|
ANTIHEMOPHILIC FVIII, B-DOM TRUNCATED 250 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna American Axle |
$1.87
|
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.93
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.16
|
| 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 |
$2.45
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.45
|
| 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 |
$1.87
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| 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 |
$1.07
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.16
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 3,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna American Axle |
$1.87
|
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.16
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 3,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna American Axle |
$1.87
|
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.93
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.16
|
| 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 |
$2.45
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.45
|
| 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 |
$1.87
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| 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 |
$1.07
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.16
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 500 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna American Axle |
$1.87
|
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.93
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.16
|
| 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 |
$2.45
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.45
|
| 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 |
$1.87
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| 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 |
$1.07
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.16
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 500 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna American Axle |
$1.87
|
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.16
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH,PEGYLATED 1,000(+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$5.38
|
|
|
Service Code
|
HCPCS J7207
|
| Hospital Charge Code |
176592
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.62
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$2.10
|
| Rate for Payer: BCN Medicare Advantage |
$2.10
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$4.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$1.13
|
| Rate for Payer: Mclaren Medicare |
$2.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.21
|
| Rate for Payer: Meridian Medicaid |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: PACE Medicare |
$2.00
|
| Rate for Payer: PACE SWMI |
$2.10
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$2.10
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: Railroad Medicare Medicare |
$2.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.10
|
| Rate for Payer: UHC Exchange |
$4.01
|
| Rate for Payer: UHC Medicare Advantage |
$2.10
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: VA VA |
$2.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH,PEGYLATED 1,500(+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$5.38
|
|
|
Service Code
|
HCPCS J7207
|
| Hospital Charge Code |
182080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.62
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$2.10
|
| Rate for Payer: BCN Medicare Advantage |
$2.10
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$4.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$1.13
|
| Rate for Payer: Mclaren Medicare |
$2.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.21
|
| Rate for Payer: Meridian Medicaid |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: PACE Medicare |
$2.00
|
| Rate for Payer: PACE SWMI |
$2.10
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$2.10
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: Railroad Medicare Medicare |
$2.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.10
|
| Rate for Payer: UHC Exchange |
$4.01
|
| Rate for Payer: UHC Medicare Advantage |
$2.10
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: VA VA |
$2.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH,PEGYLATED 2,000(+/-) UNIT IV SOLUTION
|
Facility
|
IP
|
$5.38
|
|
|
Service Code
|
HCPCS J7207
|
| Hospital Charge Code |
176593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Healthscope Commercial |
$4.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: UMR Bronson Commercial |
$2.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH,PEGYLATED 2,000(+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$5.38
|
|
|
Service Code
|
HCPCS J7207
|
| Hospital Charge Code |
176593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.62
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$2.10
|
| Rate for Payer: BCN Medicare Advantage |
$2.10
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$4.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$1.13
|
| Rate for Payer: Mclaren Medicare |
$2.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.21
|
| Rate for Payer: Meridian Medicaid |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: PACE Medicare |
$2.00
|
| Rate for Payer: PACE SWMI |
$2.10
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$2.10
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: Railroad Medicare Medicare |
$2.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.10
|
| Rate for Payer: UHC Exchange |
$4.01
|
| Rate for Payer: UHC Medicare Advantage |
$2.10
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: VA VA |
$2.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH,PEGYLATED 500 (+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$5.38
|
|
|
Service Code
|
HCPCS J7207
|
| Hospital Charge Code |
176591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.62
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$2.10
|
| Rate for Payer: BCN Medicare Advantage |
$2.10
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$4.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Mclaren Medicaid |
$1.13
|
| Rate for Payer: Mclaren Medicare |
$2.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.21
|
| Rate for Payer: Meridian Medicaid |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: PACE Medicare |
$2.00
|
| Rate for Payer: PACE SWMI |
$2.10
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$2.10
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: Railroad Medicare Medicare |
$2.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.10
|
| Rate for Payer: UHC Exchange |
$4.01
|
| Rate for Payer: UHC Medicare Advantage |
$2.10
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: VA VA |
$2.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
ANTIHEMOPHIL RFVIII FC-VWF-XTEN,BDD-EHTL 1,000 (+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$14.44
|
|
|
Service Code
|
HCPCS J7214
|
| Hospital Charge Code |
203292
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Aetna American Axle |
$9.39
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$4.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.83
|
| Rate for Payer: BCBS Complete |
$2.62
|
| Rate for Payer: BCBS MAPPO |
$4.66
|
| Rate for Payer: BCN Medicare Advantage |
$4.66
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.66
|
| Rate for Payer: Healthscope Commercial |
$13.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.83
|
| Rate for Payer: Mclaren Medicaid |
$2.50
|
| Rate for Payer: Mclaren Medicare |
$4.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.89
|
| Rate for Payer: Meridian Medicaid |
$2.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: PACE Medicare |
$4.43
|
| Rate for Payer: PACE SWMI |
$4.66
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health Medicare |
$4.66
|
| Rate for Payer: Priority Health SBD |
$9.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.66
|
| Rate for Payer: UHC Exchange |
$8.91
|
| Rate for Payer: UHC Medicare Advantage |
$4.66
|
| Rate for Payer: UHCCP Medicaid |
$2.50
|
| Rate for Payer: UMR Bronson Commercial |
$5.34
|
| Rate for Payer: VA VA |
$4.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.83
|
|
|
ANTIHEMOPHIL RFVIII FC-VWF-XTEN,BDD-EHTL 1,000 (+/-) UNIT IV SOLUTION
|
Facility
|
IP
|
$14.44
|
|
|
Service Code
|
HCPCS J7214
|
| Hospital Charge Code |
203292
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna American Axle |
$9.39
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.39
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.55
|
| Rate for Payer: Healthscope Commercial |
$13.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health SBD |
$9.10
|
| Rate for Payer: UMR Bronson Commercial |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.83
|
|
|
ANTIHEMOPHIL RFVIII FC-VWF-XTEN,BDD-EHTL 3,000 (+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$14.44
|
|
|
Service Code
|
HCPCS J7214
|
| Hospital Charge Code |
203294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Aetna American Axle |
$9.39
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$4.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.83
|
| Rate for Payer: BCBS Complete |
$2.62
|
| Rate for Payer: BCBS MAPPO |
$4.66
|
| Rate for Payer: BCN Medicare Advantage |
$4.66
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.66
|
| Rate for Payer: Healthscope Commercial |
$13.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.83
|
| Rate for Payer: Mclaren Medicaid |
$2.50
|
| Rate for Payer: Mclaren Medicare |
$4.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.89
|
| Rate for Payer: Meridian Medicaid |
$2.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: PACE Medicare |
$4.43
|
| Rate for Payer: PACE SWMI |
$4.66
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health Medicare |
$4.66
|
| Rate for Payer: Priority Health SBD |
$9.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.66
|
| Rate for Payer: UHC Exchange |
$8.91
|
| Rate for Payer: UHC Medicare Advantage |
$4.66
|
| Rate for Payer: UHCCP Medicaid |
$2.50
|
| Rate for Payer: UMR Bronson Commercial |
$5.34
|
| Rate for Payer: VA VA |
$4.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.83
|
|
|
ANTIHEMOPHIL RFVIII FC-VWF-XTEN,BDD-EHTL 3,000 (+/-) UNIT IV SOLUTION
|
Facility
|
IP
|
$14.44
|
|
|
Service Code
|
HCPCS J7214
|
| Hospital Charge Code |
203294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna American Axle |
$9.39
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.39
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.55
|
| Rate for Payer: Healthscope Commercial |
$13.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health SBD |
$9.10
|
| Rate for Payer: UMR Bronson Commercial |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.83
|
|
|
ANTIHEMOPHIL RFVIII FC-VWF-XTEN,BDD-EHTL 500 (+/-) UNIT IV SOLUTION
|
Facility
|
IP
|
$14.44
|
|
|
Service Code
|
HCPCS J7214
|
| Hospital Charge Code |
203291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna American Axle |
$9.39
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.39
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.55
|
| Rate for Payer: Healthscope Commercial |
$13.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health SBD |
$9.10
|
| Rate for Payer: UMR Bronson Commercial |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.83
|
|
|
ANTIHEMOPHIL RFVIII FC-VWF-XTEN,BDD-EHTL 500 (+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$14.44
|
|
|
Service Code
|
HCPCS J7214
|
| Hospital Charge Code |
203291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Aetna American Axle |
$9.39
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$4.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.83
|
| Rate for Payer: BCBS Complete |
$2.62
|
| Rate for Payer: BCBS MAPPO |
$4.66
|
| Rate for Payer: BCN Medicare Advantage |
$4.66
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.66
|
| Rate for Payer: Healthscope Commercial |
$13.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.83
|
| Rate for Payer: Mclaren Medicaid |
$2.50
|
| Rate for Payer: Mclaren Medicare |
$4.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.89
|
| Rate for Payer: Meridian Medicaid |
$2.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: PACE Medicare |
$4.43
|
| Rate for Payer: PACE SWMI |
$4.66
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health Medicare |
$4.66
|
| Rate for Payer: Priority Health SBD |
$9.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.66
|
| Rate for Payer: UHC Exchange |
$8.91
|
| Rate for Payer: UHC Medicare Advantage |
$4.66
|
| Rate for Payer: UHCCP Medicaid |
$2.50
|
| Rate for Payer: UMR Bronson Commercial |
$5.34
|
| Rate for Payer: VA VA |
$4.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.83
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 350 UNIT-650 UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
191212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 350 UNIT-650 UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
191212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$6.78 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna Medicare |
$2.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.01
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS MAPPO |
$2.41
|
| Rate for Payer: BCN Medicare Advantage |
$2.41
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.41
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Mclaren Medicaid |
$1.29
|
| Rate for Payer: Mclaren Medicare |
$2.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.53
|
| Rate for Payer: Meridian Medicaid |
$1.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: PACE Medicare |
$2.29
|
| Rate for Payer: PACE SWMI |
$2.41
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: PHP Medicare Advantage |
$2.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health Medicare |
$2.41
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.41
|
| Rate for Payer: UHC Exchange |
$4.61
|
| Rate for Payer: UHC Medicare Advantage |
$2.41
|
| Rate for Payer: UHCCP Medicaid |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: VA VA |
$2.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
191213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$6.78 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna Medicare |
$2.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.01
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS MAPPO |
$2.41
|
| Rate for Payer: BCN Medicare Advantage |
$2.41
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.41
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Mclaren Medicaid |
$1.29
|
| Rate for Payer: Mclaren Medicare |
$2.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.53
|
| Rate for Payer: Meridian Medicaid |
$1.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: PACE Medicare |
$2.29
|
| Rate for Payer: PACE SWMI |
$2.41
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: PHP Medicare Advantage |
$2.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health Medicare |
$2.41
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.41
|
| Rate for Payer: UHC Exchange |
$4.61
|
| Rate for Payer: UHC Medicare Advantage |
$2.41
|
| Rate for Payer: UHCCP Medicaid |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: VA VA |
$2.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
191213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
116307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
116307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$6.78 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna Medicare |
$2.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.01
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS MAPPO |
$2.41
|
| Rate for Payer: BCN Medicare Advantage |
$2.41
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.41
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Mclaren Medicaid |
$1.29
|
| Rate for Payer: Mclaren Medicare |
$2.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.53
|
| Rate for Payer: Meridian Medicaid |
$1.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: PACE Medicare |
$2.29
|
| Rate for Payer: PACE SWMI |
$2.41
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: PHP Medicare Advantage |
$2.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health Medicare |
$2.41
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.41
|
| Rate for Payer: UHC Exchange |
$4.61
|
| Rate for Payer: UHC Medicare Advantage |
$2.41
|
| Rate for Payer: UHCCP Medicaid |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: VA VA |
$2.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$10.72
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
9116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna American Axle |
$6.97
|
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.97
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cofinity Commercial |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$9.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.58
|
| Rate for Payer: Healthscope Commercial |
$9.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: PHP Commercial |
$9.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.97
|
| Rate for Payer: Priority Health SBD |
$6.75
|
| Rate for Payer: UMR Bronson Commercial |
$4.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.04
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10.72
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
9116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$11.54 |
| Rate for Payer: Aetna American Axle |
$6.97
|
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna Medicare |
$4.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.12
|
| Rate for Payer: BCBS Complete |
$2.31
|
| Rate for Payer: BCBS MAPPO |
$4.10
|
| Rate for Payer: BCN Medicare Advantage |
$4.10
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cofinity Commercial |
$9.22
|
| Rate for Payer: Cofinity Commercial |
$7.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.10
|
| Rate for Payer: Healthscope Commercial |
$9.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.04
|
| Rate for Payer: Mclaren Medicaid |
$2.20
|
| Rate for Payer: Mclaren Medicare |
$4.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.30
|
| Rate for Payer: Meridian Medicaid |
$2.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: PACE Medicare |
$3.90
|
| Rate for Payer: PACE SWMI |
$4.10
|
| Rate for Payer: PHP Commercial |
$9.11
|
| Rate for Payer: PHP Medicare Advantage |
$4.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.97
|
| Rate for Payer: Priority Health Medicare |
$4.10
|
| Rate for Payer: Priority Health SBD |
$6.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.10
|
| Rate for Payer: UHC Exchange |
$7.84
|
| Rate for Payer: UHC Medicare Advantage |
$4.10
|
| Rate for Payer: UHCCP Medicaid |
$2.20
|
| Rate for Payer: UMR Bronson Commercial |
$3.97
|
| Rate for Payer: VA VA |
$4.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.04
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,142.04
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
24585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$535.66 |
| Max. Negotiated Rate |
$3,727.84 |
| Rate for Payer: Aetna American Axle |
$2,692.33
|
| Rate for Payer: Aetna Commercial |
$3,520.73
|
| Rate for Payer: Aetna Medicare |
$1,039.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,692.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,249.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,249.21
|
| Rate for Payer: BCBS Complete |
$562.45
|
| Rate for Payer: BCBS MAPPO |
$999.37
|
| Rate for Payer: BCN Medicare Advantage |
$999.37
|
| Rate for Payer: Cash Price |
$3,313.63
|
| Rate for Payer: Cash Price |
$3,313.63
|
| Rate for Payer: Cofinity Commercial |
$3,562.15
|
| Rate for Payer: Cofinity Commercial |
$2,899.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,899.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,313.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$999.37
|
| Rate for Payer: Healthscope Commercial |
$3,727.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,899.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,106.53
|
| Rate for Payer: Mclaren Medicaid |
$535.66
|
| Rate for Payer: Mclaren Medicare |
$999.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,049.34
|
| Rate for Payer: Meridian Medicaid |
$562.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,149.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,520.73
|
| Rate for Payer: PACE Medicare |
$949.40
|
| Rate for Payer: PACE SWMI |
$999.37
|
| Rate for Payer: PHP Commercial |
$3,520.73
|
| Rate for Payer: PHP Medicare Advantage |
$999.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,692.33
|
| Rate for Payer: Priority Health Medicare |
$999.37
|
| Rate for Payer: Priority Health SBD |
$2,609.49
|
| Rate for Payer: Railroad Medicare Medicare |
$999.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,813.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$999.37
|
| Rate for Payer: UHC Exchange |
$1,909.90
|
| Rate for Payer: UHC Medicare Advantage |
$999.37
|
| Rate for Payer: UHCCP Medicaid |
$535.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,532.55
|
| Rate for Payer: VA VA |
$999.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,106.53
|
|
