|
ANTIHEMOPHILIC FVIII, B-DOM TRUNCATED 250 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174369
|
|
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 3,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| 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 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 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 500 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174370
|
|
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 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 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,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 |
$1.12 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.67
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$7.00
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: BCN Medicare Advantage |
$2.14
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Advantage |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.14
|
| 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 |
$2.14
|
| Rate for Payer: Mclaren Medicare |
$2.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.25
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: Nomi Health Commercial |
$6.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.04
|
| Rate for Payer: PACE Medicare |
$2.03
|
| Rate for Payer: PACE SWMI |
$2.14
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.60
|
| Rate for Payer: Priority Health Medicare |
$2.14
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: Priority Health Tiered Network |
$5.28
|
| Rate for Payer: Railroad Medicare Medicare |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.14
|
| Rate for Payer: UHC Exchange |
$3.56
|
| Rate for Payer: UHC Medicaid |
$1.12
|
| Rate for Payer: UHCCP Medicaid |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: VA VA |
$2.14
|
| 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 |
$1.12 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.67
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$7.00
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: BCN Medicare Advantage |
$2.14
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Advantage |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.14
|
| 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 |
$2.14
|
| Rate for Payer: Mclaren Medicare |
$2.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.25
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: Nomi Health Commercial |
$6.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.04
|
| Rate for Payer: PACE Medicare |
$2.03
|
| Rate for Payer: PACE SWMI |
$2.14
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.60
|
| Rate for Payer: Priority Health Medicare |
$2.14
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: Priority Health Tiered Network |
$5.28
|
| Rate for Payer: Railroad Medicare Medicare |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.14
|
| Rate for Payer: UHC Exchange |
$3.56
|
| Rate for Payer: UHC Medicaid |
$1.12
|
| Rate for Payer: UHCCP Medicaid |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: VA VA |
$2.14
|
| 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 |
$1.12 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.67
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$7.00
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: BCN Medicare Advantage |
$2.14
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Advantage |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.14
|
| 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 |
$2.14
|
| Rate for Payer: Mclaren Medicare |
$2.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.25
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: Nomi Health Commercial |
$6.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.04
|
| Rate for Payer: PACE Medicare |
$2.03
|
| Rate for Payer: PACE SWMI |
$2.14
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.60
|
| Rate for Payer: Priority Health Medicare |
$2.14
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: Priority Health Tiered Network |
$5.28
|
| Rate for Payer: Railroad Medicare Medicare |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.14
|
| Rate for Payer: UHC Exchange |
$3.56
|
| Rate for Payer: UHC Medicaid |
$1.12
|
| Rate for Payer: UHCCP Medicaid |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: VA VA |
$2.14
|
| 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 Advantage |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| 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: Opus (Opus Packaging Group) HMA |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.57
|
| 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 500 (+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$5.38
|
|
|
Service Code
|
HCPCS J7207
|
| Hospital Charge Code |
176591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna American Axle |
$3.50
|
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.67
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$7.00
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: BCN Medicare Advantage |
$2.14
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Advantage |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.14
|
| 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 |
$2.14
|
| Rate for Payer: Mclaren Medicare |
$2.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.25
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: Nomi Health Commercial |
$6.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.04
|
| Rate for Payer: PACE Medicare |
$2.03
|
| Rate for Payer: PACE SWMI |
$2.14
|
| Rate for Payer: PHP Commercial |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.60
|
| Rate for Payer: Priority Health Medicare |
$2.14
|
| Rate for Payer: Priority Health SBD |
$3.39
|
| Rate for Payer: Priority Health Tiered Network |
$5.28
|
| Rate for Payer: Railroad Medicare Medicare |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.14
|
| Rate for Payer: UHC Exchange |
$3.56
|
| Rate for Payer: UHC Medicaid |
$1.12
|
| Rate for Payer: UHCCP Medicaid |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: VA VA |
$2.14
|
| 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 |
$2.35 |
| Max. Negotiated Rate |
$14.93 |
| Rate for Payer: Aetna American Axle |
$9.39
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.61
|
| Rate for Payer: BCBS Complete |
$2.47
|
| Rate for Payer: BCBS MAPPO |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$14.93
|
| Rate for Payer: BCN Commercial |
$14.93
|
| Rate for Payer: BCN Medicare Advantage |
$4.49
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cofinity Advantage |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.49
|
| 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 |
$4.49
|
| Rate for Payer: Mclaren Medicare |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.71
|
| Rate for Payer: Meridian Medicaid |
$4.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$13.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.83
|
| Rate for Payer: PACE Medicare |
$4.27
|
| Rate for Payer: PACE SWMI |
$4.49
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.70
|
| Rate for Payer: Priority Health Medicare |
$4.49
|
| Rate for Payer: Priority Health SBD |
$9.10
|
| Rate for Payer: Priority Health Tiered Network |
$11.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.61
|
| Rate for Payer: UHC Core |
$7.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.49
|
| Rate for Payer: UHC Exchange |
$7.61
|
| Rate for Payer: UHC Medicaid |
$2.35
|
| Rate for Payer: UHCCP Medicaid |
$2.35
|
| Rate for Payer: UMR Bronson Commercial |
$5.34
|
| Rate for Payer: VA VA |
$4.49
|
| 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 Advantage |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| 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: Opus (Opus Packaging Group) HMA |
$10.83
|
| Rate for Payer: PHP Commercial |
$12.27
|
| 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 2,000 (+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$14.44
|
|
|
Service Code
|
HCPCS J7214
|
| Hospital Charge Code |
203293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$14.93 |
| Rate for Payer: Aetna American Axle |
$9.39
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.61
|
| Rate for Payer: BCBS Complete |
$2.47
|
| Rate for Payer: BCBS MAPPO |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$14.93
|
| Rate for Payer: BCN Commercial |
$14.93
|
| Rate for Payer: BCN Medicare Advantage |
$4.49
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cofinity Advantage |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.49
|
| 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 |
$4.49
|
| Rate for Payer: Mclaren Medicare |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.71
|
| Rate for Payer: Meridian Medicaid |
$4.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$13.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.83
|
| Rate for Payer: PACE Medicare |
$4.27
|
| Rate for Payer: PACE SWMI |
$4.49
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.70
|
| Rate for Payer: Priority Health Medicare |
$4.49
|
| Rate for Payer: Priority Health SBD |
$9.10
|
| Rate for Payer: Priority Health Tiered Network |
$11.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.61
|
| Rate for Payer: UHC Core |
$7.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.49
|
| Rate for Payer: UHC Exchange |
$7.61
|
| Rate for Payer: UHC Medicaid |
$2.35
|
| Rate for Payer: UHCCP Medicaid |
$2.35
|
| Rate for Payer: UMR Bronson Commercial |
$5.34
|
| Rate for Payer: VA VA |
$4.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.83
|
|
|
ANTIHEMOPHIL RFVIII FC-VWF-XTEN,BDD-EHTL 2,000 (+/-) UNIT IV SOLUTION
|
Facility
|
IP
|
$14.44
|
|
|
Service Code
|
HCPCS J7214
|
| Hospital Charge Code |
203293
|
|
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 Advantage |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| 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: Opus (Opus Packaging Group) HMA |
$10.83
|
| Rate for Payer: PHP Commercial |
$12.27
|
| 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 250 (+/-) UNIT IV SOLUTION
|
Facility
|
IP
|
$14.44
|
|
|
Service Code
|
HCPCS J7214
|
| Hospital Charge Code |
203290
|
|
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 Advantage |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| 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: Opus (Opus Packaging Group) HMA |
$10.83
|
| Rate for Payer: PHP Commercial |
$12.27
|
| 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 250 (+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$14.44
|
|
|
Service Code
|
HCPCS J7214
|
| Hospital Charge Code |
203290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$14.93 |
| Rate for Payer: Aetna American Axle |
$9.39
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.61
|
| Rate for Payer: BCBS Complete |
$2.47
|
| Rate for Payer: BCBS MAPPO |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$14.93
|
| Rate for Payer: BCN Commercial |
$14.93
|
| Rate for Payer: BCN Medicare Advantage |
$4.49
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cofinity Advantage |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.49
|
| 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 |
$4.49
|
| Rate for Payer: Mclaren Medicare |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.71
|
| Rate for Payer: Meridian Medicaid |
$4.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$13.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.83
|
| Rate for Payer: PACE Medicare |
$4.27
|
| Rate for Payer: PACE SWMI |
$4.49
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.70
|
| Rate for Payer: Priority Health Medicare |
$4.49
|
| Rate for Payer: Priority Health SBD |
$9.10
|
| Rate for Payer: Priority Health Tiered Network |
$11.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.61
|
| Rate for Payer: UHC Core |
$7.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.49
|
| Rate for Payer: UHC Exchange |
$7.61
|
| Rate for Payer: UHC Medicaid |
$2.35
|
| Rate for Payer: UHCCP Medicaid |
$2.35
|
| Rate for Payer: UMR Bronson Commercial |
$5.34
|
| Rate for Payer: VA VA |
$4.49
|
| 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 Advantage |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| 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: Opus (Opus Packaging Group) HMA |
$10.83
|
| Rate for Payer: PHP Commercial |
$12.27
|
| 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 |
$2.35 |
| Max. Negotiated Rate |
$14.93 |
| Rate for Payer: Aetna American Axle |
$9.39
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.61
|
| Rate for Payer: BCBS Complete |
$2.47
|
| Rate for Payer: BCBS MAPPO |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$14.93
|
| Rate for Payer: BCN Commercial |
$14.93
|
| Rate for Payer: BCN Medicare Advantage |
$4.49
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cofinity Advantage |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.49
|
| 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 |
$4.49
|
| Rate for Payer: Mclaren Medicare |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.71
|
| Rate for Payer: Meridian Medicaid |
$4.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$13.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.83
|
| Rate for Payer: PACE Medicare |
$4.27
|
| Rate for Payer: PACE SWMI |
$4.49
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.70
|
| Rate for Payer: Priority Health Medicare |
$4.49
|
| Rate for Payer: Priority Health SBD |
$9.10
|
| Rate for Payer: Priority Health Tiered Network |
$11.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.61
|
| Rate for Payer: UHC Core |
$7.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.49
|
| Rate for Payer: UHC Exchange |
$7.61
|
| Rate for Payer: UHC Medicaid |
$2.35
|
| Rate for Payer: UHCCP Medicaid |
$2.35
|
| Rate for Payer: UMR Bronson Commercial |
$5.34
|
| Rate for Payer: VA VA |
$4.49
|
| 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 Advantage |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| 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: Opus (Opus Packaging Group) HMA |
$10.83
|
| Rate for Payer: PHP Commercial |
$12.27
|
| 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 |
$2.35 |
| Max. Negotiated Rate |
$14.93 |
| Rate for Payer: Aetna American Axle |
$9.39
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.61
|
| Rate for Payer: BCBS Complete |
$2.47
|
| Rate for Payer: BCBS MAPPO |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$14.93
|
| Rate for Payer: BCN Commercial |
$14.93
|
| Rate for Payer: BCN Medicare Advantage |
$4.49
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cofinity Advantage |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.49
|
| 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 |
$4.49
|
| Rate for Payer: Mclaren Medicare |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.71
|
| Rate for Payer: Meridian Medicaid |
$4.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$13.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.83
|
| Rate for Payer: PACE Medicare |
$4.27
|
| Rate for Payer: PACE SWMI |
$4.49
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.70
|
| Rate for Payer: Priority Health Medicare |
$4.49
|
| Rate for Payer: Priority Health SBD |
$9.10
|
| Rate for Payer: Priority Health Tiered Network |
$11.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.61
|
| Rate for Payer: UHC Core |
$7.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.49
|
| Rate for Payer: UHC Exchange |
$7.61
|
| Rate for Payer: UHC Medicaid |
$2.35
|
| Rate for Payer: UHCCP Medicaid |
$2.35
|
| Rate for Payer: UMR Bronson Commercial |
$5.34
|
| Rate for Payer: VA VA |
$4.49
|
| 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 Advantage |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| 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: Opus (Opus Packaging Group) HMA |
$4.16
|
| Rate for Payer: PHP Commercial |
$4.71
|
| 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 |
$1.27 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.02
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$7.89
|
| Rate for Payer: BCN Commercial |
$7.89
|
| Rate for Payer: BCN Medicare Advantage |
$2.42
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Advantage |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.42
|
| 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 |
$2.42
|
| Rate for Payer: Mclaren Medicare |
$2.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.54
|
| Rate for Payer: Meridian Medicaid |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.16
|
| Rate for Payer: PACE Medicare |
$2.30
|
| Rate for Payer: PACE SWMI |
$2.42
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: PHP Medicare Advantage |
$2.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.61
|
| Rate for Payer: Priority Health Medicare |
$2.42
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: Priority Health Tiered Network |
$6.09
|
| Rate for Payer: Railroad Medicare Medicare |
$2.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.03
|
| Rate for Payer: UHC Core |
$4.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.42
|
| Rate for Payer: UHC Exchange |
$4.03
|
| Rate for Payer: UHC Medicaid |
$1.27
|
| Rate for Payer: UHCCP Medicaid |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: VA VA |
$2.42
|
| 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 Advantage |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| 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: Opus (Opus Packaging Group) HMA |
$4.16
|
| Rate for Payer: PHP Commercial |
$4.71
|
| 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 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 |
$1.27 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.02
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$7.89
|
| Rate for Payer: BCN Commercial |
$7.89
|
| Rate for Payer: BCN Medicare Advantage |
$2.42
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Advantage |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.42
|
| 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 |
$2.42
|
| Rate for Payer: Mclaren Medicare |
$2.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.54
|
| Rate for Payer: Meridian Medicaid |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.16
|
| Rate for Payer: PACE Medicare |
$2.30
|
| Rate for Payer: PACE SWMI |
$2.42
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: PHP Medicare Advantage |
$2.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.61
|
| Rate for Payer: Priority Health Medicare |
$2.42
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: Priority Health Tiered Network |
$6.09
|
| Rate for Payer: Railroad Medicare Medicare |
$2.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.03
|
| Rate for Payer: UHC Core |
$4.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.42
|
| Rate for Payer: UHC Exchange |
$4.03
|
| Rate for Payer: UHC Medicaid |
$1.27
|
| Rate for Payer: UHCCP Medicaid |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: VA VA |
$2.42
|
| 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 |
$1.27 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.02
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$7.89
|
| Rate for Payer: BCN Commercial |
$7.89
|
| Rate for Payer: BCN Medicare Advantage |
$2.42
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Advantage |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.42
|
| 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 |
$2.42
|
| Rate for Payer: Mclaren Medicare |
$2.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.54
|
| Rate for Payer: Meridian Medicaid |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.16
|
| Rate for Payer: PACE Medicare |
$2.30
|
| Rate for Payer: PACE SWMI |
$2.42
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: PHP Medicare Advantage |
$2.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.61
|
| Rate for Payer: Priority Health Medicare |
$2.42
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: Priority Health Tiered Network |
$6.09
|
| Rate for Payer: Railroad Medicare Medicare |
$2.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.03
|
| Rate for Payer: UHC Core |
$4.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.42
|
| Rate for Payer: UHC Exchange |
$4.03
|
| Rate for Payer: UHC Medicaid |
$1.27
|
| Rate for Payer: UHCCP Medicaid |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: VA VA |
$2.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
