
| Rate for Payer: Meridian Medicaid |
$1.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$5.52
|
| Rate for Payer: PACE Medicare |
$1.75
|
| Rate for Payer: PACE SWMI |
$1.84
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: PHP Medicare Advantage |
$1.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.34
|
| Rate for Payer: Priority Health Medicare |
$1.84
|
| Rate for Payer: Priority Health Narrow Network |
$4.27
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.84
|
| Rate for Payer: UHC Exchange |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$1.84
|
| Rate for Payer: UHCCP Medicaid |
$0.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: VA VA |
$1.84
|
| 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 J7200
|
| Hospital Charge Code |
168017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.50 |
| 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: BCBS Trust/PPO |
$4.50
|
| Rate for Payer: BCN Commercial |
$4.50
|
| 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: 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 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 |
$5.52 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.30
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS MAPPO |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$4.98
|
| Rate for Payer: BCN Commercial |
$4.98
|
| Rate for Payer: BCN Medicare Advantage |
$1.84
|
| 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 |
$1.84
|
| 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 |
$1.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.93
|
| Rate for Payer: Meridian Medicaid |
$1.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$5.52
|
| Rate for Payer: PACE Medicare |
$1.75
|
| Rate for Payer: PACE SWMI |
$1.84
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: PHP Medicare Advantage |
$1.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.34
|
| Rate for Payer: Priority Health Medicare |
$1.84
|
| Rate for Payer: Priority Health Narrow Network |
$4.27
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.84
|
| Rate for Payer: UHC Exchange |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$1.84
|
| Rate for Payer: UHCCP Medicaid |
$0.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: VA VA |
$1.84
|
| 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 |
$5.52 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.30
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS MAPPO |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$4.98
|
| Rate for Payer: BCN Commercial |
$4.98
|
| Rate for Payer: BCN Medicare Advantage |
$1.84
|
| 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 |
$1.84
|
| 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 |
$1.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.93
|
| Rate for Payer: Meridian Medicaid |
$1.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$5.52
|
| Rate for Payer: PACE Medicare |
$1.75
|
| Rate for Payer: PACE SWMI |
$1.84
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: PHP Medicare Advantage |
$1.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.34
|
| Rate for Payer: Priority Health Medicare |
$1.84
|
| Rate for Payer: Priority Health Narrow Network |
$4.27
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.84
|
| Rate for Payer: UHC Exchange |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$1.84
|
| Rate for Payer: UHCCP Medicaid |
$0.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: VA VA |
$1.84
|
| 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 |
$4.50 |
| 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: BCBS Trust/PPO |
$4.50
|
| Rate for Payer: BCN Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$2.74
|
| 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 |
$4.50 |
| 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: BCBS Trust/PPO |
$4.50
|
| Rate for Payer: BCN Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$2.74
|
| 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) 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 |
$4.50 |
| 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: BCBS Trust/PPO |
$4.50
|
| Rate for Payer: BCN Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$2.74
|
| 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) 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 Commercial |
$2.92
|
| Rate for Payer: Aetna American Axle |
$2.23
|
| 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
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.50 |
| 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: BCBS Trust/PPO |
$4.50
|
| Rate for Payer: BCN Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$2.74
|
| 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) 500 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: PHP Commercial |
$2.92
|
| 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: BCBS Trust/PPO |
$4.50
|
| Rate for Payer: BCN Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$2.74
|
| 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: 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) 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 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 VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,327.57
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,784.13 |
| Max. Negotiated Rate |
$5,694.81 |
| Rate for Payer: Aetna American Axle |
$4,112.92
|
| Rate for Payer: Aetna Commercial |
$5,378.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,112.92
|
| Rate for Payer: Cash Price |
$5,062.06
|
| Rate for Payer: Cofinity Commercial |
$4,429.30
|
| Rate for Payer: Cofinity Commercial |
$5,441.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,429.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,062.06
|
| Rate for Payer: Healthscope Commercial |
$5,694.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,429.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,745.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,378.43
|
| Rate for Payer: PHP Commercial |
$5,378.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,112.92
|
| Rate for Payer: Priority Health SBD |
$3,986.37
|
| Rate for Payer: UMR Bronson Commercial |
$2,784.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,745.68
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,327.57
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$5,694.81 |
| Rate for Payer: Aetna American Axle |
$4,112.92
|
| Rate for Payer: Aetna Commercial |
$5,378.43
|
| Rate for Payer: Aetna Medicare |
$2.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,112.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.19
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: BCBS MAPPO |
$2.55
|
| Rate for Payer: BCBS Trust/PPO |
$6.85
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: BCN Medicare Advantage |
$2.55
|
| Rate for Payer: Cash Price |
$5,062.06
|
| Rate for Payer: Cash Price |
$5,062.06
|
| Rate for Payer: Cofinity Commercial |
$5,441.71
|
| Rate for Payer: Cofinity Commercial |
$4,429.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,429.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,062.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$5,694.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,429.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,745.68
|
| Rate for Payer: Mclaren Medicaid |
$1.37
|
| Rate for Payer: Mclaren Medicare |
$2.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.68
|
| Rate for Payer: Meridian Medicaid |
$1.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,378.43
|
| Rate for Payer: Nomi Health Commercial |
$7.65
|
| Rate for Payer: PACE Medicare |
$2.42
|
| Rate for Payer: PACE SWMI |
$2.55
|
| Rate for Payer: PHP Commercial |
$5,378.43
|
| Rate for Payer: PHP Medicare Advantage |
$2.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,112.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.24
|
| Rate for Payer: Priority Health Medicare |
$2.55
|
| Rate for Payer: Priority Health Narrow Network |
$5.79
|
| Rate for Payer: Priority Health SBD |
$3,986.37
|
| Rate for Payer: Railroad Medicare Medicare |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.55
|
| Rate for Payer: UHC Exchange |
$4.87
|
| Rate for Payer: UHC Medicare Advantage |
$2.55
|
| Rate for Payer: UHCCP Medicaid |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$2,341.20
|
| Rate for Payer: VA VA |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,745.68
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,655.09
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$11,389.58 |
| Rate for Payer: Aetna American Axle |
$8,225.81
|
| Rate for Payer: Aetna Commercial |
$10,756.83
|
| Rate for Payer: Aetna Medicare |
$2.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,225.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.19
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: BCBS MAPPO |
$2.55
|
| Rate for Payer: BCBS Trust/PPO |
$6.85
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: BCN Medicare Advantage |
$2.55
|
| Rate for Payer: Cash Price |
$10,124.07
|
| Rate for Payer: Cash Price |
$10,124.07
|
| Rate for Payer: Cofinity Commercial |
$8,858.56
|
| Rate for Payer: Cofinity Commercial |
$10,883.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,858.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,124.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$11,389.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,858.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,491.32
|
| Rate for Payer: Mclaren Medicaid |
$1.37
|
| Rate for Payer: Mclaren Medicare |
$2.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.68
|
| Rate for Payer: Meridian Medicaid |
$1.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,756.83
|
| Rate for Payer: Nomi Health Commercial |
$7.65
|
| Rate for Payer: PACE Medicare |
$2.42
|
| Rate for Payer: PACE SWMI |
$2.55
|
| Rate for Payer: PHP Commercial |
$10,756.83
|
| Rate for Payer: PHP Medicare Advantage |
$2.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,225.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.24
|
| Rate for Payer: Priority Health Medicare |
$2.55
|
| Rate for Payer: Priority Health Narrow Network |
$5.79
|
| Rate for Payer: Priority Health SBD |
$7,972.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.55
|
| Rate for Payer: UHC Exchange |
$4.87
|
| Rate for Payer: UHC Medicare Advantage |
$2.55
|
| Rate for Payer: UHCCP Medicaid |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$4,682.38
|
| Rate for Payer: VA VA |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,491.32
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,655.09
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,568.24 |
| Max. Negotiated Rate |
$11,389.58 |
| Rate for Payer: Aetna American Axle |
$8,225.81
|
| Rate for Payer: Aetna Commercial |
$10,756.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,225.81
|
| Rate for Payer: Cash Price |
$10,124.07
|
| Rate for Payer: Cofinity Commercial |
$10,883.38
|
| Rate for Payer: Cofinity Commercial |
$8,858.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,858.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,124.07
|
| Rate for Payer: Healthscope Commercial |
$11,389.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,858.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,491.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,756.83
|
| Rate for Payer: PHP Commercial |
$10,756.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,225.81
|
| Rate for Payer: Priority Health SBD |
$7,972.71
|
| Rate for Payer: UMR Bronson Commercial |
$5,568.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,491.32
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30,174.07
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,276.59 |
| Max. Negotiated Rate |
$27,156.66 |
| Rate for Payer: Aetna American Axle |
$19,613.15
|
| Rate for Payer: Aetna Commercial |
$25,647.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,613.15
|
| Rate for Payer: Cash Price |
$24,139.26
|
| Rate for Payer: Cofinity Commercial |
$21,121.85
|
| Rate for Payer: Cofinity Commercial |
$25,949.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,121.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,139.26
|
| Rate for Payer: Healthscope Commercial |
$27,156.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,121.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,630.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,647.96
|
| Rate for Payer: PHP Commercial |
$25,647.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,613.15
|
| Rate for Payer: Priority Health SBD |
$19,009.66
|
| Rate for Payer: UMR Bronson Commercial |
$13,276.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,630.55
|
|
