|
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 Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PHP Commercial |
$2.94
|
| 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) 1,500 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
106293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.96
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.57
|
| Rate for Payer: BCBS Trust/PPO |
$5.16
|
| Rate for Payer: BCN Commercial |
$5.16
|
| Rate for Payer: BCN Medicare Advantage |
$1.57
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.57
|
| 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 |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$1.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.65
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PACE Medicare |
$1.49
|
| Rate for Payer: PACE SWMI |
$1.57
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.07
|
| Rate for Payer: Priority Health Medicare |
$1.57
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Priority Health Tiered Network |
$4.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.57
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.57
|
| 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 Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PHP Commercial |
$2.94
|
| 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 |
$0.82 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.96
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.57
|
| Rate for Payer: BCBS Trust/PPO |
$5.16
|
| Rate for Payer: BCN Commercial |
$5.16
|
| Rate for Payer: BCN Medicare Advantage |
$1.57
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.57
|
| 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 |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$1.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.65
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PACE Medicare |
$1.49
|
| Rate for Payer: PACE SWMI |
$1.57
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.07
|
| Rate for Payer: Priority Health Medicare |
$1.57
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Priority Health Tiered Network |
$4.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.57
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.57
|
| 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 Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PHP Commercial |
$2.94
|
| 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) 250 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
24924
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.96
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.57
|
| Rate for Payer: BCBS Trust/PPO |
$5.16
|
| Rate for Payer: BCN Commercial |
$5.16
|
| Rate for Payer: BCN Medicare Advantage |
$1.57
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.57
|
| 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 |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$1.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.65
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PACE Medicare |
$1.49
|
| Rate for Payer: PACE SWMI |
$1.57
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.07
|
| Rate for Payer: Priority Health Medicare |
$1.57
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Priority Health Tiered Network |
$4.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.57
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.57
|
| 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 Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PHP Commercial |
$2.94
|
| 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 |
$0.82 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.96
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.57
|
| Rate for Payer: BCBS Trust/PPO |
$5.16
|
| Rate for Payer: BCN Commercial |
$5.16
|
| Rate for Payer: BCN Medicare Advantage |
$1.57
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.57
|
| 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 |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$1.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.65
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PACE Medicare |
$1.49
|
| Rate for Payer: PACE SWMI |
$1.57
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.07
|
| Rate for Payer: Priority Health Medicare |
$1.57
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Priority Health Tiered Network |
$4.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.57
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.57
|
| 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 Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PHP Commercial |
$2.94
|
| 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 2,000 (+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$3.01
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
78225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$5.16 |
| 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 |
$1.63
|
| Rate for Payer: Aetna Medicare |
$1.63
|
| 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 |
$1.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.96
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.57
|
| Rate for Payer: BCBS MAPPO |
$1.57
|
| Rate for Payer: BCBS Trust/PPO |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$5.16
|
| Rate for Payer: BCN Commercial |
$5.16
|
| Rate for Payer: BCN Commercial |
$5.16
|
| Rate for Payer: BCN Medicare Advantage |
$1.57
|
| Rate for Payer: BCN Medicare Advantage |
$1.57
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Advantage |
$2.42
|
| Rate for Payer: Cofinity Advantage |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.57
|
| Rate for Payer: Healthscope Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| 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 |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.26
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$1.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.65
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.56
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PACE Medicare |
$1.49
|
| Rate for Payer: PACE Medicare |
$1.49
|
| Rate for Payer: PACE SWMI |
$1.57
|
| Rate for Payer: PACE SWMI |
$1.57
|
| Rate for Payer: PHP Commercial |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.57
|
| Rate for Payer: PHP Medicare Advantage |
$1.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.07
|
| Rate for Payer: Priority Health Medicare |
$1.57
|
| Rate for Payer: Priority Health Medicare |
$1.57
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: Priority Health Tiered Network |
$4.06
|
| Rate for Payer: Priority Health Tiered Network |
$4.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.57
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.11
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.57
|
| Rate for Payer: VA VA |
$1.57
|
| 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 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 Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PHP Commercial |
$2.94
|
| 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 |
$0.82 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.96
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.57
|
| Rate for Payer: BCBS Trust/PPO |
$5.16
|
| Rate for Payer: BCN Commercial |
$5.16
|
| Rate for Payer: BCN Medicare Advantage |
$1.57
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.57
|
| 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 |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$1.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.65
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PACE Medicare |
$1.49
|
| Rate for Payer: PACE SWMI |
$1.57
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.07
|
| Rate for Payer: Priority Health Medicare |
$1.57
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Priority Health Tiered Network |
$4.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.57
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.57
|
| 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 |
$0.82 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.96
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.57
|
| Rate for Payer: BCBS Trust/PPO |
$5.16
|
| Rate for Payer: BCN Commercial |
$5.16
|
| Rate for Payer: BCN Medicare Advantage |
$1.57
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.57
|
| 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 |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$1.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.65
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PACE Medicare |
$1.49
|
| Rate for Payer: PACE SWMI |
$1.57
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.07
|
| Rate for Payer: Priority Health Medicare |
$1.57
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: Priority Health Tiered Network |
$4.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.57
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: VA VA |
$1.57
|
| 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 Advantage |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,200 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$1.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.86
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS MAPPO |
$1.49
|
| Rate for Payer: BCBS Trust/PPO |
$4.81
|
| Rate for Payer: BCN Commercial |
$4.81
|
| Rate for Payer: BCN Medicare Advantage |
$1.49
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.49
|
| 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 |
$1.49
|
| Rate for Payer: Mclaren Medicare |
$1.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.56
|
| Rate for Payer: Meridian Medicaid |
$1.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$4.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PACE Medicare |
$1.42
|
| Rate for Payer: PACE SWMI |
$1.49
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$1.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.70
|
| Rate for Payer: Priority Health Medicare |
$1.49
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.46
|
| Rate for Payer: UHC Core |
$2.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.49
|
| Rate for Payer: UHC Exchange |
$2.46
|
| Rate for Payer: UHC Medicaid |
$0.78
|
| Rate for Payer: UHCCP Medicaid |
$0.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: VA VA |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,200 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 2,400 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 2,400 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$1.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.86
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS MAPPO |
$1.49
|
| Rate for Payer: BCBS Trust/PPO |
$4.81
|
| Rate for Payer: BCN Commercial |
$4.81
|
| Rate for Payer: BCN Medicare Advantage |
$1.49
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.49
|
| 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 |
$1.49
|
| Rate for Payer: Mclaren Medicare |
$1.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.56
|
| Rate for Payer: Meridian Medicaid |
$1.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$4.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PACE Medicare |
$1.42
|
| Rate for Payer: PACE SWMI |
$1.49
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$1.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.70
|
| Rate for Payer: Priority Health Medicare |
$1.49
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.46
|
| Rate for Payer: UHC Core |
$2.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.49
|
| Rate for Payer: UHC Exchange |
$2.46
|
| Rate for Payer: UHC Medicaid |
$0.78
|
| Rate for Payer: UHCCP Medicaid |
$0.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: VA VA |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 600 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$1.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.86
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS MAPPO |
$1.49
|
| Rate for Payer: BCBS Trust/PPO |
$4.81
|
| Rate for Payer: BCN Commercial |
$4.81
|
| Rate for Payer: BCN Medicare Advantage |
$1.49
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.49
|
| 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 |
$1.49
|
| Rate for Payer: Mclaren Medicare |
$1.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.56
|
| Rate for Payer: Meridian Medicaid |
$1.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$4.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PACE Medicare |
$1.42
|
| Rate for Payer: PACE SWMI |
$1.49
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$1.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.70
|
| Rate for Payer: Priority Health Medicare |
$1.49
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.46
|
| Rate for Payer: UHC Core |
$2.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.49
|
| Rate for Payer: UHC Exchange |
$2.46
|
| Rate for Payer: UHC Medicaid |
$0.78
|
| Rate for Payer: UHCCP Medicaid |
$0.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: VA VA |
$1.49
|
| 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 Advantage |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 1,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: Aetna American Axle |
$1.87
|
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.76
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$1.41
|
| Rate for Payer: BCBS Trust/PPO |
$5.03
|
| Rate for Payer: BCN Commercial |
$5.03
|
| Rate for Payer: BCN Medicare Advantage |
$1.41
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.41
|
| 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 |
$1.41
|
| Rate for Payer: Mclaren Medicare |
$1.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.48
|
| Rate for Payer: Meridian Medicaid |
$1.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$4.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PACE Medicare |
$1.34
|
| Rate for Payer: PACE SWMI |
$1.41
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.84
|
| Rate for Payer: Priority Health Medicare |
$1.41
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Priority Health Tiered Network |
$3.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.41
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Medicaid |
$0.74
|
| Rate for Payer: UHCCP Medicaid |
$0.74
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: VA VA |
$1.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.16
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 1,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174371
|
|
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 Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| 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: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.45
|
| 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 2,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174374
|
|
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 Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| 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: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.45
|
| 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 2,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: Aetna American Axle |
$1.87
|
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.76
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$1.41
|
| Rate for Payer: BCBS Trust/PPO |
$5.03
|
| Rate for Payer: BCN Commercial |
$5.03
|
| Rate for Payer: BCN Medicare Advantage |
$1.41
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.41
|
| 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 |
$1.41
|
| Rate for Payer: Mclaren Medicare |
$1.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.48
|
| Rate for Payer: Meridian Medicaid |
$1.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$4.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PACE Medicare |
$1.34
|
| Rate for Payer: PACE SWMI |
$1.41
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.84
|
| Rate for Payer: Priority Health Medicare |
$1.41
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Priority Health Tiered Network |
$3.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.41
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Medicaid |
$0.74
|
| Rate for Payer: UHCCP Medicaid |
$0.74
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: VA VA |
$1.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.16
|
|
|
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 |
$0.74 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: Aetna American Axle |
$1.87
|
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.76
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$1.41
|
| Rate for Payer: BCBS Trust/PPO |
$5.03
|
| Rate for Payer: BCN Commercial |
$5.03
|
| Rate for Payer: BCN Medicare Advantage |
$1.41
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.41
|
| 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 |
$1.41
|
| Rate for Payer: Mclaren Medicare |
$1.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.48
|
| Rate for Payer: Meridian Medicaid |
$1.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$4.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PACE Medicare |
$1.34
|
| Rate for Payer: PACE SWMI |
$1.41
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.84
|
| Rate for Payer: Priority Health Medicare |
$1.41
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Priority Health Tiered Network |
$3.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.41
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Medicaid |
$0.74
|
| Rate for Payer: UHCCP Medicaid |
$0.74
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: VA VA |
$1.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.16
|
|
