|
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 |
$11.15 |
| 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 |
$11.71
|
| Rate for Payer: BCBS MAPPO |
$15.82
|
| Rate for Payer: BCBS Trust/PPO |
$52.01
|
| Rate for Payer: BCN Commercial |
$52.01
|
| 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: Mclaren Medicaid |
$11.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.61
|
| Rate for Payer: Meridian Medicaid |
$11.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.78
|
| Rate for Payer: Nomi Health Commercial |
$51.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.45
|
| 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 Choice Medicaid |
$11.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.04
|
| Rate for Payer: Priority Health Medicare |
$15.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.04
|
| 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 Exchange |
$15.82
|
| Rate for Payer: UHC Medicaid |
$11.15
|
| Rate for Payer: UHC Medicare Advantage |
$15.82
|
| Rate for Payer: UHCCP Medicaid |
$11.15
|
| Rate for Payer: VA VA |
$15.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.45
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$17.42
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$15.68 |
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Commercial |
$23.51
|
| Rate for Payer: Aetna Commercial |
$47.15
|
| Rate for Payer: Aetna Commercial |
$15.51
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Aetna Medicare |
$4.53
|
| Rate for Payer: Aetna Medicare |
$7.19
|
| Rate for Payer: Aetna Medicare |
$14.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.44
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: BCBS Complete |
$3.38
|
| Rate for Payer: BCBS Complete |
$3.22
|
| Rate for Payer: BCBS Complete |
$5.12
|
| Rate for Payer: BCBS MAPPO |
$4.36
|
| Rate for Payer: BCBS MAPPO |
$4.56
|
| Rate for Payer: BCBS MAPPO |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$6.92
|
| Rate for Payer: BCBS Trust/PPO |
$22.74
|
| Rate for Payer: BCBS Trust/PPO |
$14.32
|
| Rate for Payer: BCBS Trust/PPO |
$45.60
|
| Rate for Payer: BCBS Trust/PPO |
$15.00
|
| Rate for Payer: BCN Commercial |
$22.74
|
| Rate for Payer: BCN Commercial |
$45.60
|
| Rate for Payer: BCN Commercial |
$15.00
|
| Rate for Payer: BCN Commercial |
$14.32
|
| Rate for Payer: BCN Medicare Advantage |
$6.92
|
| Rate for Payer: BCN Medicare Advantage |
$4.56
|
| Rate for Payer: BCN Medicare Advantage |
$13.87
|
| Rate for Payer: BCN Medicare Advantage |
$4.36
|
| Rate for Payer: Cash Price |
$44.38
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Cofinity Commercial |
$15.70
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$23.79
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.92
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$49.92
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$16.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.06
|
| Rate for Payer: Mclaren Medicaid |
$4.88
|
| Rate for Payer: Mclaren Medicaid |
$3.22
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicaid |
$9.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.57
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$5.12
|
| Rate for Payer: Meridian Medicaid |
$10.27
|
| Rate for Payer: Meridian Medicaid |
$3.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.15
|
| Rate for Payer: Nomi Health Commercial |
$22.68
|
| Rate for Payer: Nomi Health Commercial |
$14.28
|
| Rate for Payer: Nomi Health Commercial |
$14.96
|
| Rate for Payer: Nomi Health Commercial |
$45.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.06
|
| Rate for Payer: PACE Senior Care Partners |
$6.57
|
| Rate for Payer: PACE Senior Care Partners |
$13.17
|
| Rate for Payer: PACE Senior Care Partners |
$4.14
|
| Rate for Payer: PACE Senior Care Partners |
$4.33
|
| Rate for Payer: PACE SWMI |
$4.36
|
| Rate for Payer: PACE SWMI |
$13.87
|
| Rate for Payer: PACE SWMI |
$4.56
|
| Rate for Payer: PACE SWMI |
$6.92
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: PHP Commercial |
$15.51
|
| Rate for Payer: PHP Commercial |
$23.51
|
| Rate for Payer: PHP Commercial |
$47.15
|
| Rate for Payer: PHP Medicare Advantage |
$4.36
|
| Rate for Payer: PHP Medicare Advantage |
$13.87
|
| Rate for Payer: PHP Medicare Advantage |
$4.56
|
| Rate for Payer: PHP Medicare Advantage |
$6.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.16
|
| Rate for Payer: Priority Health Medicare |
$4.61
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health Medicare |
$6.98
|
| Rate for Payer: Priority Health Medicare |
$14.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.12
|
| Rate for Payer: Railroad Medicare Medicare |
$6.92
|
| Rate for Payer: Railroad Medicare Medicare |
$4.36
|
| Rate for Payer: Railroad Medicare Medicare |
$13.87
|
| Rate for Payer: Railroad Medicare Medicare |
$4.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.81
|
| Rate for Payer: UHC Core |
$14.55
|
| Rate for Payer: UHC Core |
$23.10
|
| Rate for Payer: UHC Core |
$15.24
|
| Rate for Payer: UHC Core |
$46.32
|
| Rate for Payer: UHC Exchange |
$6.92
|
| Rate for Payer: UHC Exchange |
$4.56
|
| Rate for Payer: UHC Exchange |
$13.87
|
| Rate for Payer: UHC Exchange |
$4.36
|
| Rate for Payer: UHC Medicaid |
$3.07
|
| Rate for Payer: UHC Medicaid |
$3.22
|
| Rate for Payer: UHC Medicaid |
$4.88
|
| Rate for Payer: UHC Medicaid |
$9.78
|
| Rate for Payer: UHC Medicare Advantage |
$4.56
|
| Rate for Payer: UHC Medicare Advantage |
$4.36
|
| Rate for Payer: UHC Medicare Advantage |
$13.87
|
| Rate for Payer: UHC Medicare Advantage |
$6.92
|
| Rate for Payer: UHCCP Medicaid |
$4.88
|
| Rate for Payer: UHCCP Medicaid |
$9.78
|
| Rate for Payer: UHCCP Medicaid |
$3.22
|
| Rate for Payer: UHCCP Medicaid |
$3.07
|
| Rate for Payer: VA VA |
$4.36
|
| Rate for Payer: VA VA |
$13.87
|
| Rate for Payer: VA VA |
$6.92
|
| Rate for Payer: VA VA |
$4.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.60
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$27.66
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$23.51
|
| Rate for Payer: Aetna Commercial |
$15.51
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Commercial |
$47.15
|
| Rate for Payer: BCBS Trust/PPO |
$22.84
|
| Rate for Payer: BCBS Trust/PPO |
$45.81
|
| Rate for Payer: BCBS Trust/PPO |
$15.07
|
| Rate for Payer: BCBS Trust/PPO |
$14.39
|
| Rate for Payer: BCN Commercial |
$22.84
|
| Rate for Payer: BCN Commercial |
$14.39
|
| Rate for Payer: BCN Commercial |
$45.81
|
| Rate for Payer: BCN Commercial |
$15.07
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Cash Price |
$44.38
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$23.79
|
| Rate for Payer: Cofinity Commercial |
$15.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.38
|
| Rate for Payer: Healthscope Commercial |
$49.92
|
| Rate for Payer: Healthscope Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.15
|
| Rate for Payer: Nomi Health Commercial |
$14.28
|
| Rate for Payer: Nomi Health Commercial |
$14.96
|
| Rate for Payer: Nomi Health Commercial |
$45.49
|
| Rate for Payer: Nomi Health Commercial |
$22.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.60
|
| Rate for Payer: PHP Commercial |
$47.15
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: PHP Commercial |
$15.51
|
| Rate for Payer: PHP Commercial |
$23.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.34
|
| Rate for Payer: UHC Core |
$23.10
|
| Rate for Payer: UHC Core |
$46.32
|
| Rate for Payer: UHC Core |
$15.24
|
| Rate for Payer: UHC Core |
$14.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.75
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$55.47
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.61 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$47.15
|
| Rate for Payer: BCBS Trust/PPO |
$45.81
|
| Rate for Payer: BCN Commercial |
$45.81
|
| Rate for Payer: Cash Price |
$44.38
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.38
|
| Rate for Payer: Healthscope Commercial |
$49.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.15
|
| Rate for Payer: Nomi Health Commercial |
$45.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.60
|
| Rate for Payer: PHP Commercial |
$47.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.81
|
| Rate for Payer: UHC Core |
$46.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.60
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$55.47
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$47.15
|
| Rate for Payer: Aetna Medicare |
$14.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.33
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: BCBS MAPPO |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$45.60
|
| Rate for Payer: BCN Commercial |
$45.60
|
| Rate for Payer: BCN Medicare Advantage |
$13.87
|
| Rate for Payer: Cash Price |
$44.38
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.87
|
| Rate for Payer: Healthscope Commercial |
$49.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.60
|
| Rate for Payer: Mclaren Medicaid |
$9.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.56
|
| Rate for Payer: Meridian Medicaid |
$10.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.15
|
| Rate for Payer: Nomi Health Commercial |
$45.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.60
|
| Rate for Payer: PACE Senior Care Partners |
$13.17
|
| Rate for Payer: PACE SWMI |
$13.87
|
| Rate for Payer: PHP Commercial |
$47.15
|
| Rate for Payer: PHP Medicare Advantage |
$13.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.26
|
| Rate for Payer: Priority Health Medicare |
$14.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.61
|
| Rate for Payer: Railroad Medicare Medicare |
$13.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.81
|
| Rate for Payer: UHC Core |
$46.32
|
| Rate for Payer: UHC Exchange |
$13.87
|
| Rate for Payer: UHC Medicaid |
$9.78
|
| Rate for Payer: UHC Medicare Advantage |
$13.87
|
| Rate for Payer: UHCCP Medicaid |
$9.78
|
| Rate for Payer: VA VA |
$13.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.60
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$28.32
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$25.49 |
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: BCBS Trust/PPO |
$23.39
|
| Rate for Payer: BCBS Trust/PPO |
$25.89
|
| Rate for Payer: BCBS Trust/PPO |
$17.62
|
| Rate for Payer: BCBS Trust/PPO |
$16.48
|
| Rate for Payer: BCN Commercial |
$23.39
|
| Rate for Payer: BCN Commercial |
$16.48
|
| Rate for Payer: BCN Commercial |
$25.89
|
| Rate for Payer: BCN Commercial |
$17.62
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.08
|
| Rate for Payer: Healthscope Commercial |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$19.21
|
| Rate for Payer: Healthscope Commercial |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Nomi Health Commercial |
$16.37
|
| Rate for Payer: Nomi Health Commercial |
$17.50
|
| Rate for Payer: Nomi Health Commercial |
$25.71
|
| Rate for Payer: Nomi Health Commercial |
$23.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: PHP Commercial |
$26.65
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$18.14
|
| Rate for Payer: PHP Commercial |
$24.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.92
|
| Rate for Payer: UHC Core |
$23.65
|
| Rate for Payer: UHC Core |
$26.18
|
| Rate for Payer: UHC Core |
$17.82
|
| Rate for Payer: UHC Core |
$16.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.24
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$19.96
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Aetna Medicare |
$5.55
|
| Rate for Payer: Aetna Medicare |
$5.19
|
| Rate for Payer: Aetna Medicare |
$7.36
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.24
|
| Rate for Payer: BCBS Complete |
$5.80
|
| Rate for Payer: BCBS Complete |
$3.95
|
| Rate for Payer: BCBS Complete |
$3.69
|
| Rate for Payer: BCBS Complete |
$5.24
|
| Rate for Payer: BCBS MAPPO |
$4.99
|
| Rate for Payer: BCBS MAPPO |
$5.33
|
| Rate for Payer: BCBS MAPPO |
$7.84
|
| Rate for Payer: BCBS MAPPO |
$7.08
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$16.41
|
| Rate for Payer: BCBS Trust/PPO |
$25.77
|
| Rate for Payer: BCBS Trust/PPO |
$17.54
|
| Rate for Payer: BCN Commercial |
$23.28
|
| Rate for Payer: BCN Commercial |
$25.77
|
| Rate for Payer: BCN Commercial |
$17.54
|
| Rate for Payer: BCN Commercial |
$16.41
|
| Rate for Payer: BCN Medicare Advantage |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$5.33
|
| Rate for Payer: BCN Medicare Advantage |
$7.84
|
| Rate for Payer: BCN Medicare Advantage |
$4.99
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$19.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Mclaren Medicaid |
$4.99
|
| Rate for Payer: Mclaren Medicaid |
$3.76
|
| Rate for Payer: Mclaren Medicaid |
$3.52
|
| Rate for Payer: Mclaren Medicaid |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.60
|
| 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 |
$5.24
|
| Rate for Payer: Meridian Medicaid |
$3.69
|
| Rate for Payer: Meridian Medicaid |
$5.24
|
| Rate for Payer: Meridian Medicaid |
$5.80
|
| Rate for Payer: Meridian Medicaid |
$3.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Nomi Health Commercial |
$23.22
|
| Rate for Payer: Nomi Health Commercial |
$16.37
|
| Rate for Payer: Nomi Health Commercial |
$17.50
|
| Rate for Payer: Nomi Health Commercial |
$25.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.97
|
| Rate for Payer: PACE Senior Care Partners |
$6.73
|
| Rate for Payer: PACE Senior Care Partners |
$7.45
|
| Rate for Payer: PACE Senior Care Partners |
$4.74
|
| Rate for Payer: PACE Senior Care Partners |
$5.07
|
| Rate for Payer: PACE SWMI |
$4.99
|
| Rate for Payer: PACE SWMI |
$7.84
|
| Rate for Payer: PACE SWMI |
$5.33
|
| Rate for Payer: PACE SWMI |
$7.08
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$18.14
|
| Rate for Payer: PHP Commercial |
$24.07
|
| Rate for Payer: PHP Commercial |
$26.65
|
| Rate for Payer: PHP Medicare Advantage |
$4.99
|
| Rate for Payer: PHP Medicare Advantage |
$7.84
|
| Rate for Payer: PHP Medicare Advantage |
$5.33
|
| Rate for Payer: PHP Medicare Advantage |
$7.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.37
|
| Rate for Payer: Priority Health Medicare |
$5.39
|
| Rate for Payer: Priority Health Medicare |
$5.04
|
| Rate for Payer: Priority Health Medicare |
$7.15
|
| Rate for Payer: Priority Health Medicare |
$7.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.89
|
| Rate for Payer: Railroad Medicare Medicare |
$7.08
|
| Rate for Payer: Railroad Medicare Medicare |
$4.99
|
| Rate for Payer: Railroad Medicare Medicare |
$7.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.59
|
| Rate for Payer: UHC Core |
$16.67
|
| Rate for Payer: UHC Core |
$23.65
|
| Rate for Payer: UHC Core |
$17.82
|
| Rate for Payer: UHC Core |
$26.18
|
| Rate for Payer: UHC Exchange |
$7.08
|
| Rate for Payer: UHC Exchange |
$5.33
|
| Rate for Payer: UHC Exchange |
$7.84
|
| Rate for Payer: UHC Exchange |
$4.99
|
| Rate for Payer: UHC Medicaid |
$3.52
|
| Rate for Payer: UHC Medicaid |
$3.76
|
| Rate for Payer: UHC Medicaid |
$4.99
|
| Rate for Payer: UHC Medicaid |
$5.53
|
| Rate for Payer: UHC Medicare Advantage |
$5.33
|
| Rate for Payer: UHC Medicare Advantage |
$4.99
|
| Rate for Payer: UHC Medicare Advantage |
$7.84
|
| Rate for Payer: UHC Medicare Advantage |
$7.08
|
| Rate for Payer: UHCCP Medicaid |
$4.99
|
| Rate for Payer: UHCCP Medicaid |
$5.53
|
| Rate for Payer: UHCCP Medicaid |
$3.76
|
| Rate for Payer: UHCCP Medicaid |
$3.52
|
| Rate for Payer: VA VA |
$4.99
|
| Rate for Payer: VA VA |
$7.84
|
| Rate for Payer: VA VA |
$7.08
|
| Rate for Payer: VA VA |
$5.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.51
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$31.35
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$28.21 |
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: BCBS Trust/PPO |
$25.89
|
| Rate for Payer: BCN Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.08
|
| Rate for Payer: Healthscope Commercial |
$28.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Nomi Health Commercial |
$25.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: PHP Commercial |
$26.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.59
|
| Rate for Payer: UHC Core |
$26.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.51
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$31.35
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$28.21 |
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.80
|
| Rate for Payer: BCBS Complete |
$5.80
|
| Rate for Payer: BCBS MAPPO |
$7.84
|
| Rate for Payer: BCBS Trust/PPO |
$25.77
|
| Rate for Payer: BCN Commercial |
$25.77
|
| Rate for Payer: BCN Medicare Advantage |
$7.84
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.84
|
| Rate for Payer: Healthscope Commercial |
$28.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.51
|
| Rate for Payer: Mclaren Medicaid |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.23
|
| Rate for Payer: Meridian Medicaid |
$5.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Nomi Health Commercial |
$25.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: PACE Senior Care Partners |
$7.45
|
| Rate for Payer: PACE SWMI |
$7.84
|
| Rate for Payer: PHP Commercial |
$26.65
|
| Rate for Payer: PHP Medicare Advantage |
$7.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.27
|
| Rate for Payer: Priority Health Medicare |
$7.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.59
|
| Rate for Payer: UHC Core |
$26.18
|
| Rate for Payer: UHC Exchange |
$7.84
|
| Rate for Payer: UHC Medicaid |
$5.53
|
| Rate for Payer: UHC Medicare Advantage |
$7.84
|
| Rate for Payer: UHCCP Medicaid |
$5.53
|
| Rate for Payer: VA VA |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.51
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$19.48
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$17.53 |
| Rate for Payer: Aetna Commercial |
$16.56
|
| Rate for Payer: Aetna Commercial |
$17.11
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$30.94
|
| Rate for Payer: Aetna Commercial |
$50.38
|
| Rate for Payer: Aetna Medicare |
$9.45
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Aetna Medicare |
$15.41
|
| Rate for Payer: Aetna Medicare |
$9.46
|
| Rate for Payer: Aetna Medicare |
$6.08
|
| Rate for Payer: Aetna Medicare |
$6.54
|
| Rate for Payer: Aetna Medicare |
$5.06
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.31
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS Complete |
$3.73
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS Complete |
$4.66
|
| Rate for Payer: BCBS Complete |
$3.61
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS Complete |
$10.97
|
| Rate for Payer: BCBS MAPPO |
$5.03
|
| Rate for Payer: BCBS MAPPO |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$4.87
|
| Rate for Payer: BCBS MAPPO |
$14.82
|
| Rate for Payer: BCBS MAPPO |
$9.10
|
| Rate for Payer: BCBS MAPPO |
$5.85
|
| Rate for Payer: BCBS MAPPO |
$6.29
|
| Rate for Payer: BCBS MAPPO |
$9.09
|
| Rate for Payer: BCBS Trust/PPO |
$29.92
|
| Rate for Payer: BCBS Trust/PPO |
$22.16
|
| Rate for Payer: BCBS Trust/PPO |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.01
|
| Rate for Payer: BCBS Trust/PPO |
$48.73
|
| Rate for Payer: BCBS Trust/PPO |
$29.89
|
| Rate for Payer: BCBS Trust/PPO |
$19.24
|
| Rate for Payer: BCN Commercial |
$29.92
|
| Rate for Payer: BCN Commercial |
$16.01
|
| Rate for Payer: BCN Commercial |
$22.16
|
| Rate for Payer: BCN Commercial |
$20.69
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: BCN Commercial |
$29.89
|
| Rate for Payer: BCN Commercial |
$48.73
|
| Rate for Payer: BCN Commercial |
$19.24
|
| Rate for Payer: BCN Medicare Advantage |
$5.03
|
| Rate for Payer: BCN Medicare Advantage |
$4.87
|
| 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 |
$6.74
|
| Rate for Payer: BCN Medicare Advantage |
$9.10
|
| Rate for Payer: BCN Medicare Advantage |
$14.82
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$15.58
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Commercial |
$50.97
|
| Rate for Payer: Cofinity Commercial |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Cofinity Commercial |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.10
|
| 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 |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.85
|
| Rate for Payer: Healthscope Commercial |
$53.34
|
| Rate for Payer: Healthscope Commercial |
$32.76
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$18.12
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$17.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.27
|
| Rate for Payer: Mclaren Medicaid |
$10.45
|
| Rate for Payer: Mclaren Medicaid |
$4.13
|
| Rate for Payer: Mclaren Medicaid |
$6.42
|
| Rate for Payer: Mclaren Medicaid |
$6.41
|
| Rate for Payer: Mclaren Medicaid |
$3.55
|
| Rate for Payer: Mclaren Medicaid |
$4.44
|
| Rate for Payer: Mclaren Medicaid |
$4.75
|
| Rate for Payer: Mclaren Medicaid |
$3.43
|
| 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 |
$9.55
|
| 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 |
$6.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.11
|
| 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 |
$15.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.28
|
| Rate for Payer: Meridian Medicaid |
$3.73
|
| Rate for Payer: Meridian Medicaid |
$4.66
|
| Rate for Payer: Meridian Medicaid |
$6.73
|
| Rate for Payer: Meridian Medicaid |
$4.99
|
| Rate for Payer: Meridian Medicaid |
$3.61
|
| Rate for Payer: Meridian Medicaid |
$4.33
|
| Rate for Payer: Meridian Medicaid |
$10.97
|
| Rate for Payer: Meridian Medicaid |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.38
|
| Rate for Payer: Nomi Health Commercial |
$19.19
|
| Rate for Payer: Nomi Health Commercial |
$15.97
|
| Rate for Payer: Nomi Health Commercial |
$20.64
|
| Rate for Payer: Nomi Health Commercial |
$29.85
|
| Rate for Payer: Nomi Health Commercial |
$29.82
|
| Rate for Payer: Nomi Health Commercial |
$48.60
|
| Rate for Payer: Nomi Health Commercial |
$16.51
|
| Rate for Payer: Nomi Health Commercial |
$22.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.27
|
| Rate for Payer: PACE Senior Care Partners |
$8.64
|
| Rate for Payer: PACE Senior Care Partners |
$14.08
|
| Rate for Payer: PACE Senior Care Partners |
$4.78
|
| Rate for Payer: PACE Senior Care Partners |
$6.40
|
| Rate for Payer: PACE Senior Care Partners |
$4.63
|
| Rate for Payer: PACE Senior Care Partners |
$8.64
|
| Rate for Payer: PACE Senior Care Partners |
$5.56
|
| Rate for Payer: PACE Senior Care Partners |
$5.98
|
| Rate for Payer: PACE SWMI |
$6.74
|
| Rate for Payer: PACE SWMI |
$6.29
|
| Rate for Payer: PACE SWMI |
$4.87
|
| Rate for Payer: PACE SWMI |
$5.03
|
| Rate for Payer: PACE SWMI |
$14.82
|
| Rate for Payer: PACE SWMI |
$9.09
|
| Rate for Payer: PACE SWMI |
$5.85
|
| Rate for Payer: PACE SWMI |
$9.10
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$16.56
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$50.38
|
| Rate for Payer: PHP Commercial |
$17.11
|
| Rate for Payer: PHP Commercial |
$30.94
|
| Rate for Payer: PHP Medicare Advantage |
$5.03
|
| Rate for Payer: PHP Medicare Advantage |
$6.29
|
| Rate for Payer: PHP Medicare Advantage |
$6.74
|
| Rate for Payer: PHP Medicare Advantage |
$5.85
|
| Rate for Payer: PHP Medicare Advantage |
$9.09
|
| Rate for Payer: PHP Medicare Advantage |
$9.10
|
| Rate for Payer: PHP Medicare Advantage |
$4.87
|
| Rate for Payer: PHP Medicare Advantage |
$14.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$51.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.67
|
| Rate for Payer: Priority Health Medicare |
$14.97
|
| Rate for Payer: Priority Health Medicare |
$5.91
|
| Rate for Payer: Priority Health Medicare |
$4.92
|
| Rate for Payer: Priority Health Medicare |
$6.36
|
| Rate for Payer: Priority Health Medicare |
$6.81
|
| Rate for Payer: Priority Health Medicare |
$9.18
|
| Rate for Payer: Priority Health Medicare |
$9.19
|
| Rate for Payer: Priority Health Medicare |
$5.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.25
|
| Rate for Payer: Railroad Medicare Medicare |
$5.85
|
| Rate for Payer: Railroad Medicare Medicare |
$9.10
|
| Rate for Payer: Railroad Medicare Medicare |
$14.82
|
| Rate for Payer: Railroad Medicare Medicare |
$4.87
|
| Rate for Payer: Railroad Medicare Medicare |
$9.09
|
| Rate for Payer: Railroad Medicare Medicare |
$5.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.29
|
| Rate for Payer: Railroad Medicare Medicare |
$6.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.15
|
| 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) |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.16
|
| Rate for Payer: UHC Core |
$16.81
|
| Rate for Payer: UHC Core |
$21.02
|
| Rate for Payer: UHC Core |
$22.51
|
| Rate for Payer: UHC Core |
$19.54
|
| Rate for Payer: UHC Core |
$30.39
|
| Rate for Payer: UHC Core |
$49.49
|
| Rate for Payer: UHC Core |
$16.27
|
| Rate for Payer: UHC Core |
$30.36
|
| Rate for Payer: UHC Exchange |
$5.85
|
| Rate for Payer: UHC Exchange |
$9.10
|
| Rate for Payer: UHC Exchange |
$6.74
|
| Rate for Payer: UHC Exchange |
$5.03
|
| Rate for Payer: UHC Exchange |
$4.87
|
| Rate for Payer: UHC Exchange |
$14.82
|
| Rate for Payer: UHC Exchange |
$9.09
|
| Rate for Payer: UHC Exchange |
$6.29
|
| Rate for Payer: UHC Medicaid |
$6.41
|
| Rate for Payer: UHC Medicaid |
$6.42
|
| Rate for Payer: UHC Medicaid |
$4.75
|
| Rate for Payer: UHC Medicaid |
$4.13
|
| Rate for Payer: UHC Medicaid |
$3.43
|
| Rate for Payer: UHC Medicaid |
$10.45
|
| Rate for Payer: UHC Medicaid |
$3.55
|
| Rate for Payer: UHC Medicaid |
$4.44
|
| Rate for Payer: UHC Medicare Advantage |
$4.87
|
| Rate for Payer: UHC Medicare Advantage |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.85
|
| Rate for Payer: UHC Medicare Advantage |
$14.82
|
| Rate for Payer: UHC Medicare Advantage |
$9.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.03
|
| Rate for Payer: UHC Medicare Advantage |
$6.29
|
| Rate for Payer: UHC Medicare Advantage |
$6.74
|
| Rate for Payer: UHCCP Medicaid |
$4.75
|
| Rate for Payer: UHCCP Medicaid |
$3.43
|
| Rate for Payer: UHCCP Medicaid |
$6.41
|
| Rate for Payer: UHCCP Medicaid |
$4.13
|
| Rate for Payer: UHCCP Medicaid |
$3.55
|
| Rate for Payer: UHCCP Medicaid |
$4.44
|
| Rate for Payer: UHCCP Medicaid |
$10.45
|
| Rate for Payer: UHCCP Medicaid |
$6.42
|
| Rate for Payer: VA VA |
$5.85
|
| Rate for Payer: VA VA |
$14.82
|
| Rate for Payer: VA VA |
$9.09
|
| Rate for Payer: VA VA |
$9.10
|
| Rate for Payer: VA VA |
$4.87
|
| Rate for Payer: VA VA |
$6.29
|
| Rate for Payer: VA VA |
$5.03
|
| Rate for Payer: VA VA |
$6.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$36.36
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.31 |
| Max. Negotiated Rate |
$32.72 |
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$16.56
|
| Rate for Payer: Aetna Commercial |
$17.11
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$50.38
|
| Rate for Payer: Aetna Commercial |
$30.94
|
| Rate for Payer: BCBS Trust/PPO |
$30.06
|
| Rate for Payer: BCBS Trust/PPO |
$22.27
|
| Rate for Payer: BCBS Trust/PPO |
$30.03
|
| Rate for Payer: BCBS Trust/PPO |
$16.09
|
| Rate for Payer: BCBS Trust/PPO |
$48.95
|
| Rate for Payer: BCBS Trust/PPO |
$16.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCBS Trust/PPO |
$19.33
|
| Rate for Payer: BCN Commercial |
$19.33
|
| Rate for Payer: BCN Commercial |
$16.09
|
| Rate for Payer: BCN Commercial |
$20.79
|
| Rate for Payer: BCN Commercial |
$16.63
|
| Rate for Payer: BCN Commercial |
$30.03
|
| Rate for Payer: BCN Commercial |
$48.95
|
| Rate for Payer: BCN Commercial |
$22.27
|
| Rate for Payer: BCN Commercial |
$30.06
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$15.58
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Commercial |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$50.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.10
|
| Rate for Payer: Healthscope Commercial |
$17.53
|
| Rate for Payer: Healthscope Commercial |
$53.34
|
| Rate for Payer: Healthscope Commercial |
$32.76
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$18.12
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.94
|
| Rate for Payer: Nomi Health Commercial |
$29.85
|
| Rate for Payer: Nomi Health Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$29.82
|
| Rate for Payer: Nomi Health Commercial |
$48.60
|
| Rate for Payer: Nomi Health Commercial |
$15.97
|
| Rate for Payer: Nomi Health Commercial |
$16.51
|
| Rate for Payer: Nomi Health Commercial |
$20.64
|
| Rate for Payer: Nomi Health Commercial |
$19.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.27
|
| Rate for Payer: PHP Commercial |
$16.56
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$17.11
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$30.94
|
| Rate for Payer: PHP Commercial |
$50.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$51.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.71
|
| Rate for Payer: UHC Core |
$21.02
|
| Rate for Payer: UHC Core |
$16.27
|
| Rate for Payer: UHC Core |
$30.36
|
| Rate for Payer: UHC Core |
$16.81
|
| Rate for Payer: UHC Core |
$22.51
|
| Rate for Payer: UHC Core |
$49.49
|
| Rate for Payer: UHC Core |
$30.39
|
| Rate for Payer: UHC Core |
$19.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.22
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$19.48
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$17.53 |
| Rate for Payer: Aetna Commercial |
$16.56
|
| Rate for Payer: Aetna Commercial |
$50.38
|
| Rate for Payer: Aetna Medicare |
$15.41
|
| Rate for Payer: Aetna Medicare |
$5.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.52
|
| Rate for Payer: BCBS Complete |
$3.61
|
| Rate for Payer: BCBS Complete |
$10.97
|
| Rate for Payer: BCBS MAPPO |
$4.87
|
| Rate for Payer: BCBS MAPPO |
$14.82
|
| Rate for Payer: BCBS Trust/PPO |
$16.01
|
| Rate for Payer: BCBS Trust/PPO |
$48.73
|
| Rate for Payer: BCN Commercial |
$48.73
|
| Rate for Payer: BCN Commercial |
$16.01
|
| Rate for Payer: BCN Medicare Advantage |
$14.82
|
| Rate for Payer: BCN Medicare Advantage |
$4.87
|
| Rate for Payer: Cash Price |
$15.58
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Cofinity Commercial |
$50.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.87
|
| Rate for Payer: Healthscope Commercial |
$17.53
|
| Rate for Payer: Healthscope Commercial |
$53.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.45
|
| Rate for Payer: Mclaren Medicaid |
$10.45
|
| Rate for Payer: Mclaren Medicaid |
$3.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.11
|
| Rate for Payer: Meridian Medicaid |
$3.61
|
| Rate for Payer: Meridian Medicaid |
$10.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.56
|
| Rate for Payer: Nomi Health Commercial |
$48.60
|
| Rate for Payer: Nomi Health Commercial |
$15.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.45
|
| Rate for Payer: PACE Senior Care Partners |
$14.08
|
| Rate for Payer: PACE Senior Care Partners |
$4.63
|
| Rate for Payer: PACE SWMI |
$14.82
|
| Rate for Payer: PACE SWMI |
$4.87
|
| Rate for Payer: PHP Commercial |
$16.56
|
| Rate for Payer: PHP Commercial |
$50.38
|
| Rate for Payer: PHP Medicare Advantage |
$4.87
|
| Rate for Payer: PHP Medicare Advantage |
$14.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$51.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.95
|
| Rate for Payer: Priority Health Medicare |
$14.97
|
| Rate for Payer: Priority Health Medicare |
$4.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.25
|
| Rate for Payer: Railroad Medicare Medicare |
$4.87
|
| Rate for Payer: Railroad Medicare Medicare |
$14.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.16
|
| Rate for Payer: UHC Core |
$49.49
|
| Rate for Payer: UHC Core |
$16.27
|
| Rate for Payer: UHC Exchange |
$14.82
|
| Rate for Payer: UHC Exchange |
$4.87
|
| Rate for Payer: UHC Medicaid |
$10.45
|
| Rate for Payer: UHC Medicaid |
$3.43
|
| Rate for Payer: UHC Medicare Advantage |
$4.87
|
| Rate for Payer: UHC Medicare Advantage |
$14.82
|
| Rate for Payer: UHCCP Medicaid |
$3.43
|
| Rate for Payer: UHCCP Medicaid |
$10.45
|
| Rate for Payer: VA VA |
$4.87
|
| Rate for Payer: VA VA |
$14.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.61
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$19.48
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$17.53 |
| Rate for Payer: Aetna Commercial |
$16.56
|
| Rate for Payer: Aetna Commercial |
$50.38
|
| Rate for Payer: BCBS Trust/PPO |
$16.09
|
| Rate for Payer: BCBS Trust/PPO |
$48.95
|
| Rate for Payer: BCN Commercial |
$16.09
|
| Rate for Payer: BCN Commercial |
$48.95
|
| Rate for Payer: Cash Price |
$15.58
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cofinity Commercial |
$50.97
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.58
|
| Rate for Payer: Healthscope Commercial |
$17.53
|
| Rate for Payer: Healthscope Commercial |
$53.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.38
|
| Rate for Payer: Nomi Health Commercial |
$15.97
|
| Rate for Payer: Nomi Health Commercial |
$48.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.45
|
| Rate for Payer: PHP Commercial |
$50.38
|
| Rate for Payer: PHP Commercial |
$16.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$51.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.16
|
| Rate for Payer: UHC Core |
$16.27
|
| Rate for Payer: UHC Core |
$49.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.45
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
OP
|
$31.35
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$28.21 |
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.80
|
| Rate for Payer: BCBS Complete |
$5.80
|
| Rate for Payer: BCBS MAPPO |
$7.84
|
| Rate for Payer: BCBS Trust/PPO |
$25.77
|
| Rate for Payer: BCN Commercial |
$25.77
|
| Rate for Payer: BCN Medicare Advantage |
$7.84
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.84
|
| Rate for Payer: Healthscope Commercial |
$28.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.51
|
| Rate for Payer: Mclaren Medicaid |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.23
|
| Rate for Payer: Meridian Medicaid |
$5.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Nomi Health Commercial |
$25.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: PACE Senior Care Partners |
$7.45
|
| Rate for Payer: PACE SWMI |
$7.84
|
| Rate for Payer: PHP Commercial |
$26.65
|
| Rate for Payer: PHP Medicare Advantage |
$7.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.27
|
| Rate for Payer: Priority Health Medicare |
$7.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.59
|
| Rate for Payer: UHC Core |
$26.18
|
| Rate for Payer: UHC Exchange |
$7.84
|
| Rate for Payer: UHC Medicaid |
$5.53
|
| Rate for Payer: UHC Medicare Advantage |
$7.84
|
| Rate for Payer: UHCCP Medicaid |
$5.53
|
| Rate for Payer: VA VA |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.51
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
IP
|
$31.35
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$28.21 |
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: BCBS Trust/PPO |
$25.89
|
| Rate for Payer: BCN Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.08
|
| Rate for Payer: Healthscope Commercial |
$28.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Nomi Health Commercial |
$25.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: PHP Commercial |
$26.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.59
|
| Rate for Payer: UHC Core |
$26.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.51
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$14,037.82
|
|
|
Service Code
|
APR-DRG 3053
|
| Min. Negotiated Rate |
$13,369.36 |
| Max. Negotiated Rate |
$14,037.82 |
| Rate for Payer: BCBS Complete |
$14,037.82
|
| Rate for Payer: Mclaren Medicaid |
$13,369.36
|
| Rate for Payer: Meridian Medicaid |
$14,037.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,369.36
|
| Rate for Payer: UHC Medicaid |
$13,369.36
|
| Rate for Payer: UHCCP Medicaid |
$13,369.36
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$8,566.99
|
|
|
Service Code
|
APR-DRG 3051
|
| Min. Negotiated Rate |
$8,159.03 |
| Max. Negotiated Rate |
$8,566.99 |
| Rate for Payer: BCBS Complete |
$8,566.99
|
| Rate for Payer: Mclaren Medicaid |
$8,159.03
|
| Rate for Payer: Meridian Medicaid |
$8,566.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,159.03
|
| Rate for Payer: UHC Medicaid |
$8,159.03
|
| Rate for Payer: UHCCP Medicaid |
$8,159.03
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$9,461.96
|
|
|
Service Code
|
APR-DRG 3052
|
| Min. Negotiated Rate |
$9,011.40 |
| Max. Negotiated Rate |
$9,461.96 |
| Rate for Payer: BCBS Complete |
$9,461.96
|
| Rate for Payer: Mclaren Medicaid |
$9,011.40
|
| Rate for Payer: Meridian Medicaid |
$9,461.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,011.40
|
| Rate for Payer: UHC Medicaid |
$9,011.40
|
| Rate for Payer: UHCCP Medicaid |
$9,011.40
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$19,194.74
|
|
|
Service Code
|
APR-DRG 3054
|
| Min. Negotiated Rate |
$18,280.70 |
| Max. Negotiated Rate |
$19,194.74 |
| Rate for Payer: BCBS Complete |
$19,194.74
|
| Rate for Payer: Mclaren Medicaid |
$18,280.70
|
| Rate for Payer: Meridian Medicaid |
$19,194.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,280.70
|
| Rate for Payer: UHC Medicaid |
$18,280.70
|
| Rate for Payer: UHCCP Medicaid |
$18,280.70
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$18,024.74
|
|
|
Service Code
|
APR-DRG 2264
|
| Min. Negotiated Rate |
$17,166.42 |
| Max. Negotiated Rate |
$18,024.74 |
| Rate for Payer: BCBS Complete |
$18,024.74
|
| Rate for Payer: Mclaren Medicaid |
$17,166.42
|
| Rate for Payer: Meridian Medicaid |
$18,024.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,166.42
|
| Rate for Payer: UHC Medicaid |
$17,166.42
|
| Rate for Payer: UHCCP Medicaid |
$17,166.42
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$5,994.05
|
|
|
Service Code
|
APR-DRG 2262
|
| Min. Negotiated Rate |
$5,708.62 |
| Max. Negotiated Rate |
$5,994.05 |
| Rate for Payer: BCBS Complete |
$5,994.05
|
| Rate for Payer: Mclaren Medicaid |
$5,708.62
|
| Rate for Payer: Meridian Medicaid |
$5,994.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,708.62
|
| Rate for Payer: UHC Medicaid |
$5,708.62
|
| Rate for Payer: UHCCP Medicaid |
$5,708.62
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$5,490.82
|
|
|
Service Code
|
APR-DRG 2261
|
| Min. Negotiated Rate |
$5,229.35 |
| Max. Negotiated Rate |
$5,490.82 |
| Rate for Payer: BCBS Complete |
$5,490.82
|
| Rate for Payer: Mclaren Medicaid |
$5,229.35
|
| Rate for Payer: Meridian Medicaid |
$5,490.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,229.35
|
| Rate for Payer: UHC Medicaid |
$5,229.35
|
| Rate for Payer: UHCCP Medicaid |
$5,229.35
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$11,122.04
|
|
|
Service Code
|
APR-DRG 2263
|
| Min. Negotiated Rate |
$10,592.42 |
| Max. Negotiated Rate |
$11,122.04 |
| Rate for Payer: BCBS Complete |
$11,122.04
|
| Rate for Payer: Mclaren Medicaid |
$10,592.42
|
| Rate for Payer: Meridian Medicaid |
$11,122.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,592.42
|
| Rate for Payer: UHC Medicaid |
$10,592.42
|
| Rate for Payer: UHCCP Medicaid |
$10,592.42
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
IP
|
$40.89
|
|
|
Service Code
|
NDC 16729003510
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna Commercial |
$34.76
|
| Rate for Payer: BCBS Trust/PPO |
$33.77
|
| Rate for Payer: BCN Commercial |
$33.77
|
| Rate for Payer: Cash Price |
$32.71
|
| Rate for Payer: Cofinity Commercial |
$35.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.71
|
| Rate for Payer: Healthscope Commercial |
$36.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.76
|
| Rate for Payer: Nomi Health Commercial |
$33.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.67
|
| Rate for Payer: PHP Commercial |
$34.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.98
|
| Rate for Payer: UHC Core |
$34.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.67
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
OP
|
$40.89
|
|
|
Service Code
|
NDC 16729003510
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna Commercial |
$34.76
|
| Rate for Payer: Aetna Medicare |
$10.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.78
|
| Rate for Payer: BCBS Complete |
$7.57
|
| Rate for Payer: BCBS MAPPO |
$10.22
|
| Rate for Payer: BCBS Trust/PPO |
$33.62
|
| Rate for Payer: BCN Commercial |
$33.62
|
| Rate for Payer: BCN Medicare Advantage |
$10.22
|
| Rate for Payer: Cash Price |
$32.71
|
| Rate for Payer: Cofinity Commercial |
$35.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.22
|
| Rate for Payer: Healthscope Commercial |
$36.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.67
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.73
|
| Rate for Payer: Meridian Medicaid |
$7.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.76
|
| Rate for Payer: Nomi Health Commercial |
$33.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.67
|
| Rate for Payer: PACE Senior Care Partners |
$9.71
|
| Rate for Payer: PACE SWMI |
$10.22
|
| Rate for Payer: PHP Commercial |
$34.76
|
| Rate for Payer: PHP Medicare Advantage |
$10.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.57
|
| Rate for Payer: Priority Health Medicare |
$10.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.46
|
| Rate for Payer: Railroad Medicare Medicare |
$10.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.98
|
| Rate for Payer: UHC Core |
$34.14
|
| Rate for Payer: UHC Exchange |
$10.22
|
| Rate for Payer: UHC Medicaid |
$7.21
|
| Rate for Payer: UHC Medicare Advantage |
$10.22
|
| Rate for Payer: UHCCP Medicaid |
$7.21
|
| Rate for Payer: VA VA |
$10.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.67
|
|
