|
ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED
|
Facility
|
OP
|
$15,201.47
|
|
|
Service Code
|
CPT 57240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$15,201.47 |
| Rate for Payer: Aetna Medicare |
$5,030.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,650.19
|
| Rate for Payer: BCN Commercial |
$3,650.19
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Nomi Health Commercial |
$10,156.92
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,201.47
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,161.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.50
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$595.00
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
ANTERIOR INSTRUMENTATION; 2 TO 3 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$8,596.00
|
|
|
Service Code
|
CPT 22845
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$715.99 |
| Max. Negotiated Rate |
$8,596.00 |
| Rate for Payer: BCBS Trust/PPO |
$2,706.35
|
| Rate for Payer: BCN Commercial |
$2,706.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.59
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Exchange |
$715.99
|
|
|
ANTERIOR INSTRUMENTATION; 4 TO 7 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$8,596.00
|
|
|
Service Code
|
CPT 22846
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$745.51 |
| Max. Negotiated Rate |
$8,596.00 |
| Rate for Payer: BCBS Trust/PPO |
$2,809.98
|
| Rate for Payer: BCN Commercial |
$2,809.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$820.06
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Exchange |
$745.51
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY (EG, MAQUET TYPE PROCEDURE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$796.17 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$875.79
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$796.17
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
ANTIHEMOPHILIC FACTOR (RECOMB) 1,000 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
24926
|
|
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: Cofinity Medicare Advantage |
$2.42
|
| 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 Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| 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 (RECOMB) 1,000 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
24926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.92
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| 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 |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.47
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$3.58
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Exchange |
$2.94
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
ANTIHEMOPHILIC FACTOR (RECOMB) 1,500 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
106293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.92
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| 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 |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.47
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$3.58
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Exchange |
$2.94
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
ANTIHEMOPHILIC FACTOR (RECOMB) 1,500 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
106293
|
|
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: Cofinity Medicare Advantage |
$2.42
|
| 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 Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| 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 (RECOMB) 2,000 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
106294
|
|
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: Cofinity Medicare Advantage |
$2.42
|
| 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 Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| 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 (RECOMB) 2,000 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
106294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.92
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| 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 |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.47
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$3.58
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Exchange |
$2.94
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
ANTIHEMOPHILIC FACTOR (RECOMB) 250 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
24924
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.92
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| 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 |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.47
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$3.58
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Exchange |
$2.94
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
ANTIHEMOPHILIC FACTOR (RECOMB) 250 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
24924
|
|
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: Cofinity Medicare Advantage |
$2.42
|
| 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 Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| 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 (RECOMB) 500 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
24925
|
|
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: Cofinity Medicare Advantage |
$2.42
|
| 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 Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| 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 (RECOMB) 500 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
24925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Cofinity Medicare Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.92
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| 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 |
$1.54
|
| 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 |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.47
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$3.58
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Exchange |
$2.94
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 2,000 (+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$3.01
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
78225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.92
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Healthscope Commercial |
$2.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Mclaren Medicare |
$1.54
|
| Rate for Payer: Mclaren Medicare |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.56
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.47
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$3.58
|
| Rate for Payer: Priority Health Narrow Network |
$3.58
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Exchange |
$2.94
|
| Rate for Payer: UHC Exchange |
$2.94
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.11
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 2,000 (+/-) UNIT IV SOLUTION
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
78225
|
|
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: Cofinity Medicare Advantage |
$2.42
|
| 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 Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| 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 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: Cofinity Medicare Advantage |
$2.42
|
| 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 Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| 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 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 |
$4.62 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.92
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| 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 |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.47
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$3.58
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Exchange |
$2.94
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 500 (+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
76366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.92
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| 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 |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.47
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$3.58
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Exchange |
$2.94
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 500 (+/-) UNIT IV SOLUTION
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
76366
|
|
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: Cofinity Medicare Advantage |
$2.42
|
| 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 Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| 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
|
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: Cofinity Medicare Advantage |
$1.90
|
| 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 Commercial |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| 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 1,200 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| 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 |
$1.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.81
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS MAPPO |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.89
|
| Rate for Payer: BCN Medicare Advantage |
$1.45
|
| 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: Cofinity Medicare Advantage |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.45
|
| 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 |
$0.78
|
| Rate for Payer: Mclaren Medicare |
$1.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.52
|
| Rate for Payer: Meridian Medicaid |
$0.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$4.35
|
| Rate for Payer: PACE Medicare |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.45
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$1.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.00
|
| Rate for Payer: Priority Health Medicare |
$1.45
|
| Rate for Payer: Priority Health Narrow Network |
$3.20
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.45
|
| Rate for Payer: UHC Exchange |
$2.77
|
| Rate for Payer: UHC Medicare Advantage |
$1.45
|
| Rate for Payer: UHCCP Medicaid |
$0.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: VA VA |
$1.45
|
| 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 |
$0.78 |
| 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 |
$1.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.81
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS MAPPO |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.89
|
| Rate for Payer: BCN Medicare Advantage |
$1.45
|
| 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: Cofinity Medicare Advantage |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.45
|
| 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 |
$0.78
|
| Rate for Payer: Mclaren Medicare |
$1.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.52
|
| Rate for Payer: Meridian Medicaid |
$0.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$4.35
|
| Rate for Payer: PACE Medicare |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.45
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$1.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.00
|
| Rate for Payer: Priority Health Medicare |
$1.45
|
| Rate for Payer: Priority Health Narrow Network |
$3.20
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.45
|
| Rate for Payer: UHC Exchange |
$2.77
|
| Rate for Payer: UHC Medicare Advantage |
$1.45
|
| Rate for Payer: UHCCP Medicaid |
$0.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: VA VA |
$1.45
|
| 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: Cofinity Medicare Advantage |
$1.90
|
| 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 Commercial |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| 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 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: Cofinity Medicare Advantage |
$1.90
|
| 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 Commercial |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| 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
|
|
