Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CEFEPIME IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION

Facility

$16.75

Service Code	HCPCS J0692
Hospital Charge Code	180550
Hospital Revenue Code	636
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$15.08
Rate for Payer: Aetna Commercial	$14.24
Rate for Payer: Aetna New Business (MI Preferred)	$10.89
Rate for Payer: Cash Price	$13.40
Rate for Payer: Cofinity Commercial	$11.72
Rate for Payer: Cofinity Commercial	$14.40
Rate for Payer: Cofinity Medicare Advantage	$11.72
Rate for Payer: Encore Health Key Benefits Commercial	$13.40
Rate for Payer: Healthscope Commercial	$15.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.24
Rate for Payer: PHP Commercial	$14.24
Rate for Payer: Priority Health Cigna Priority Health	$10.89
Rate for Payer: Priority Health SBD	$10.55

CEFEPIME (MAXIPIME) 4 GRAM /540 ML CONTINUOUS INFUSION (IV PREMIX)

Facility

$45.66

Service Code	HCPCS J2543
Hospital Charge Code	200113
Hospital Revenue Code	636
Min. Negotiated Rate	$28.77
Max. Negotiated Rate	$41.09
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna New Business (MI Preferred)	$29.68
Rate for Payer: Cash Price	$36.53
Rate for Payer: Cofinity Commercial	$31.96
Rate for Payer: Cofinity Commercial	$39.27
Rate for Payer: Cofinity Medicare Advantage	$31.96
Rate for Payer: Encore Health Key Benefits Commercial	$36.53
Rate for Payer: Healthscope Commercial	$41.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.81
Rate for Payer: PHP Commercial	$38.81
Rate for Payer: Priority Health Cigna Priority Health	$29.68
Rate for Payer: Priority Health SBD	$28.77

CEFEPIME (MAXIPIME) 4 GRAM /540 ML CONTINUOUS INFUSION (IV PREMIX)

Facility

$45.66

Service Code	HCPCS J2543
Hospital Charge Code	200113
Hospital Revenue Code	636
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$41.09
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Medicare	$22.83
Rate for Payer: Aetna New Business (MI Preferred)	$29.68
Rate for Payer: BCBS Complete	$18.26
Rate for Payer: BCBS Trust/PPO	$3.11
Rate for Payer: BCN Commercial	$3.11
Rate for Payer: Cash Price	$36.53
Rate for Payer: Cash Price	$36.53
Rate for Payer: Cofinity Commercial	$31.96
Rate for Payer: Cofinity Commercial	$39.27
Rate for Payer: Cofinity Medicare Advantage	$31.96
Rate for Payer: Encore Health Key Benefits Commercial	$36.53
Rate for Payer: Healthscope Commercial	$41.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.81
Rate for Payer: PHP Commercial	$38.81
Rate for Payer: Priority Health Cigna Priority Health	$29.68
Rate for Payer: Priority Health SBD	$28.77

CEFOXITIN 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM

Facility

$17.21

Service Code	HCPCS J0694
Hospital Charge Code	301721
Hospital Revenue Code	636
Min. Negotiated Rate	$10.84
Max. Negotiated Rate	$15.49
Rate for Payer: Aetna Commercial	$14.63
Rate for Payer: Aetna New Business (MI Preferred)	$11.19
Rate for Payer: Cash Price	$13.77
Rate for Payer: Cofinity Commercial	$12.05
Rate for Payer: Cofinity Commercial	$14.80
Rate for Payer: Cofinity Medicare Advantage	$12.05
Rate for Payer: Encore Health Key Benefits Commercial	$13.77
Rate for Payer: Healthscope Commercial	$15.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.63
Rate for Payer: PHP Commercial	$14.63
Rate for Payer: Priority Health Cigna Priority Health	$11.19
Rate for Payer: Priority Health SBD	$10.84

CEFOXITIN 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM

Facility

$17.21

Service Code	HCPCS J0694
Hospital Charge Code	301721
Hospital Revenue Code	636
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$15.49
Rate for Payer: Aetna Commercial	$14.63
Rate for Payer: Aetna Medicare	$8.60
Rate for Payer: Aetna New Business (MI Preferred)	$11.19
Rate for Payer: BCBS Complete	$6.88
Rate for Payer: BCBS Trust/PPO	$12.73
Rate for Payer: BCN Commercial	$12.73
Rate for Payer: Cash Price	$13.77
Rate for Payer: Cash Price	$13.77
Rate for Payer: Cofinity Commercial	$12.05
Rate for Payer: Cofinity Commercial	$14.80
Rate for Payer: Cofinity Medicare Advantage	$12.05
Rate for Payer: Encore Health Key Benefits Commercial	$13.77
Rate for Payer: Healthscope Commercial	$15.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.63
Rate for Payer: PHP Commercial	$14.63
Rate for Payer: Priority Health Cigna Priority Health	$11.19
Rate for Payer: Priority Health SBD	$10.84

CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION

Facility

$17.21

Service Code	HCPCS J0694
Hospital Charge Code	9461
Hospital Revenue Code	636
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$15.49
Rate for Payer: Aetna Commercial	$14.63
Rate for Payer: Aetna Medicare	$8.60
Rate for Payer: Aetna New Business (MI Preferred)	$11.19
Rate for Payer: BCBS Complete	$6.88
Rate for Payer: BCBS Trust/PPO	$12.73
Rate for Payer: BCN Commercial	$12.73
Rate for Payer: Cash Price	$13.77
Rate for Payer: Cash Price	$13.77
Rate for Payer: Cofinity Commercial	$12.05
Rate for Payer: Cofinity Commercial	$14.80
Rate for Payer: Cofinity Medicare Advantage	$12.05
Rate for Payer: Encore Health Key Benefits Commercial	$13.77
Rate for Payer: Healthscope Commercial	$15.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.63
Rate for Payer: PHP Commercial	$14.63
Rate for Payer: Priority Health Cigna Priority Health	$11.19
Rate for Payer: Priority Health SBD	$10.84

CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION

Facility

$17.21

Service Code	HCPCS J0694
Hospital Charge Code	9461
Hospital Revenue Code	636
Min. Negotiated Rate	$10.84
Max. Negotiated Rate	$15.49
Rate for Payer: Aetna Commercial	$14.63
Rate for Payer: Aetna New Business (MI Preferred)	$11.19
Rate for Payer: Cash Price	$13.77
Rate for Payer: Cofinity Commercial	$12.05
Rate for Payer: Cofinity Commercial	$14.80
Rate for Payer: Cofinity Medicare Advantage	$12.05
Rate for Payer: Encore Health Key Benefits Commercial	$13.77
Rate for Payer: Healthscope Commercial	$15.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.63
Rate for Payer: PHP Commercial	$14.63
Rate for Payer: Priority Health Cigna Priority Health	$11.19
Rate for Payer: Priority Health SBD	$10.84

CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM

Facility

$29.39

Service Code	NDC 25021011020
Hospital Charge Code	301722
Hospital Revenue Code	250
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$26.45
Rate for Payer: Aetna Commercial	$24.98
Rate for Payer: Aetna New Business (MI Preferred)	$19.10
Rate for Payer: Cash Price	$23.51
Rate for Payer: Cofinity Commercial	$20.57
Rate for Payer: Cofinity Commercial	$25.28
Rate for Payer: Cofinity Medicare Advantage	$20.57
Rate for Payer: Encore Health Key Benefits Commercial	$23.51
Rate for Payer: Healthscope Commercial	$26.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.98
Rate for Payer: PHP Commercial	$24.98
Rate for Payer: Priority Health Cigna Priority Health	$19.10
Rate for Payer: Priority Health SBD	$18.52

CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM

Facility

$29.39

Service Code	NDC 25021011020
Hospital Charge Code	301722
Hospital Revenue Code	250
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$26.45
Rate for Payer: Aetna Commercial	$24.98
Rate for Payer: Aetna Medicare	$14.70
Rate for Payer: Aetna New Business (MI Preferred)	$19.10
Rate for Payer: BCBS Complete	$11.76
Rate for Payer: Cash Price	$23.51
Rate for Payer: Cofinity Commercial	$20.57
Rate for Payer: Cofinity Commercial	$25.28
Rate for Payer: Cofinity Medicare Advantage	$20.57
Rate for Payer: Encore Health Key Benefits Commercial	$23.51
Rate for Payer: Healthscope Commercial	$26.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.98
Rate for Payer: PHP Commercial	$24.98
Rate for Payer: Priority Health Cigna Priority Health	$19.10
Rate for Payer: Priority Health SBD	$18.52

CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION

Facility

$29.39

Service Code	NDC 25021011020
Hospital Charge Code	9463
Hospital Revenue Code	250
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$26.45
Rate for Payer: Aetna Commercial	$24.98
Rate for Payer: Aetna Medicare	$14.70
Rate for Payer: Aetna New Business (MI Preferred)	$19.10
Rate for Payer: BCBS Complete	$11.76
Rate for Payer: Cash Price	$23.51
Rate for Payer: Cofinity Commercial	$20.57
Rate for Payer: Cofinity Commercial	$25.28
Rate for Payer: Cofinity Medicare Advantage	$20.57
Rate for Payer: Encore Health Key Benefits Commercial	$23.51
Rate for Payer: Healthscope Commercial	$26.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.98
Rate for Payer: PHP Commercial	$24.98
Rate for Payer: Priority Health Cigna Priority Health	$19.10
Rate for Payer: Priority Health SBD	$18.52

CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION

Facility

$29.39

Service Code	NDC 25021011020
Hospital Charge Code	9463
Hospital Revenue Code	250
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$26.45
Rate for Payer: Aetna Commercial	$24.98
Rate for Payer: Aetna New Business (MI Preferred)	$19.10
Rate for Payer: Cash Price	$23.51
Rate for Payer: Cofinity Commercial	$25.28
Rate for Payer: Cofinity Commercial	$20.57
Rate for Payer: Cofinity Medicare Advantage	$20.57
Rate for Payer: Encore Health Key Benefits Commercial	$23.51
Rate for Payer: Healthscope Commercial	$26.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.98
Rate for Payer: PHP Commercial	$24.98
Rate for Payer: Priority Health Cigna Priority Health	$19.10
Rate for Payer: Priority Health SBD	$18.52

CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION

Facility

$29.39

Service Code	NDC 44567024625
Hospital Charge Code	9463
Hospital Revenue Code	250
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$26.45
Rate for Payer: Aetna Commercial	$24.98
Rate for Payer: Aetna New Business (MI Preferred)	$19.10
Rate for Payer: Cash Price	$23.51
Rate for Payer: Cofinity Commercial	$20.57
Rate for Payer: Cofinity Commercial	$25.28
Rate for Payer: Cofinity Medicare Advantage	$20.57
Rate for Payer: Encore Health Key Benefits Commercial	$23.51
Rate for Payer: Healthscope Commercial	$26.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.98
Rate for Payer: PHP Commercial	$24.98
Rate for Payer: Priority Health Cigna Priority Health	$19.10
Rate for Payer: Priority Health SBD	$18.52

CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION

Facility

$29.39

Service Code	NDC 44567024625
Hospital Charge Code	9463
Hospital Revenue Code	250
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$26.45
Rate for Payer: Aetna Commercial	$24.98
Rate for Payer: Aetna Medicare	$14.70
Rate for Payer: Aetna New Business (MI Preferred)	$19.10
Rate for Payer: BCBS Complete	$11.76
Rate for Payer: Cash Price	$23.51
Rate for Payer: Cofinity Commercial	$20.57
Rate for Payer: Cofinity Commercial	$25.28
Rate for Payer: Cofinity Medicare Advantage	$20.57
Rate for Payer: Encore Health Key Benefits Commercial	$23.51
Rate for Payer: Healthscope Commercial	$26.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.98
Rate for Payer: PHP Commercial	$24.98
Rate for Payer: Priority Health Cigna Priority Health	$19.10
Rate for Payer: Priority Health SBD	$18.52

CEFTAROLINE FOSAMIL 0.06 MCG CUSTOM IV FOR DESENSITIZATION

Facility

$0.05

Service Code	NDC 09900000955
Hospital Charge Code	180576
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna Commercial	$0.04
Rate for Payer: Aetna Medicare	$0.03
Rate for Payer: Aetna New Business (MI Preferred)	$0.03
Rate for Payer: BCBS Complete	$0.02
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cofinity Commercial	$0.04
Rate for Payer: Cofinity Commercial	$0.04
Rate for Payer: Cofinity Medicare Advantage	$0.04
Rate for Payer: Encore Health Key Benefits Commercial	$0.04
Rate for Payer: Healthscope Commercial	$0.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.04
Rate for Payer: PHP Commercial	$0.04
Rate for Payer: Priority Health Cigna Priority Health	$0.03
Rate for Payer: Priority Health SBD	$0.03

CEFTAROLINE FOSAMIL 0.06 MCG CUSTOM IV FOR DESENSITIZATION

Facility

$0.05

Service Code	NDC 09900000955
Hospital Charge Code	180576
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna Commercial	$0.04
Rate for Payer: Aetna New Business (MI Preferred)	$0.03
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cofinity Commercial	$0.04
Rate for Payer: Cofinity Commercial	$0.04
Rate for Payer: Cofinity Medicare Advantage	$0.04
Rate for Payer: Encore Health Key Benefits Commercial	$0.04
Rate for Payer: Healthscope Commercial	$0.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.04
Rate for Payer: PHP Commercial	$0.04
Rate for Payer: Priority Health Cigna Priority Health	$0.03
Rate for Payer: Priority Health SBD	$0.03

CEFTAROLINE FOSAMIL 0.6 MCG CUSTOM IV FOR DESENSITIZATION

Facility

$0.05

Service Code	NDC 09900000956
Hospital Charge Code	180577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna Commercial	$0.04
Rate for Payer: Aetna New Business (MI Preferred)	$0.03
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cofinity Commercial	$0.04
Rate for Payer: Cofinity Commercial	$0.04
Rate for Payer: Cofinity Medicare Advantage	$0.04
Rate for Payer: Encore Health Key Benefits Commercial	$0.04
Rate for Payer: Healthscope Commercial	$0.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.04
Rate for Payer: PHP Commercial	$0.04
Rate for Payer: Priority Health Cigna Priority Health	$0.03
Rate for Payer: Priority Health SBD	$0.03

CEFTAROLINE FOSAMIL 0.6 MCG CUSTOM IV FOR DESENSITIZATION

Facility

$0.05

Service Code	NDC 09900000956
Hospital Charge Code	180577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna Commercial	$0.04
Rate for Payer: Aetna Medicare	$0.03
Rate for Payer: Aetna New Business (MI Preferred)	$0.03
Rate for Payer: BCBS Complete	$0.02
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cofinity Commercial	$0.04
Rate for Payer: Cofinity Commercial	$0.04
Rate for Payer: Cofinity Medicare Advantage	$0.04
Rate for Payer: Encore Health Key Benefits Commercial	$0.04
Rate for Payer: Healthscope Commercial	$0.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.04
Rate for Payer: PHP Commercial	$0.04
Rate for Payer: Priority Health Cigna Priority Health	$0.03
Rate for Payer: Priority Health SBD	$0.03

CEFTAROLINE FOSAMIL 600 MCG CUSTOM IV FOR DESENSITIZATION

Facility

$3.60

Service Code	NDC 09900000958
Hospital Charge Code	180579
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$3.24
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare	$1.80
Rate for Payer: Aetna New Business (MI Preferred)	$2.34
Rate for Payer: BCBS Complete	$1.44
Rate for Payer: Cash Price	$2.88
Rate for Payer: Cofinity Commercial	$2.52
Rate for Payer: Cofinity Commercial	$3.10
Rate for Payer: Cofinity Medicare Advantage	$2.52
Rate for Payer: Encore Health Key Benefits Commercial	$2.88
Rate for Payer: Healthscope Commercial	$3.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.06
Rate for Payer: PHP Commercial	$3.06
Rate for Payer: Priority Health Cigna Priority Health	$2.34
Rate for Payer: Priority Health SBD	$2.27

CEFTAROLINE FOSAMIL 600 MCG CUSTOM IV FOR DESENSITIZATION

Facility

$3.60

Service Code	NDC 09900000958
Hospital Charge Code	180579
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$3.24
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna New Business (MI Preferred)	$2.34
Rate for Payer: Cash Price	$2.88
Rate for Payer: Cofinity Commercial	$2.52
Rate for Payer: Cofinity Commercial	$3.10
Rate for Payer: Cofinity Medicare Advantage	$2.52
Rate for Payer: Encore Health Key Benefits Commercial	$2.88
Rate for Payer: Healthscope Commercial	$3.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.06
Rate for Payer: PHP Commercial	$3.06
Rate for Payer: Priority Health Cigna Priority Health	$2.34
Rate for Payer: Priority Health SBD	$2.27

CEFTAROLINE FOSAMIL 600 MG CUSTOM INTRAVENOUS SOLUTION FOR DESENSITIZATION

Facility

$513.76

Service Code	HCPCS J0712
Hospital Charge Code	180582
Hospital Revenue Code	636
Min. Negotiated Rate	$323.67
Max. Negotiated Rate	$462.38
Rate for Payer: Aetna Commercial	$436.70
Rate for Payer: Aetna New Business (MI Preferred)	$333.94
Rate for Payer: Cash Price	$411.01
Rate for Payer: Cofinity Commercial	$359.63
Rate for Payer: Cofinity Commercial	$441.83
Rate for Payer: Cofinity Medicare Advantage	$359.63
Rate for Payer: Encore Health Key Benefits Commercial	$411.01
Rate for Payer: Healthscope Commercial	$462.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$436.70
Rate for Payer: PHP Commercial	$436.70
Rate for Payer: Priority Health Cigna Priority Health	$333.94
Rate for Payer: Priority Health SBD	$323.67

CEFTAROLINE FOSAMIL 600 MG CUSTOM INTRAVENOUS SOLUTION FOR DESENSITIZATION

Facility

$513.76

Service Code	HCPCS J0712
Hospital Charge Code	180582
Hospital Revenue Code	636
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$462.38
Rate for Payer: Aetna Commercial	$436.70
Rate for Payer: Aetna Medicare	$4.11
Rate for Payer: Aetna New Business (MI Preferred)	$333.94
Rate for Payer: Allen County Amish Medical Aid Commercial	$4.94
Rate for Payer: Amish Plain Church Group Commercial	$4.94
Rate for Payer: BCBS Complete	$2.22
Rate for Payer: BCBS MAPPO	$3.95
Rate for Payer: BCBS Trust/PPO	$11.09
Rate for Payer: BCN Commercial	$11.09
Rate for Payer: BCN Medicare Advantage	$3.95
Rate for Payer: Cash Price	$411.01
Rate for Payer: Cash Price	$411.01
Rate for Payer: Cofinity Commercial	$441.83
Rate for Payer: Cofinity Commercial	$359.63
Rate for Payer: Cofinity Medicare Advantage	$359.63
Rate for Payer: Encore Health Key Benefits Commercial	$411.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$3.95
Rate for Payer: Healthscope Commercial	$462.38
Rate for Payer: Mclaren Medicaid	$2.12
Rate for Payer: Mclaren Medicare	$3.95
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$4.15
Rate for Payer: Meridian Medicaid	$2.22
Rate for Payer: MI Amish Medical Board Commercial	$4.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$436.70
Rate for Payer: Nomi Health Commercial	$11.85
Rate for Payer: PACE Medicare	$3.75
Rate for Payer: PACE SWMI	$3.95
Rate for Payer: PHP Commercial	$436.70
Rate for Payer: PHP Medicare Advantage	$3.95
Rate for Payer: Priority Health Choice Medicaid	$2.12
Rate for Payer: Priority Health Cigna Priority Health	$333.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.32
Rate for Payer: Priority Health Medicare	$3.95
Rate for Payer: Priority Health Narrow Network	$9.06
Rate for Payer: Priority Health SBD	$323.67
Rate for Payer: Railroad Medicare Medicare	$3.95
Rate for Payer: UHC All Payor (Choice/PPO)	$11.12
Rate for Payer: UHC Dual Complete DSNP	$3.95
Rate for Payer: UHC Medicare Advantage	$3.95
Rate for Payer: UHCCP Medicaid	$2.22
Rate for Payer: VA VA	$3.95

CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION

Facility

$671.51

Service Code	HCPCS J0712
Hospital Charge Code	107671
Hospital Revenue Code	636
Min. Negotiated Rate	$423.05
Max. Negotiated Rate	$604.36
Rate for Payer: Aetna Commercial	$570.78
Rate for Payer: Aetna New Business (MI Preferred)	$436.48
Rate for Payer: Cash Price	$537.21
Rate for Payer: Cofinity Commercial	$470.06
Rate for Payer: Cofinity Commercial	$577.50
Rate for Payer: Cofinity Medicare Advantage	$470.06
Rate for Payer: Encore Health Key Benefits Commercial	$537.21
Rate for Payer: Healthscope Commercial	$604.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$570.78
Rate for Payer: PHP Commercial	$570.78
Rate for Payer: Priority Health Cigna Priority Health	$436.48
Rate for Payer: Priority Health SBD	$423.05

CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION

Facility

$671.51

Service Code	HCPCS J0712
Hospital Charge Code	107671
Hospital Revenue Code	636
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$604.36
Rate for Payer: Aetna Commercial	$570.78
Rate for Payer: Aetna Medicare	$4.11
Rate for Payer: Aetna New Business (MI Preferred)	$436.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$4.94
Rate for Payer: Amish Plain Church Group Commercial	$4.94
Rate for Payer: BCBS Complete	$2.22
Rate for Payer: BCBS MAPPO	$3.95
Rate for Payer: BCBS Trust/PPO	$11.09
Rate for Payer: BCN Commercial	$11.09
Rate for Payer: BCN Medicare Advantage	$3.95
Rate for Payer: Cash Price	$537.21
Rate for Payer: Cash Price	$537.21
Rate for Payer: Cofinity Commercial	$577.50
Rate for Payer: Cofinity Commercial	$470.06
Rate for Payer: Cofinity Medicare Advantage	$470.06
Rate for Payer: Encore Health Key Benefits Commercial	$537.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$3.95
Rate for Payer: Healthscope Commercial	$604.36
Rate for Payer: Mclaren Medicaid	$2.12
Rate for Payer: Mclaren Medicare	$3.95
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$4.15
Rate for Payer: Meridian Medicaid	$2.22
Rate for Payer: MI Amish Medical Board Commercial	$4.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$570.78
Rate for Payer: Nomi Health Commercial	$11.85
Rate for Payer: PACE Medicare	$3.75
Rate for Payer: PACE SWMI	$3.95
Rate for Payer: PHP Commercial	$570.78
Rate for Payer: PHP Medicare Advantage	$3.95
Rate for Payer: Priority Health Choice Medicaid	$2.12
Rate for Payer: Priority Health Cigna Priority Health	$436.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.32
Rate for Payer: Priority Health Medicare	$3.95
Rate for Payer: Priority Health Narrow Network	$9.06
Rate for Payer: Priority Health SBD	$423.05
Rate for Payer: Railroad Medicare Medicare	$3.95
Rate for Payer: UHC All Payor (Choice/PPO)	$11.12
Rate for Payer: UHC Dual Complete DSNP	$3.95
Rate for Payer: UHC Medicare Advantage	$3.95
Rate for Payer: UHCCP Medicaid	$2.22
Rate for Payer: VA VA	$3.95

CEFTAROLINE FOSAMIL 600 MG IV MINI-BAG PLUS COMPONENT CUSTOM

Facility

$671.51

Service Code	HCPCS J0712
Hospital Charge Code	301724
Hospital Revenue Code	636
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$604.36
Rate for Payer: Aetna Commercial	$570.78
Rate for Payer: Aetna Medicare	$4.11
Rate for Payer: Aetna New Business (MI Preferred)	$436.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$4.94
Rate for Payer: Amish Plain Church Group Commercial	$4.94
Rate for Payer: BCBS Complete	$2.22
Rate for Payer: BCBS MAPPO	$3.95
Rate for Payer: BCBS Trust/PPO	$11.09
Rate for Payer: BCN Commercial	$11.09
Rate for Payer: BCN Medicare Advantage	$3.95
Rate for Payer: Cash Price	$537.21
Rate for Payer: Cash Price	$537.21
Rate for Payer: Cofinity Commercial	$577.50
Rate for Payer: Cofinity Commercial	$470.06
Rate for Payer: Cofinity Medicare Advantage	$470.06
Rate for Payer: Encore Health Key Benefits Commercial	$537.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$3.95
Rate for Payer: Healthscope Commercial	$604.36
Rate for Payer: Mclaren Medicaid	$2.12
Rate for Payer: Mclaren Medicare	$3.95
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$4.15
Rate for Payer: Meridian Medicaid	$2.22
Rate for Payer: MI Amish Medical Board Commercial	$4.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$570.78
Rate for Payer: Nomi Health Commercial	$11.85
Rate for Payer: PACE Medicare	$3.75
Rate for Payer: PACE SWMI	$3.95
Rate for Payer: PHP Commercial	$570.78
Rate for Payer: PHP Medicare Advantage	$3.95
Rate for Payer: Priority Health Choice Medicaid	$2.12
Rate for Payer: Priority Health Cigna Priority Health	$436.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.32
Rate for Payer: Priority Health Medicare	$3.95
Rate for Payer: Priority Health Narrow Network	$9.06
Rate for Payer: Priority Health SBD	$423.05
Rate for Payer: Railroad Medicare Medicare	$3.95
Rate for Payer: UHC All Payor (Choice/PPO)	$11.12
Rate for Payer: UHC Dual Complete DSNP	$3.95
Rate for Payer: UHC Medicare Advantage	$3.95
Rate for Payer: UHCCP Medicaid	$2.22
Rate for Payer: VA VA	$3.95

CEFTAROLINE FOSAMIL 600 MG IV MINI-BAG PLUS COMPONENT CUSTOM

Facility

$671.51

Service Code	HCPCS J0712
Hospital Charge Code	301724
Hospital Revenue Code	636
Min. Negotiated Rate	$423.05
Max. Negotiated Rate	$604.36
Rate for Payer: Aetna Commercial	$570.78
Rate for Payer: Aetna New Business (MI Preferred)	$436.48
Rate for Payer: Cash Price	$537.21
Rate for Payer: Cofinity Commercial	$470.06
Rate for Payer: Cofinity Commercial	$577.50
Rate for Payer: Cofinity Medicare Advantage	$470.06
Rate for Payer: Encore Health Key Benefits Commercial	$537.21
Rate for Payer: Healthscope Commercial	$604.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$570.78
Rate for Payer: PHP Commercial	$570.78
Rate for Payer: Priority Health Cigna Priority Health	$436.48
Rate for Payer: Priority Health SBD	$423.05

Know your out-of-pocket cost for care.

All Charges