|
CEFEPIME 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$20.64
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna Commercial |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cofinity Advantage |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.51
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.48
|
| Rate for Payer: PHP Commercial |
$17.54
|
| Rate for Payer: Priority Health SBD |
$13.00
|
|
|
CEFEPIME 2 GM IVPB (IV PREMIX)
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Advantage |
$15.57
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.69
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health SBD |
$14.02
|
|
|
CEFEPIME 2 GM IVPB (IV PREMIX)
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Advantage |
$15.57
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.69
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$25.19
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$22.67 |
| Rate for Payer: Aetna Commercial |
$21.41
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Commercial |
$27.57
|
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Commercial |
$36.77
|
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Commercial |
$23.28
|
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Medicare |
$15.03
|
| Rate for Payer: Aetna Medicare |
$13.70
|
| Rate for Payer: Aetna Medicare |
$9.59
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Aetna Medicare |
$12.83
|
| Rate for Payer: Aetna Medicare |
$21.63
|
| Rate for Payer: Aetna Medicare |
$16.52
|
| Rate for Payer: Aetna Medicare |
$16.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.08
|
| Rate for Payer: BCBS Complete |
$10.96
|
| Rate for Payer: BCBS Complete |
$13.21
|
| Rate for Payer: BCBS Complete |
$10.08
|
| Rate for Payer: BCBS Complete |
$10.26
|
| Rate for Payer: BCBS Complete |
$12.97
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS Complete |
$17.30
|
| Rate for Payer: BCBS Complete |
$12.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$34.61
|
| Rate for Payer: Cash Price |
$34.61
|
| Rate for Payer: Cofinity Advantage |
$13.42
|
| Rate for Payer: Cofinity Advantage |
$22.70
|
| Rate for Payer: Cofinity Advantage |
$17.96
|
| Rate for Payer: Cofinity Advantage |
$30.28
|
| Rate for Payer: Cofinity Advantage |
$17.63
|
| Rate for Payer: Cofinity Advantage |
$19.17
|
| Rate for Payer: Cofinity Advantage |
$21.04
|
| Rate for Payer: Cofinity Advantage |
$23.12
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Cofinity Commercial |
$37.20
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$21.66
|
| Rate for Payer: Cofinity Commercial |
$25.85
|
| Rate for Payer: Cofinity Commercial |
$22.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.94
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$38.93
|
| Rate for Payer: Healthscope Commercial |
$27.05
|
| Rate for Payer: Healthscope Commercial |
$24.65
|
| Rate for Payer: Healthscope Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Healthscope Commercial |
$22.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.54
|
| Rate for Payer: PHP Commercial |
$21.81
|
| Rate for Payer: PHP Commercial |
$25.55
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$21.41
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$23.28
|
| Rate for Payer: PHP Commercial |
$36.77
|
| Rate for Payer: PHP Commercial |
$27.57
|
| Rate for Payer: Priority Health SBD |
$15.87
|
| Rate for Payer: Priority Health SBD |
$27.25
|
| Rate for Payer: Priority Health SBD |
$20.43
|
| Rate for Payer: Priority Health SBD |
$16.17
|
| Rate for Payer: Priority Health SBD |
$18.94
|
| Rate for Payer: Priority Health SBD |
$20.81
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: Priority Health SBD |
$17.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$32.43
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.43 |
| Max. Negotiated Rate |
$29.19 |
| Rate for Payer: Aetna Commercial |
$27.57
|
| Rate for Payer: Aetna Commercial |
$23.28
|
| Rate for Payer: Aetna Commercial |
$36.77
|
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Commercial |
$21.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.54
|
| Rate for Payer: Cash Price |
$34.61
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cofinity Advantage |
$23.12
|
| Rate for Payer: Cofinity Advantage |
$30.28
|
| Rate for Payer: Cofinity Advantage |
$21.04
|
| Rate for Payer: Cofinity Advantage |
$17.63
|
| Rate for Payer: Cofinity Advantage |
$22.70
|
| Rate for Payer: Cofinity Advantage |
$13.42
|
| Rate for Payer: Cofinity Advantage |
$19.17
|
| Rate for Payer: Cofinity Advantage |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Cofinity Commercial |
$21.66
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$25.85
|
| Rate for Payer: Cofinity Commercial |
$37.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.91
|
| Rate for Payer: Healthscope Commercial |
$24.65
|
| Rate for Payer: Healthscope Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$22.67
|
| Rate for Payer: Healthscope Commercial |
$27.05
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$38.93
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Healthscope Commercial |
$23.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.25
|
| Rate for Payer: PHP Commercial |
$21.41
|
| Rate for Payer: PHP Commercial |
$36.77
|
| Rate for Payer: PHP Commercial |
$23.28
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$27.57
|
| Rate for Payer: PHP Commercial |
$21.81
|
| Rate for Payer: PHP Commercial |
$25.55
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: Priority Health SBD |
$20.43
|
| Rate for Payer: Priority Health SBD |
$17.26
|
| Rate for Payer: Priority Health SBD |
$16.17
|
| Rate for Payer: Priority Health SBD |
$20.81
|
| Rate for Payer: Priority Health SBD |
$27.25
|
| Rate for Payer: Priority Health SBD |
$18.94
|
| Rate for Payer: Priority Health SBD |
$15.87
|
|
|
CEFEPIME 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$30.06
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$27.05 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Medicare |
$15.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.54
|
| Rate for Payer: BCBS Complete |
$12.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cofinity Advantage |
$21.04
|
| Rate for Payer: Cofinity Commercial |
$25.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$27.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.55
|
| Rate for Payer: PHP Commercial |
$25.55
|
| Rate for Payer: Priority Health SBD |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
|
|
CEFEPIME 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$30.06
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$27.05 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.54
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cofinity Advantage |
$21.04
|
| Rate for Payer: Cofinity Commercial |
$25.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$27.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.55
|
| Rate for Payer: PHP Commercial |
$25.55
|
| Rate for Payer: Priority Health SBD |
$18.94
|
|
|
CEFEPIME IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$1.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Advantage |
$1.23
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.31
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health SBD |
$1.10
|
|
|
CEFEPIME IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$1.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: BCBS Complete |
$0.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Advantage |
$1.23
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.31
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health SBD |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
|
|
CEFEPIME IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$16.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$15.07 |
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna Medicare |
$8.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.89
|
| Rate for Payer: BCBS Complete |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cofinity Advantage |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.56
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
|
|
CEFEPIME IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$16.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$15.07 |
| 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 Advantage |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.56
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: Priority Health SBD |
$10.55
|
|
|
CEFEPIME (MAXIPIME) 4 GRAM /540 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
IP
|
$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 Advantage |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| 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: Opus (Opus Packaging Group) HMA |
$34.24
|
| Rate for Payer: PHP Commercial |
$38.81
|
| Rate for Payer: Priority Health SBD |
$28.77
|
|
|
CEFEPIME (MAXIPIME) 4 GRAM /540 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
OP
|
$45.66
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| 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 |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cofinity Advantage |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.53
|
| Rate for Payer: Healthscope Commercial |
$41.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.24
|
| Rate for Payer: PHP Commercial |
$38.81
|
| Rate for Payer: Priority Health SBD |
$28.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$814.85
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
192885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$513.36 |
| Max. Negotiated Rate |
$733.37 |
| Rate for Payer: Aetna Commercial |
$692.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$529.65
|
| Rate for Payer: Cash Price |
$651.88
|
| Rate for Payer: Cofinity Advantage |
$570.39
|
| Rate for Payer: Cofinity Commercial |
$700.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$651.88
|
| Rate for Payer: Healthscope Commercial |
$733.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$692.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$611.14
|
| Rate for Payer: PHP Commercial |
$692.62
|
| Rate for Payer: Priority Health SBD |
$513.36
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$814.85
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
192885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$733.37 |
| Rate for Payer: Aetna Commercial |
$692.62
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$529.65
|
| 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 |
$6.06
|
| Rate for Payer: BCN Commercial |
$6.06
|
| Rate for Payer: BCN Medicare Advantage |
$2.42
|
| Rate for Payer: Cash Price |
$651.88
|
| Rate for Payer: Cash Price |
$651.88
|
| Rate for Payer: Cofinity Advantage |
$570.39
|
| Rate for Payer: Cofinity Commercial |
$700.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$651.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$733.37
|
| Rate for Payer: Mclaren Medicaid |
$1.27
|
| 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 |
$692.62
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$611.14
|
| Rate for Payer: PACE Medicare |
$2.30
|
| Rate for Payer: PACE SWMI |
$2.42
|
| Rate for Payer: PHP Commercial |
$692.62
|
| 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 |
$7.64
|
| Rate for Payer: Priority Health Medicare |
$2.42
|
| Rate for Payer: Priority Health SBD |
$513.36
|
| Rate for Payer: Priority Health Tiered Network |
$6.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.99
|
| Rate for Payer: UHC Core |
$3.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.42
|
| Rate for Payer: UHC Exchange |
$3.99
|
| Rate for Payer: UHC Medicaid |
$1.27
|
| Rate for Payer: UHCCP Medicaid |
$1.27
|
| Rate for Payer: VA VA |
$2.42
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$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 Advantage |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| 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: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health SBD |
$10.84
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$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 |
$8.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Trust/PPO |
$11.89
|
| Rate for Payer: BCN Commercial |
$11.89
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Advantage |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.82
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Exchange |
$7.82
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$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 Advantage |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| 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: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health SBD |
$10.84
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$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 |
$8.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Trust/PPO |
$11.89
|
| Rate for Payer: BCN Commercial |
$11.89
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Advantage |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.82
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Exchange |
$7.82
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$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 Advantage |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| 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: Opus (Opus Packaging Group) HMA |
$22.04
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health SBD |
$18.52
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
NDC 25021011020
|
| Hospital Charge Code |
301722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| 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 Advantage |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.04
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.10
|
| Rate for Payer: UHC Core |
$15.31
|
| Rate for Payer: UHC Exchange |
$11.55
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
NDC 25021011020
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| 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 Advantage |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.04
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.10
|
| Rate for Payer: UHC Core |
$15.31
|
| Rate for Payer: UHC Exchange |
$11.55
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.91
|
|
|
Service Code
|
NDC 44567024625
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.73
|
| Rate for Payer: Cofinity Advantage |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$22.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.73
|
| Rate for Payer: Healthscope Commercial |
$23.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$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 Advantage |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| 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: Opus (Opus Packaging Group) HMA |
$22.04
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health SBD |
$18.52
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.91
|
|
|
Service Code
|
NDC 44567024625
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$12.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: Cash Price |
$20.73
|
| Rate for Payer: Cofinity Advantage |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$22.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.73
|
| Rate for Payer: Healthscope Commercial |
$23.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.84
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Exchange |
$10.18
|
|
