|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$423.70
|
|
|
Service Code
|
NDC 65862050301
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.63 |
| Max. Negotiated Rate |
$381.33 |
| Rate for Payer: Aetna Commercial |
$360.14
|
| Rate for Payer: Aetna Medicare |
$110.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.41
|
| Rate for Payer: BCBS Complete |
$169.48
|
| Rate for Payer: BCBS MAPPO |
$105.92
|
| Rate for Payer: BCBS Trust/PPO |
$348.32
|
| Rate for Payer: BCN Commercial |
$329.43
|
| Rate for Payer: BCN Medicare Advantage |
$105.92
|
| Rate for Payer: Cash Price |
$338.96
|
| Rate for Payer: Cofinity Commercial |
$364.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.92
|
| Rate for Payer: Healthscope Commercial |
$381.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.14
|
| Rate for Payer: Nomi Health Commercial |
$347.43
|
| Rate for Payer: PACE Senior Care Partners |
$100.63
|
| Rate for Payer: PACE SWMI |
$105.92
|
| Rate for Payer: PHP Commercial |
$360.14
|
| Rate for Payer: PHP Medicare Advantage |
$105.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.40
|
| Rate for Payer: Priority Health HMO/PPO |
$368.62
|
| Rate for Payer: Priority Health Medicare |
$106.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.88
|
| Rate for Payer: Railroad Medicare Medicare |
$105.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.86
|
| Rate for Payer: UHC Core |
$353.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.92
|
| Rate for Payer: UHC Exchange |
$105.92
|
| Rate for Payer: UHC Medicare Advantage |
$105.92
|
| Rate for Payer: VA VA |
$105.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.78
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$14.68
|
|
|
Service Code
|
NDC 60687080311
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$13.21 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: Aetna Medicare |
$3.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.59
|
| Rate for Payer: BCBS Complete |
$5.87
|
| Rate for Payer: BCBS MAPPO |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$12.07
|
| Rate for Payer: BCN Commercial |
$11.41
|
| Rate for Payer: BCN Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$11.74
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$13.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.48
|
| Rate for Payer: Nomi Health Commercial |
$12.04
|
| Rate for Payer: PACE Senior Care Partners |
$3.49
|
| Rate for Payer: PACE SWMI |
$3.67
|
| Rate for Payer: PHP Commercial |
$12.48
|
| Rate for Payer: PHP Medicare Advantage |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.54
|
| Rate for Payer: Priority Health HMO/PPO |
$12.77
|
| Rate for Payer: Priority Health Medicare |
$3.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.84
|
| Rate for Payer: Railroad Medicare Medicare |
$3.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.92
|
| Rate for Payer: UHC Core |
$12.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.67
|
| Rate for Payer: UHC Exchange |
$3.67
|
| Rate for Payer: UHC Medicare Advantage |
$3.67
|
| Rate for Payer: VA VA |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.01
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$423.70
|
|
|
Service Code
|
NDC 65862050301
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$381.33 |
| Rate for Payer: Aetna Commercial |
$360.14
|
| Rate for Payer: BCBS Trust/PPO |
$345.87
|
| Rate for Payer: BCN Commercial |
$327.44
|
| Rate for Payer: Cash Price |
$338.96
|
| Rate for Payer: Cofinity Commercial |
$364.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.96
|
| Rate for Payer: Healthscope Commercial |
$381.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.14
|
| Rate for Payer: Nomi Health Commercial |
$347.43
|
| Rate for Payer: PHP Commercial |
$360.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.40
|
| Rate for Payer: Priority Health HMO/PPO |
$368.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.86
|
| Rate for Payer: UHC Core |
$353.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.78
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$63.27
|
|
|
Service Code
|
NDC 00093227534
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.13 |
| Max. Negotiated Rate |
$56.94 |
| Rate for Payer: Aetna Commercial |
$53.78
|
| Rate for Payer: BCBS Trust/PPO |
$51.65
|
| Rate for Payer: BCN Commercial |
$48.90
|
| Rate for Payer: Cash Price |
$50.62
|
| Rate for Payer: Cofinity Commercial |
$54.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.62
|
| Rate for Payer: Healthscope Commercial |
$56.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.78
|
| Rate for Payer: Nomi Health Commercial |
$51.88
|
| Rate for Payer: PHP Commercial |
$53.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.13
|
| Rate for Payer: Priority Health HMO/PPO |
$55.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.68
|
| Rate for Payer: UHC Core |
$52.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.45
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$1,467.79
|
|
|
Service Code
|
NDC 60687080301
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$1,321.01 |
| Rate for Payer: Aetna Commercial |
$1,247.62
|
| Rate for Payer: Aetna Medicare |
$381.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.68
|
| Rate for Payer: BCBS Complete |
$587.12
|
| Rate for Payer: BCBS MAPPO |
$366.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.67
|
| Rate for Payer: BCN Commercial |
$1,141.21
|
| Rate for Payer: BCN Medicare Advantage |
$366.95
|
| Rate for Payer: Cash Price |
$1,174.23
|
| Rate for Payer: Cofinity Commercial |
$1,262.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,174.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.95
|
| Rate for Payer: Healthscope Commercial |
$1,321.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,100.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$385.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,247.62
|
| Rate for Payer: Nomi Health Commercial |
$1,203.59
|
| Rate for Payer: PACE Senior Care Partners |
$348.60
|
| Rate for Payer: PACE SWMI |
$366.95
|
| Rate for Payer: PHP Commercial |
$1,247.62
|
| Rate for Payer: PHP Medicare Advantage |
$366.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.06
|
| Rate for Payer: Priority Health HMO/PPO |
$1,276.98
|
| Rate for Payer: Priority Health Medicare |
$370.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$983.42
|
| Rate for Payer: Railroad Medicare Medicare |
$366.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,291.66
|
| Rate for Payer: UHC Core |
$1,225.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.95
|
| Rate for Payer: UHC Exchange |
$366.95
|
| Rate for Payer: UHC Medicare Advantage |
$366.95
|
| Rate for Payer: VA VA |
$366.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,100.84
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$1,467.79
|
|
|
Service Code
|
NDC 60687080301
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$954.06 |
| Max. Negotiated Rate |
$1,321.01 |
| Rate for Payer: Aetna Commercial |
$1,247.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,198.16
|
| Rate for Payer: BCN Commercial |
$1,134.31
|
| Rate for Payer: Cash Price |
$1,174.23
|
| Rate for Payer: Cofinity Commercial |
$1,262.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,174.23
|
| Rate for Payer: Healthscope Commercial |
$1,321.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,100.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,247.62
|
| Rate for Payer: Nomi Health Commercial |
$1,203.59
|
| Rate for Payer: PHP Commercial |
$1,247.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.06
|
| Rate for Payer: Priority Health HMO/PPO |
$1,276.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$983.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,291.66
|
| Rate for Payer: UHC Core |
$1,225.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,100.84
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$101.86
|
|
|
Service Code
|
NDC 66685100100
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.21 |
| Max. Negotiated Rate |
$91.67 |
| Rate for Payer: Aetna Commercial |
$86.58
|
| Rate for Payer: BCBS Trust/PPO |
$83.15
|
| Rate for Payer: BCN Commercial |
$78.72
|
| Rate for Payer: Cash Price |
$81.49
|
| Rate for Payer: Cofinity Commercial |
$87.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.49
|
| Rate for Payer: Healthscope Commercial |
$91.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.58
|
| Rate for Payer: Nomi Health Commercial |
$83.53
|
| Rate for Payer: PHP Commercial |
$86.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.21
|
| Rate for Payer: Priority Health HMO/PPO |
$88.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.64
|
| Rate for Payer: UHC Core |
$85.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.40
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$101.28
|
|
|
Service Code
|
NDC 00781185220
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$91.15 |
| Rate for Payer: Aetna Commercial |
$86.09
|
| Rate for Payer: Aetna Medicare |
$26.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.65
|
| Rate for Payer: BCBS Complete |
$40.51
|
| Rate for Payer: BCBS MAPPO |
$25.32
|
| Rate for Payer: BCBS Trust/PPO |
$83.26
|
| Rate for Payer: BCN Commercial |
$78.75
|
| Rate for Payer: BCN Medicare Advantage |
$25.32
|
| Rate for Payer: Cash Price |
$81.02
|
| Rate for Payer: Cofinity Commercial |
$87.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.32
|
| Rate for Payer: Healthscope Commercial |
$91.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.09
|
| Rate for Payer: Nomi Health Commercial |
$83.05
|
| Rate for Payer: PACE Senior Care Partners |
$24.05
|
| Rate for Payer: PACE SWMI |
$25.32
|
| Rate for Payer: PHP Commercial |
$86.09
|
| Rate for Payer: PHP Medicare Advantage |
$25.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.83
|
| Rate for Payer: Priority Health HMO/PPO |
$88.11
|
| Rate for Payer: Priority Health Medicare |
$25.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.86
|
| Rate for Payer: Railroad Medicare Medicare |
$25.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.13
|
| Rate for Payer: UHC Core |
$84.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.32
|
| Rate for Payer: UHC Exchange |
$25.32
|
| Rate for Payer: UHC Medicare Advantage |
$25.32
|
| Rate for Payer: VA VA |
$25.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.96
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$101.28
|
|
|
Service Code
|
NDC 00781185220
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.83 |
| Max. Negotiated Rate |
$91.15 |
| Rate for Payer: Aetna Commercial |
$86.09
|
| Rate for Payer: BCBS Trust/PPO |
$82.67
|
| Rate for Payer: BCN Commercial |
$78.27
|
| Rate for Payer: Cash Price |
$81.02
|
| Rate for Payer: Cofinity Commercial |
$87.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.02
|
| Rate for Payer: Healthscope Commercial |
$91.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.09
|
| Rate for Payer: Nomi Health Commercial |
$83.05
|
| Rate for Payer: PHP Commercial |
$86.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.83
|
| Rate for Payer: Priority Health HMO/PPO |
$88.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.13
|
| Rate for Payer: UHC Core |
$84.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.96
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$63.27
|
|
|
Service Code
|
NDC 00093227534
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$56.94 |
| Rate for Payer: Aetna Commercial |
$53.78
|
| Rate for Payer: Aetna Medicare |
$16.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.77
|
| Rate for Payer: BCBS Complete |
$25.31
|
| Rate for Payer: BCBS MAPPO |
$15.82
|
| Rate for Payer: BCBS Trust/PPO |
$52.01
|
| Rate for Payer: BCN Commercial |
$49.19
|
| Rate for Payer: BCN Medicare Advantage |
$15.82
|
| Rate for Payer: Cash Price |
$50.62
|
| Rate for Payer: Cofinity Commercial |
$54.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$56.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.78
|
| Rate for Payer: Nomi Health Commercial |
$51.88
|
| Rate for Payer: PACE Senior Care Partners |
$15.03
|
| Rate for Payer: PACE SWMI |
$15.82
|
| Rate for Payer: PHP Commercial |
$53.78
|
| Rate for Payer: PHP Medicare Advantage |
$15.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.13
|
| Rate for Payer: Priority Health HMO/PPO |
$55.04
|
| Rate for Payer: Priority Health Medicare |
$15.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.39
|
| Rate for Payer: Railroad Medicare Medicare |
$15.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.68
|
| Rate for Payer: UHC Core |
$52.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.82
|
| Rate for Payer: UHC Exchange |
$15.82
|
| Rate for Payer: UHC Medicare Advantage |
$15.82
|
| Rate for Payer: VA VA |
$15.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.45
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$14.68
|
|
|
Service Code
|
NDC 60687080311
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$13.21 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: BCBS Trust/PPO |
$11.98
|
| Rate for Payer: BCN Commercial |
$11.34
|
| Rate for Payer: Cash Price |
$11.74
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$13.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.48
|
| Rate for Payer: Nomi Health Commercial |
$12.04
|
| Rate for Payer: PHP Commercial |
$12.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.54
|
| Rate for Payer: Priority Health HMO/PPO |
$12.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.92
|
| Rate for Payer: UHC Core |
$12.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.01
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Commercial |
$13.41
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: BCBS Trust/PPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$14.51
|
| Rate for Payer: BCN Commercial |
$12.19
|
| Rate for Payer: BCN Commercial |
$11.59
|
| Rate for Payer: BCN Commercial |
$13.74
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$14.20
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.11
|
| Rate for Payer: Nomi Health Commercial |
$12.30
|
| Rate for Payer: Nomi Health Commercial |
$12.94
|
| Rate for Payer: Nomi Health Commercial |
$14.58
|
| Rate for Payer: PHP Commercial |
$13.41
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.26
|
| Rate for Payer: Priority Health HMO/PPO |
$15.47
|
| Rate for Payer: Priority Health HMO/PPO |
$13.73
|
| Rate for Payer: Priority Health HMO/PPO |
$13.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$12.52
|
| Rate for Payer: UHC Core |
$14.85
|
| Rate for Payer: UHC Core |
$13.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.84
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Commercial |
$13.41
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: Aetna Medicare |
$4.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.56
|
| Rate for Payer: BCBS Complete |
$6.31
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS Complete |
$7.11
|
| Rate for Payer: BCBS MAPPO |
$4.44
|
| Rate for Payer: BCBS MAPPO |
$3.75
|
| Rate for Payer: BCBS MAPPO |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$12.97
|
| Rate for Payer: BCBS Trust/PPO |
$12.33
|
| Rate for Payer: BCBS Trust/PPO |
$14.62
|
| Rate for Payer: BCN Commercial |
$12.27
|
| Rate for Payer: BCN Commercial |
$13.82
|
| Rate for Payer: BCN Commercial |
$11.66
|
| Rate for Payer: BCN Medicare Advantage |
$3.75
|
| Rate for Payer: BCN Medicare Advantage |
$3.94
|
| Rate for Payer: BCN Medicare Advantage |
$4.44
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$13.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$14.20
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Nomi Health Commercial |
$14.58
|
| Rate for Payer: Nomi Health Commercial |
$12.30
|
| Rate for Payer: Nomi Health Commercial |
$12.94
|
| Rate for Payer: PACE Senior Care Partners |
$4.22
|
| Rate for Payer: PACE Senior Care Partners |
$3.56
|
| Rate for Payer: PACE Senior Care Partners |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.94
|
| Rate for Payer: PACE SWMI |
$3.75
|
| Rate for Payer: PACE SWMI |
$4.44
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: PHP Commercial |
$13.41
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: PHP Medicare Advantage |
$3.94
|
| Rate for Payer: PHP Medicare Advantage |
$4.44
|
| Rate for Payer: PHP Medicare Advantage |
$3.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.26
|
| Rate for Payer: Priority Health HMO/PPO |
$15.47
|
| Rate for Payer: Priority Health HMO/PPO |
$13.05
|
| Rate for Payer: Priority Health HMO/PPO |
$13.73
|
| Rate for Payer: Priority Health Medicare |
$3.79
|
| Rate for Payer: Priority Health Medicare |
$4.49
|
| Rate for Payer: Priority Health Medicare |
$3.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.05
|
| Rate for Payer: Railroad Medicare Medicare |
$3.94
|
| Rate for Payer: Railroad Medicare Medicare |
$4.44
|
| Rate for Payer: Railroad Medicare Medicare |
$3.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$14.85
|
| Rate for Payer: UHC Core |
$13.18
|
| Rate for Payer: UHC Core |
$12.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.94
|
| Rate for Payer: UHC Exchange |
$3.94
|
| Rate for Payer: UHC Exchange |
$3.75
|
| Rate for Payer: UHC Exchange |
$4.44
|
| Rate for Payer: UHC Medicare Advantage |
$3.75
|
| Rate for Payer: UHC Medicare Advantage |
$3.94
|
| Rate for Payer: UHC Medicare Advantage |
$4.44
|
| Rate for Payer: VA VA |
$3.94
|
| Rate for Payer: VA VA |
$4.44
|
| Rate for Payer: VA VA |
$3.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.84
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$17.78
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.51
|
| Rate for Payer: BCN Commercial |
$13.74
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.11
|
| Rate for Payer: Nomi Health Commercial |
$14.58
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: Priority Health HMO/PPO |
$15.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.65
|
| Rate for Payer: UHC Core |
$14.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.34
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$17.78
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.56
|
| Rate for Payer: BCBS Complete |
$7.11
|
| Rate for Payer: BCBS MAPPO |
$4.44
|
| Rate for Payer: BCBS Trust/PPO |
$14.62
|
| Rate for Payer: BCN Commercial |
$13.82
|
| Rate for Payer: BCN Medicare Advantage |
$4.44
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.44
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.11
|
| Rate for Payer: Nomi Health Commercial |
$14.58
|
| Rate for Payer: PACE Senior Care Partners |
$4.22
|
| Rate for Payer: PACE SWMI |
$4.44
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: PHP Medicare Advantage |
$4.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: Priority Health HMO/PPO |
$15.47
|
| Rate for Payer: Priority Health Medicare |
$4.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.91
|
| Rate for Payer: Railroad Medicare Medicare |
$4.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.65
|
| Rate for Payer: UHC Core |
$14.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.44
|
| Rate for Payer: UHC Exchange |
$4.44
|
| Rate for Payer: UHC Medicare Advantage |
$4.44
|
| Rate for Payer: VA VA |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.34
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$27.70
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$24.93 |
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Medicare |
$7.56
|
| Rate for Payer: Aetna Medicare |
$7.20
|
| Rate for Payer: Aetna Medicare |
$7.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.08
|
| Rate for Payer: BCBS Complete |
$11.33
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS MAPPO |
$7.26
|
| Rate for Payer: BCBS MAPPO |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$7.08
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$22.77
|
| Rate for Payer: BCBS Trust/PPO |
$23.89
|
| Rate for Payer: BCN Commercial |
$22.02
|
| Rate for Payer: BCN Commercial |
$22.59
|
| Rate for Payer: BCN Commercial |
$21.54
|
| Rate for Payer: BCN Medicare Advantage |
$6.92
|
| Rate for Payer: BCN Medicare Advantage |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$7.26
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.92
|
| Rate for Payer: Healthscope Commercial |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Nomi Health Commercial |
$23.83
|
| Rate for Payer: Nomi Health Commercial |
$22.71
|
| Rate for Payer: Nomi Health Commercial |
$23.22
|
| Rate for Payer: PACE Senior Care Partners |
$6.90
|
| Rate for Payer: PACE Senior Care Partners |
$6.58
|
| Rate for Payer: PACE Senior Care Partners |
$6.73
|
| Rate for Payer: PACE SWMI |
$7.08
|
| Rate for Payer: PACE SWMI |
$6.92
|
| Rate for Payer: PACE SWMI |
$7.26
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: PHP Commercial |
$24.07
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: PHP Medicare Advantage |
$7.08
|
| Rate for Payer: PHP Medicare Advantage |
$7.26
|
| Rate for Payer: PHP Medicare Advantage |
$6.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.41
|
| Rate for Payer: Priority Health HMO/PPO |
$25.28
|
| Rate for Payer: Priority Health HMO/PPO |
$24.10
|
| Rate for Payer: Priority Health HMO/PPO |
$24.64
|
| Rate for Payer: Priority Health Medicare |
$6.99
|
| Rate for Payer: Priority Health Medicare |
$7.34
|
| Rate for Payer: Priority Health Medicare |
$7.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.56
|
| Rate for Payer: Railroad Medicare Medicare |
$7.08
|
| Rate for Payer: Railroad Medicare Medicare |
$7.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.38
|
| Rate for Payer: UHC Core |
$24.27
|
| Rate for Payer: UHC Core |
$23.65
|
| Rate for Payer: UHC Core |
$23.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.08
|
| Rate for Payer: UHC Exchange |
$7.08
|
| Rate for Payer: UHC Exchange |
$6.92
|
| Rate for Payer: UHC Exchange |
$7.26
|
| Rate for Payer: UHC Medicare Advantage |
$6.92
|
| Rate for Payer: UHC Medicare Advantage |
$7.08
|
| Rate for Payer: UHC Medicare Advantage |
$7.26
|
| Rate for Payer: VA VA |
$7.08
|
| Rate for Payer: VA VA |
$7.26
|
| Rate for Payer: VA VA |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.24
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$27.70
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$24.93 |
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: BCBS Trust/PPO |
$23.12
|
| Rate for Payer: BCBS Trust/PPO |
$22.61
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$21.89
|
| Rate for Payer: BCN Commercial |
$21.41
|
| Rate for Payer: BCN Commercial |
$22.46
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Healthscope Commercial |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Nomi Health Commercial |
$22.71
|
| Rate for Payer: Nomi Health Commercial |
$23.22
|
| Rate for Payer: Nomi Health Commercial |
$23.83
|
| Rate for Payer: PHP Commercial |
$24.07
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.41
|
| Rate for Payer: Priority Health HMO/PPO |
$25.28
|
| Rate for Payer: Priority Health HMO/PPO |
$24.64
|
| Rate for Payer: Priority Health HMO/PPO |
$24.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.38
|
| Rate for Payer: UHC Core |
$23.13
|
| Rate for Payer: UHC Core |
$24.27
|
| Rate for Payer: UHC Core |
$23.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.24
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$29.06
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$26.15 |
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Medicare |
$7.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.08
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS MAPPO |
$7.26
|
| Rate for Payer: BCBS Trust/PPO |
$23.89
|
| Rate for Payer: BCN Commercial |
$22.59
|
| Rate for Payer: BCN Medicare Advantage |
$7.26
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.26
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Nomi Health Commercial |
$23.83
|
| Rate for Payer: PACE Senior Care Partners |
$6.90
|
| Rate for Payer: PACE SWMI |
$7.26
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: PHP Medicare Advantage |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health HMO/PPO |
$25.28
|
| Rate for Payer: Priority Health Medicare |
$7.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.47
|
| Rate for Payer: Railroad Medicare Medicare |
$7.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.57
|
| Rate for Payer: UHC Core |
$24.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.26
|
| Rate for Payer: UHC Exchange |
$7.26
|
| Rate for Payer: UHC Medicare Advantage |
$7.26
|
| Rate for Payer: VA VA |
$7.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$29.06
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$26.15 |
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$22.46
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Nomi Health Commercial |
$23.83
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health HMO/PPO |
$25.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.57
|
| Rate for Payer: UHC Core |
$24.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$36.42
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$32.78 |
| Rate for Payer: Aetna Commercial |
$30.96
|
| Rate for Payer: Aetna Commercial |
$21.29
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: BCBS Trust/PPO |
$29.73
|
| Rate for Payer: BCBS Trust/PPO |
$20.45
|
| Rate for Payer: BCBS Trust/PPO |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$20.55
|
| Rate for Payer: BCBS Trust/PPO |
$22.01
|
| Rate for Payer: BCN Commercial |
$19.45
|
| Rate for Payer: BCN Commercial |
$28.10
|
| Rate for Payer: BCN Commercial |
$28.15
|
| Rate for Payer: BCN Commercial |
$22.61
|
| Rate for Payer: BCN Commercial |
$19.36
|
| Rate for Payer: BCN Commercial |
$20.83
|
| Rate for Payer: BCN Commercial |
$18.08
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$20.04
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Healthscope Commercial |
$22.54
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Nomi Health Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$19.19
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Nomi Health Commercial |
$29.82
|
| Rate for Payer: Nomi Health Commercial |
$23.99
|
| Rate for Payer: Nomi Health Commercial |
$20.64
|
| Rate for Payer: Nomi Health Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$30.96
|
| Rate for Payer: PHP Commercial |
$21.29
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.52
|
| Rate for Payer: Priority Health HMO/PPO |
$21.79
|
| Rate for Payer: Priority Health HMO/PPO |
$25.46
|
| Rate for Payer: Priority Health HMO/PPO |
$31.69
|
| Rate for Payer: Priority Health HMO/PPO |
$21.90
|
| Rate for Payer: Priority Health HMO/PPO |
$23.46
|
| Rate for Payer: Priority Health HMO/PPO |
$20.36
|
| Rate for Payer: Priority Health HMO/PPO |
$31.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.15
|
| Rate for Payer: UHC Core |
$19.54
|
| Rate for Payer: UHC Core |
$30.36
|
| Rate for Payer: UHC Core |
$20.92
|
| Rate for Payer: UHC Core |
$21.02
|
| Rate for Payer: UHC Core |
$24.43
|
| Rate for Payer: UHC Core |
$30.41
|
| Rate for Payer: UHC Core |
$22.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.27
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$29.26
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna Commercial |
$30.96
|
| Rate for Payer: Aetna Commercial |
$21.29
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Medicare |
$6.51
|
| Rate for Payer: Aetna Medicare |
$6.08
|
| Rate for Payer: Aetna Medicare |
$7.61
|
| Rate for Payer: Aetna Medicare |
$9.47
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Aetna Medicare |
$9.45
|
| Rate for Payer: Aetna Medicare |
$6.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$14.54
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: BCBS Complete |
$10.02
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: BCBS Complete |
$11.70
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS Complete |
$14.57
|
| Rate for Payer: BCBS MAPPO |
$7.32
|
| Rate for Payer: BCBS MAPPO |
$9.10
|
| Rate for Payer: BCBS MAPPO |
$9.09
|
| Rate for Payer: BCBS MAPPO |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$6.26
|
| Rate for Payer: BCBS MAPPO |
$5.85
|
| Rate for Payer: BCBS MAPPO |
$6.29
|
| Rate for Payer: BCBS Trust/PPO |
$19.24
|
| Rate for Payer: BCBS Trust/PPO |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$29.94
|
| Rate for Payer: BCBS Trust/PPO |
$29.89
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCBS Trust/PPO |
$24.05
|
| Rate for Payer: BCBS Trust/PPO |
$22.16
|
| Rate for Payer: BCN Commercial |
$20.96
|
| Rate for Payer: BCN Commercial |
$18.19
|
| Rate for Payer: BCN Commercial |
$19.57
|
| Rate for Payer: BCN Commercial |
$19.48
|
| Rate for Payer: BCN Commercial |
$28.27
|
| Rate for Payer: BCN Commercial |
$22.75
|
| Rate for Payer: BCN Commercial |
$28.32
|
| Rate for Payer: BCN Medicare Advantage |
$9.10
|
| Rate for Payer: BCN Medicare Advantage |
$7.32
|
| Rate for Payer: BCN Medicare Advantage |
$9.09
|
| Rate for Payer: BCN Medicare Advantage |
$6.29
|
| Rate for Payer: BCN Medicare Advantage |
$5.85
|
| Rate for Payer: BCN Medicare Advantage |
$6.26
|
| Rate for Payer: BCN Medicare Advantage |
$6.74
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$20.04
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$22.54
|
| Rate for Payer: Healthscope Commercial |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.29
|
| Rate for Payer: Nomi Health Commercial |
$29.82
|
| Rate for Payer: Nomi Health Commercial |
$19.19
|
| Rate for Payer: Nomi Health Commercial |
$20.54
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Nomi Health Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$20.64
|
| Rate for Payer: Nomi Health Commercial |
$23.99
|
| Rate for Payer: PACE Senior Care Partners |
$6.95
|
| Rate for Payer: PACE Senior Care Partners |
$8.65
|
| Rate for Payer: PACE Senior Care Partners |
$6.40
|
| Rate for Payer: PACE Senior Care Partners |
$5.95
|
| Rate for Payer: PACE Senior Care Partners |
$5.56
|
| Rate for Payer: PACE Senior Care Partners |
$5.98
|
| Rate for Payer: PACE Senior Care Partners |
$8.64
|
| Rate for Payer: PACE SWMI |
$9.09
|
| Rate for Payer: PACE SWMI |
$6.29
|
| Rate for Payer: PACE SWMI |
$7.32
|
| Rate for Payer: PACE SWMI |
$5.85
|
| Rate for Payer: PACE SWMI |
$6.74
|
| Rate for Payer: PACE SWMI |
$6.26
|
| Rate for Payer: PACE SWMI |
$9.10
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$30.96
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$21.29
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Medicare Advantage |
$5.85
|
| Rate for Payer: PHP Medicare Advantage |
$6.74
|
| Rate for Payer: PHP Medicare Advantage |
$6.29
|
| Rate for Payer: PHP Medicare Advantage |
$7.32
|
| Rate for Payer: PHP Medicare Advantage |
$9.09
|
| Rate for Payer: PHP Medicare Advantage |
$6.26
|
| Rate for Payer: PHP Medicare Advantage |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.21
|
| Rate for Payer: Priority Health HMO/PPO |
$21.79
|
| Rate for Payer: Priority Health HMO/PPO |
$23.46
|
| Rate for Payer: Priority Health HMO/PPO |
$25.46
|
| Rate for Payer: Priority Health HMO/PPO |
$31.63
|
| Rate for Payer: Priority Health HMO/PPO |
$21.90
|
| Rate for Payer: Priority Health HMO/PPO |
$31.69
|
| Rate for Payer: Priority Health HMO/PPO |
$20.36
|
| Rate for Payer: Priority Health Medicare |
$6.33
|
| Rate for Payer: Priority Health Medicare |
$6.81
|
| Rate for Payer: Priority Health Medicare |
$6.36
|
| Rate for Payer: Priority Health Medicare |
$5.91
|
| Rate for Payer: Priority Health Medicare |
$7.39
|
| Rate for Payer: Priority Health Medicare |
$9.18
|
| Rate for Payer: Priority Health Medicare |
$9.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.06
|
| Rate for Payer: Railroad Medicare Medicare |
$9.10
|
| Rate for Payer: Railroad Medicare Medicare |
$5.85
|
| Rate for Payer: Railroad Medicare Medicare |
$9.09
|
| Rate for Payer: Railroad Medicare Medicare |
$6.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6.29
|
| Rate for Payer: Railroad Medicare Medicare |
$6.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.59
|
| Rate for Payer: UHC Core |
$20.92
|
| Rate for Payer: UHC Core |
$30.36
|
| Rate for Payer: UHC Core |
$19.54
|
| Rate for Payer: UHC Core |
$22.51
|
| Rate for Payer: UHC Core |
$21.02
|
| Rate for Payer: UHC Core |
$24.43
|
| Rate for Payer: UHC Core |
$30.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.10
|
| Rate for Payer: UHC Exchange |
$6.74
|
| Rate for Payer: UHC Exchange |
$9.09
|
| Rate for Payer: UHC Exchange |
$9.10
|
| Rate for Payer: UHC Exchange |
$6.26
|
| Rate for Payer: UHC Exchange |
$6.29
|
| Rate for Payer: UHC Exchange |
$5.85
|
| Rate for Payer: UHC Exchange |
$7.32
|
| Rate for Payer: UHC Medicare Advantage |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.85
|
| Rate for Payer: UHC Medicare Advantage |
$6.29
|
| Rate for Payer: UHC Medicare Advantage |
$6.74
|
| Rate for Payer: UHC Medicare Advantage |
$7.32
|
| Rate for Payer: UHC Medicare Advantage |
$9.09
|
| Rate for Payer: UHC Medicare Advantage |
$6.26
|
| Rate for Payer: VA VA |
$6.29
|
| Rate for Payer: VA VA |
$6.74
|
| Rate for Payer: VA VA |
$6.26
|
| Rate for Payer: VA VA |
$9.10
|
| Rate for Payer: VA VA |
$5.85
|
| Rate for Payer: VA VA |
$7.32
|
| Rate for Payer: VA VA |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.94
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$29.26
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna Medicare |
$7.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$11.70
|
| Rate for Payer: BCBS MAPPO |
$7.32
|
| Rate for Payer: BCBS Trust/PPO |
$24.05
|
| Rate for Payer: BCN Commercial |
$22.75
|
| Rate for Payer: BCN Medicare Advantage |
$7.32
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.32
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Nomi Health Commercial |
$23.99
|
| Rate for Payer: PACE Senior Care Partners |
$6.95
|
| Rate for Payer: PACE SWMI |
$7.32
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: PHP Medicare Advantage |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.02
|
| Rate for Payer: Priority Health HMO/PPO |
$25.46
|
| Rate for Payer: Priority Health Medicare |
$7.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.60
|
| Rate for Payer: Railroad Medicare Medicare |
$7.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.75
|
| Rate for Payer: UHC Core |
$24.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.32
|
| Rate for Payer: UHC Exchange |
$7.32
|
| Rate for Payer: UHC Medicare Advantage |
$7.32
|
| Rate for Payer: VA VA |
$7.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.94
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$29.26
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: BCBS Trust/PPO |
$23.88
|
| Rate for Payer: BCN Commercial |
$22.61
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Nomi Health Commercial |
$23.99
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.02
|
| Rate for Payer: Priority Health HMO/PPO |
$25.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.75
|
| Rate for Payer: UHC Core |
$24.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.94
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
IP
|
$29.06
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$26.15 |
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$22.46
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Nomi Health Commercial |
$23.83
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health HMO/PPO |
$25.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.57
|
| Rate for Payer: UHC Core |
$24.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
OP
|
$29.06
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$26.15 |
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Medicare |
$7.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.08
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS MAPPO |
$7.26
|
| Rate for Payer: BCBS Trust/PPO |
$23.89
|
| Rate for Payer: BCN Commercial |
$22.59
|
| Rate for Payer: BCN Medicare Advantage |
$7.26
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.26
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Nomi Health Commercial |
$23.83
|
| Rate for Payer: PACE Senior Care Partners |
$6.90
|
| Rate for Payer: PACE SWMI |
$7.26
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: PHP Medicare Advantage |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health HMO/PPO |
$25.28
|
| Rate for Payer: Priority Health Medicare |
$7.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.47
|
| Rate for Payer: Railroad Medicare Medicare |
$7.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.57
|
| Rate for Payer: UHC Core |
$24.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.26
|
| Rate for Payer: UHC Exchange |
$7.26
|
| Rate for Payer: UHC Medicare Advantage |
$7.26
|
| Rate for Payer: VA VA |
$7.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
|
