|
CEFEPIME 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$25.66
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$23.09 |
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Medicare |
$6.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.02
|
| Rate for Payer: BCBS Complete |
$4.75
|
| Rate for Payer: BCBS MAPPO |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$21.10
|
| Rate for Payer: BCN Commercial |
$21.10
|
| Rate for Payer: BCN Medicare Advantage |
$6.42
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cofinity Commercial |
$22.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.42
|
| Rate for Payer: Healthscope Commercial |
$23.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.25
|
| Rate for Payer: Mclaren Medicaid |
$4.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.74
|
| Rate for Payer: Meridian Medicaid |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.81
|
| Rate for Payer: Nomi Health Commercial |
$21.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.25
|
| Rate for Payer: PACE Senior Care Partners |
$6.09
|
| Rate for Payer: PACE SWMI |
$6.42
|
| Rate for Payer: PHP Commercial |
$21.81
|
| Rate for Payer: PHP Medicare Advantage |
$6.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.32
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.86
|
| Rate for Payer: Railroad Medicare Medicare |
$6.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.58
|
| Rate for Payer: UHC Core |
$21.43
|
| Rate for Payer: UHC Exchange |
$6.42
|
| Rate for Payer: UHC Medicaid |
$4.52
|
| Rate for Payer: UHC Medicare Advantage |
$6.42
|
| Rate for Payer: UHCCP Medicaid |
$4.52
|
| Rate for Payer: VA VA |
$6.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.25
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$23.75
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
301721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$21.38 |
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$19.62
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: Nomi Health Commercial |
$19.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.81
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.90
|
| Rate for Payer: UHC Core |
$19.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$23.75
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
301721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$21.38 |
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna Medicare |
$6.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.42
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$5.94
|
| Rate for Payer: BCBS Trust/PPO |
$19.52
|
| Rate for Payer: BCN Commercial |
$19.52
|
| Rate for Payer: BCN Medicare Advantage |
$5.94
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.94
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Mclaren Medicaid |
$4.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.23
|
| Rate for Payer: Meridian Medicaid |
$4.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: Nomi Health Commercial |
$19.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.81
|
| Rate for Payer: PACE Senior Care Partners |
$5.64
|
| Rate for Payer: PACE SWMI |
$5.94
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: PHP Medicare Advantage |
$5.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.66
|
| Rate for Payer: Priority Health Medicare |
$6.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.53
|
| Rate for Payer: Railroad Medicare Medicare |
$5.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.90
|
| Rate for Payer: UHC Core |
$19.83
|
| Rate for Payer: UHC Exchange |
$5.94
|
| Rate for Payer: UHC Medicaid |
$4.19
|
| Rate for Payer: UHC Medicare Advantage |
$5.94
|
| Rate for Payer: UHCCP Medicaid |
$4.19
|
| Rate for Payer: VA VA |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.21
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$14.21
|
| Rate for Payer: BCBS Trust/PPO |
$19.62
|
| Rate for Payer: BCN Commercial |
$14.21
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: Nomi Health Commercial |
$14.11
|
| Rate for Payer: Nomi Health Commercial |
$19.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.81
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.90
|
| Rate for Payer: UHC Core |
$14.37
|
| Rate for Payer: UHC Core |
$19.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.21
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna Medicare |
$6.17
|
| Rate for Payer: Aetna Medicare |
$4.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.42
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$4.30
|
| Rate for Payer: BCBS MAPPO |
$5.94
|
| Rate for Payer: BCBS Trust/PPO |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$19.52
|
| Rate for Payer: BCN Commercial |
$19.52
|
| Rate for Payer: BCN Commercial |
$14.15
|
| Rate for Payer: BCN Medicare Advantage |
$5.94
|
| Rate for Payer: BCN Medicare Advantage |
$4.30
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.30
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Mclaren Medicaid |
$4.19
|
| Rate for Payer: Mclaren Medicaid |
$3.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.52
|
| Rate for Payer: Meridian Medicaid |
$3.19
|
| Rate for Payer: Meridian Medicaid |
$4.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Nomi Health Commercial |
$19.48
|
| Rate for Payer: Nomi Health Commercial |
$14.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.81
|
| Rate for Payer: PACE Senior Care Partners |
$5.64
|
| Rate for Payer: PACE Senior Care Partners |
$4.09
|
| Rate for Payer: PACE SWMI |
$5.94
|
| Rate for Payer: PACE SWMI |
$4.30
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: PHP Medicare Advantage |
$4.30
|
| Rate for Payer: PHP Medicare Advantage |
$5.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.97
|
| Rate for Payer: Priority Health Medicare |
$6.00
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.53
|
| Rate for Payer: Railroad Medicare Medicare |
$4.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.90
|
| Rate for Payer: UHC Core |
$19.83
|
| Rate for Payer: UHC Core |
$14.37
|
| Rate for Payer: UHC Exchange |
$5.94
|
| Rate for Payer: UHC Exchange |
$4.30
|
| Rate for Payer: UHC Medicaid |
$4.19
|
| Rate for Payer: UHC Medicaid |
$3.03
|
| Rate for Payer: UHC Medicare Advantage |
$4.30
|
| Rate for Payer: UHC Medicare Advantage |
$5.94
|
| Rate for Payer: UHCCP Medicaid |
$3.03
|
| Rate for Payer: UHCCP Medicaid |
$4.19
|
| Rate for Payer: VA VA |
$4.30
|
| Rate for Payer: VA VA |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
|
|
CEFOXITIN 2 GRAM/50 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$103.42
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
91040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$93.08 |
| Rate for Payer: Aetna Commercial |
$87.91
|
| Rate for Payer: Aetna Medicare |
$26.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.32
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS MAPPO |
$25.86
|
| Rate for Payer: BCBS Trust/PPO |
$85.02
|
| Rate for Payer: BCN Commercial |
$85.02
|
| Rate for Payer: BCN Medicare Advantage |
$25.86
|
| Rate for Payer: Cash Price |
$82.74
|
| Rate for Payer: Cofinity Commercial |
$88.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.86
|
| Rate for Payer: Healthscope Commercial |
$93.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.56
|
| Rate for Payer: Mclaren Medicaid |
$18.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.15
|
| Rate for Payer: Meridian Medicaid |
$19.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.91
|
| Rate for Payer: Nomi Health Commercial |
$84.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.56
|
| Rate for Payer: PACE Senior Care Partners |
$24.56
|
| Rate for Payer: PACE SWMI |
$25.86
|
| Rate for Payer: PHP Commercial |
$87.91
|
| Rate for Payer: PHP Medicare Advantage |
$25.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.98
|
| Rate for Payer: Priority Health Medicare |
$26.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.98
|
| Rate for Payer: Railroad Medicare Medicare |
$25.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.01
|
| Rate for Payer: UHC Core |
$86.36
|
| Rate for Payer: UHC Exchange |
$25.86
|
| Rate for Payer: UHC Medicaid |
$18.23
|
| Rate for Payer: UHC Medicare Advantage |
$25.86
|
| Rate for Payer: UHCCP Medicaid |
$18.23
|
| Rate for Payer: VA VA |
$25.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.56
|
|
|
CEFOXITIN 2 GRAM/50 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$103.42
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
91040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.98 |
| Max. Negotiated Rate |
$93.08 |
| Rate for Payer: Aetna Commercial |
$87.91
|
| Rate for Payer: BCBS Trust/PPO |
$85.41
|
| Rate for Payer: BCN Commercial |
$85.41
|
| Rate for Payer: Cash Price |
$82.74
|
| Rate for Payer: Cofinity Commercial |
$88.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.74
|
| Rate for Payer: Healthscope Commercial |
$93.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.91
|
| Rate for Payer: Nomi Health Commercial |
$84.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.56
|
| Rate for Payer: PHP Commercial |
$87.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.01
|
| Rate for Payer: UHC Core |
$86.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.56
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$21.90
|
|
|
Service Code
|
NDC 00143987725
|
| Hospital Charge Code |
301722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: Aetna Medicare |
$5.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.84
|
| Rate for Payer: BCBS Complete |
$4.05
|
| Rate for Payer: BCBS MAPPO |
$5.47
|
| Rate for Payer: BCBS Trust/PPO |
$18.00
|
| Rate for Payer: BCN Commercial |
$18.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.47
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.47
|
| Rate for Payer: Healthscope Commercial |
$19.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.43
|
| Rate for Payer: Mclaren Medicaid |
$3.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.75
|
| Rate for Payer: Meridian Medicaid |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.61
|
| Rate for Payer: Nomi Health Commercial |
$17.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.43
|
| Rate for Payer: PACE Senior Care Partners |
$5.20
|
| Rate for Payer: PACE SWMI |
$5.47
|
| Rate for Payer: PHP Commercial |
$18.61
|
| Rate for Payer: PHP Medicare Advantage |
$5.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.05
|
| Rate for Payer: Priority Health Medicare |
$5.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.24
|
| Rate for Payer: Railroad Medicare Medicare |
$5.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.27
|
| Rate for Payer: UHC Core |
$18.29
|
| Rate for Payer: UHC Exchange |
$5.47
|
| Rate for Payer: UHC Medicaid |
$3.86
|
| Rate for Payer: UHC Medicare Advantage |
$5.47
|
| Rate for Payer: UHCCP Medicaid |
$3.86
|
| Rate for Payer: VA VA |
$5.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.43
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$21.90
|
|
|
Service Code
|
NDC 00143987725
|
| Hospital Charge Code |
301722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: BCBS Trust/PPO |
$18.09
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.52
|
| Rate for Payer: Healthscope Commercial |
$19.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.61
|
| Rate for Payer: Nomi Health Commercial |
$17.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.43
|
| Rate for Payer: PHP Commercial |
$18.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.27
|
| Rate for Payer: UHC Core |
$18.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.43
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.90
|
|
|
Service Code
|
NDC 00143987701
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: BCBS Trust/PPO |
$18.09
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.52
|
| Rate for Payer: Healthscope Commercial |
$19.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.61
|
| Rate for Payer: Nomi Health Commercial |
$17.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.43
|
| Rate for Payer: PHP Commercial |
$18.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.27
|
| Rate for Payer: UHC Core |
$18.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.43
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.90
|
|
|
Service Code
|
NDC 00143987725
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: Aetna Medicare |
$5.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.84
|
| Rate for Payer: BCBS Complete |
$4.05
|
| Rate for Payer: BCBS MAPPO |
$5.47
|
| Rate for Payer: BCBS Trust/PPO |
$18.00
|
| Rate for Payer: BCN Commercial |
$18.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.47
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.47
|
| Rate for Payer: Healthscope Commercial |
$19.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.43
|
| Rate for Payer: Mclaren Medicaid |
$3.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.75
|
| Rate for Payer: Meridian Medicaid |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.61
|
| Rate for Payer: Nomi Health Commercial |
$17.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.43
|
| Rate for Payer: PACE Senior Care Partners |
$5.20
|
| Rate for Payer: PACE SWMI |
$5.47
|
| Rate for Payer: PHP Commercial |
$18.61
|
| Rate for Payer: PHP Medicare Advantage |
$5.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.05
|
| Rate for Payer: Priority Health Medicare |
$5.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.24
|
| Rate for Payer: Railroad Medicare Medicare |
$5.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.27
|
| Rate for Payer: UHC Core |
$18.29
|
| Rate for Payer: UHC Exchange |
$5.47
|
| Rate for Payer: UHC Medicaid |
$3.86
|
| Rate for Payer: UHC Medicare Advantage |
$5.47
|
| Rate for Payer: UHCCP Medicaid |
$3.86
|
| Rate for Payer: VA VA |
$5.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.43
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.90
|
|
|
Service Code
|
NDC 00143987701
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: Aetna Medicare |
$5.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.84
|
| Rate for Payer: BCBS Complete |
$4.05
|
| Rate for Payer: BCBS MAPPO |
$5.47
|
| Rate for Payer: BCBS Trust/PPO |
$18.00
|
| Rate for Payer: BCN Commercial |
$18.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.47
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.47
|
| Rate for Payer: Healthscope Commercial |
$19.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.43
|
| Rate for Payer: Mclaren Medicaid |
$3.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.75
|
| Rate for Payer: Meridian Medicaid |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.61
|
| Rate for Payer: Nomi Health Commercial |
$17.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.43
|
| Rate for Payer: PACE Senior Care Partners |
$5.20
|
| Rate for Payer: PACE SWMI |
$5.47
|
| Rate for Payer: PHP Commercial |
$18.61
|
| Rate for Payer: PHP Medicare Advantage |
$5.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.05
|
| Rate for Payer: Priority Health Medicare |
$5.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.24
|
| Rate for Payer: Railroad Medicare Medicare |
$5.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.27
|
| Rate for Payer: UHC Core |
$18.29
|
| Rate for Payer: UHC Exchange |
$5.47
|
| Rate for Payer: UHC Medicaid |
$3.86
|
| Rate for Payer: UHC Medicare Advantage |
$5.47
|
| Rate for Payer: UHCCP Medicaid |
$3.86
|
| Rate for Payer: VA VA |
$5.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.43
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.74
|
|
|
Service Code
|
NDC 63323034225
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$51.97 |
| Rate for Payer: Aetna Commercial |
$49.08
|
| Rate for Payer: BCBS Trust/PPO |
$47.69
|
| Rate for Payer: BCN Commercial |
$47.69
|
| Rate for Payer: Cash Price |
$46.19
|
| Rate for Payer: Cofinity Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.19
|
| Rate for Payer: Healthscope Commercial |
$51.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.08
|
| Rate for Payer: Nomi Health Commercial |
$47.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.30
|
| Rate for Payer: PHP Commercial |
$49.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.81
|
| Rate for Payer: UHC Core |
$48.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.30
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.74
|
|
|
Service Code
|
NDC 63323034225
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$51.97 |
| Rate for Payer: Aetna Commercial |
$49.08
|
| Rate for Payer: Aetna Medicare |
$15.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.04
|
| Rate for Payer: BCBS Complete |
$10.69
|
| Rate for Payer: BCBS MAPPO |
$14.44
|
| Rate for Payer: BCBS Trust/PPO |
$47.47
|
| Rate for Payer: BCN Commercial |
$47.47
|
| Rate for Payer: BCN Medicare Advantage |
$14.44
|
| Rate for Payer: Cash Price |
$46.19
|
| Rate for Payer: Cofinity Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.44
|
| Rate for Payer: Healthscope Commercial |
$51.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.30
|
| Rate for Payer: Mclaren Medicaid |
$10.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.16
|
| Rate for Payer: Meridian Medicaid |
$10.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.08
|
| Rate for Payer: Nomi Health Commercial |
$47.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.30
|
| Rate for Payer: PACE Senior Care Partners |
$13.71
|
| Rate for Payer: PACE SWMI |
$14.44
|
| Rate for Payer: PHP Commercial |
$49.08
|
| Rate for Payer: PHP Medicare Advantage |
$14.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.23
|
| Rate for Payer: Priority Health Medicare |
$14.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.19
|
| Rate for Payer: Railroad Medicare Medicare |
$14.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.81
|
| Rate for Payer: UHC Core |
$48.21
|
| Rate for Payer: UHC Exchange |
$14.44
|
| Rate for Payer: UHC Medicaid |
$10.18
|
| Rate for Payer: UHC Medicare Advantage |
$14.44
|
| Rate for Payer: UHCCP Medicaid |
$10.18
|
| Rate for Payer: VA VA |
$14.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.30
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.90
|
|
|
Service Code
|
NDC 00143987725
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: BCBS Trust/PPO |
$18.09
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.52
|
| Rate for Payer: Healthscope Commercial |
$19.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.61
|
| Rate for Payer: Nomi Health Commercial |
$17.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.43
|
| Rate for Payer: PHP Commercial |
$18.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.27
|
| Rate for Payer: UHC Core |
$18.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.43
|
|
|
CEFPODOXIME 100 MG TABLET
|
Facility
|
OP
|
$186.82
|
|
|
Service Code
|
NDC 65862009520
|
| Hospital Charge Code |
9468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$168.14 |
| Rate for Payer: Aetna Commercial |
$158.80
|
| Rate for Payer: Aetna Medicare |
$48.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.38
|
| Rate for Payer: BCBS Complete |
$34.58
|
| Rate for Payer: BCBS MAPPO |
$46.70
|
| Rate for Payer: BCBS Trust/PPO |
$153.58
|
| Rate for Payer: BCN Commercial |
$153.58
|
| Rate for Payer: BCN Medicare Advantage |
$46.70
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$160.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.70
|
| Rate for Payer: Healthscope Commercial |
$168.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.12
|
| Rate for Payer: Mclaren Medicaid |
$32.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.04
|
| Rate for Payer: Meridian Medicaid |
$34.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.80
|
| Rate for Payer: Nomi Health Commercial |
$153.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.12
|
| Rate for Payer: PACE Senior Care Partners |
$44.37
|
| Rate for Payer: PACE SWMI |
$46.70
|
| Rate for Payer: PHP Commercial |
$158.80
|
| Rate for Payer: PHP Medicare Advantage |
$46.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$162.53
|
| Rate for Payer: Priority Health Medicare |
$47.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.03
|
| Rate for Payer: Railroad Medicare Medicare |
$46.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.40
|
| Rate for Payer: UHC Core |
$155.99
|
| Rate for Payer: UHC Exchange |
$46.70
|
| Rate for Payer: UHC Medicaid |
$32.94
|
| Rate for Payer: UHC Medicare Advantage |
$46.70
|
| Rate for Payer: UHCCP Medicaid |
$32.94
|
| Rate for Payer: VA VA |
$46.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.12
|
|
|
CEFPODOXIME 100 MG TABLET
|
Facility
|
IP
|
$186.82
|
|
|
Service Code
|
NDC 65862009520
|
| Hospital Charge Code |
9468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.03 |
| Max. Negotiated Rate |
$168.14 |
| Rate for Payer: Aetna Commercial |
$158.80
|
| Rate for Payer: BCBS Trust/PPO |
$154.29
|
| Rate for Payer: BCN Commercial |
$154.29
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$160.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Healthscope Commercial |
$168.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.80
|
| Rate for Payer: Nomi Health Commercial |
$153.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.12
|
| Rate for Payer: PHP Commercial |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$162.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.40
|
| Rate for Payer: UHC Core |
$155.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.12
|
|
|
CEFPODOXIME 100 MG TABLET
|
Facility
|
OP
|
$304.44
|
|
|
Service Code
|
NDC 00781543820
|
| Hospital Charge Code |
9468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.67 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna Commercial |
$258.77
|
| Rate for Payer: Aetna Medicare |
$79.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.14
|
| Rate for Payer: BCBS Complete |
$56.35
|
| Rate for Payer: BCBS MAPPO |
$76.11
|
| Rate for Payer: BCBS Trust/PPO |
$250.28
|
| Rate for Payer: BCN Commercial |
$250.28
|
| Rate for Payer: BCN Medicare Advantage |
$76.11
|
| Rate for Payer: Cash Price |
$243.55
|
| Rate for Payer: Cofinity Commercial |
$261.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.11
|
| Rate for Payer: Healthscope Commercial |
$274.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.33
|
| Rate for Payer: Mclaren Medicaid |
$53.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.92
|
| Rate for Payer: Meridian Medicaid |
$56.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.77
|
| Rate for Payer: Nomi Health Commercial |
$249.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.33
|
| Rate for Payer: PACE Senior Care Partners |
$72.30
|
| Rate for Payer: PACE SWMI |
$76.11
|
| Rate for Payer: PHP Commercial |
$258.77
|
| Rate for Payer: PHP Medicare Advantage |
$76.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$264.86
|
| Rate for Payer: Priority Health Medicare |
$76.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.89
|
| Rate for Payer: Railroad Medicare Medicare |
$76.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.91
|
| Rate for Payer: UHC Core |
$254.21
|
| Rate for Payer: UHC Exchange |
$76.11
|
| Rate for Payer: UHC Medicaid |
$53.67
|
| Rate for Payer: UHC Medicare Advantage |
$76.11
|
| Rate for Payer: UHCCP Medicaid |
$53.67
|
| Rate for Payer: VA VA |
$76.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.33
|
|
|
CEFPODOXIME 100 MG TABLET
|
Facility
|
IP
|
$304.44
|
|
|
Service Code
|
NDC 00781543820
|
| Hospital Charge Code |
9468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.89 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna Commercial |
$258.77
|
| Rate for Payer: BCBS Trust/PPO |
$251.44
|
| Rate for Payer: BCN Commercial |
$251.44
|
| Rate for Payer: Cash Price |
$243.55
|
| Rate for Payer: Cofinity Commercial |
$261.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.55
|
| Rate for Payer: Healthscope Commercial |
$274.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.77
|
| Rate for Payer: Nomi Health Commercial |
$249.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.33
|
| Rate for Payer: PHP Commercial |
$258.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$264.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.91
|
| Rate for Payer: UHC Core |
$254.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.33
|
|
|
CEFTRIAXONE 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
78580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$383.45 |
| Max. Negotiated Rate |
$1,957.50 |
| Rate for Payer: Aetna Commercial |
$1,848.75
|
| Rate for Payer: Aetna Medicare |
$565.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$679.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$679.69
|
| Rate for Payer: BCBS Complete |
$402.59
|
| Rate for Payer: BCBS MAPPO |
$543.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,788.07
|
| Rate for Payer: BCN Commercial |
$1,788.07
|
| Rate for Payer: BCN Medicare Advantage |
$543.75
|
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Cofinity Commercial |
$1,870.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$543.75
|
| Rate for Payer: Healthscope Commercial |
$1,957.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,631.25
|
| Rate for Payer: Mclaren Medicaid |
$383.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$570.94
|
| Rate for Payer: Meridian Medicaid |
$402.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$625.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,848.75
|
| Rate for Payer: Nomi Health Commercial |
$1,783.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,631.25
|
| Rate for Payer: PACE Senior Care Partners |
$516.56
|
| Rate for Payer: PACE SWMI |
$543.75
|
| Rate for Payer: PHP Commercial |
$1,848.75
|
| Rate for Payer: PHP Medicare Advantage |
$543.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,892.25
|
| Rate for Payer: Priority Health Medicare |
$549.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,513.80
|
| Rate for Payer: Railroad Medicare Medicare |
$543.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,914.00
|
| Rate for Payer: UHC Core |
$1,816.12
|
| Rate for Payer: UHC Exchange |
$543.75
|
| Rate for Payer: UHC Medicaid |
$383.45
|
| Rate for Payer: UHC Medicare Advantage |
$543.75
|
| Rate for Payer: UHCCP Medicaid |
$383.45
|
| Rate for Payer: VA VA |
$543.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,631.25
|
|
|
CEFTRIAXONE 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
78580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,513.80 |
| Max. Negotiated Rate |
$1,957.50 |
| Rate for Payer: Aetna Commercial |
$1,848.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,796.33
|
| Rate for Payer: BCN Commercial |
$1,796.33
|
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Cofinity Commercial |
$1,870.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.00
|
| Rate for Payer: Healthscope Commercial |
$1,957.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,631.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,848.75
|
| Rate for Payer: Nomi Health Commercial |
$1,783.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,631.25
|
| Rate for Payer: PHP Commercial |
$1,848.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,892.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,513.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,914.00
|
| Rate for Payer: UHC Core |
$1,816.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,631.25
|
|
|
CEFTRIAXONE 1 GM IV SYRINGE
|
Facility
|
IP
|
$17.98
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
500542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: BCBS Trust/PPO |
$14.85
|
| Rate for Payer: BCN Commercial |
$14.85
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Nomi Health Commercial |
$14.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.48
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.82
|
| Rate for Payer: UHC Core |
$15.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
|
|
CEFTRIAXONE 1 GM IV SYRINGE
|
Facility
|
OP
|
$17.98
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
500542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.62
|
| Rate for Payer: BCBS Complete |
$3.33
|
| Rate for Payer: BCBS MAPPO |
$4.50
|
| Rate for Payer: BCBS Trust/PPO |
$14.78
|
| Rate for Payer: BCN Commercial |
$14.78
|
| Rate for Payer: BCN Medicare Advantage |
$4.50
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Mclaren Medicaid |
$3.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.72
|
| Rate for Payer: Meridian Medicaid |
$3.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Nomi Health Commercial |
$14.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.48
|
| Rate for Payer: PACE Senior Care Partners |
$4.27
|
| Rate for Payer: PACE SWMI |
$4.50
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: PHP Medicare Advantage |
$4.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.64
|
| Rate for Payer: Priority Health Medicare |
$4.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.51
|
| Rate for Payer: Railroad Medicare Medicare |
$4.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.82
|
| Rate for Payer: UHC Core |
$15.01
|
| Rate for Payer: UHC Exchange |
$4.50
|
| Rate for Payer: UHC Medicaid |
$3.17
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHCCP Medicaid |
$3.17
|
| Rate for Payer: VA VA |
$4.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION
|
Facility
|
OP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
150848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Medicare |
$3.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.15
|
| Rate for Payer: BCBS Complete |
$2.46
|
| Rate for Payer: BCBS MAPPO |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$10.91
|
| Rate for Payer: BCN Commercial |
$10.91
|
| Rate for Payer: BCN Medicare Advantage |
$3.32
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.48
|
| Rate for Payer: Meridian Medicaid |
$2.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Nomi Health Commercial |
$10.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.95
|
| Rate for Payer: PACE Senior Care Partners |
$3.15
|
| Rate for Payer: PACE SWMI |
$3.32
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Medicare Advantage |
$3.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.54
|
| Rate for Payer: Priority Health Medicare |
$3.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.24
|
| Rate for Payer: Railroad Medicare Medicare |
$3.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.68
|
| Rate for Payer: UHC Core |
$11.08
|
| Rate for Payer: UHC Exchange |
$3.32
|
| Rate for Payer: UHC Medicaid |
$2.34
|
| Rate for Payer: UHC Medicare Advantage |
$3.32
|
| Rate for Payer: UHCCP Medicaid |
$2.34
|
| Rate for Payer: VA VA |
$3.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
150848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Nomi Health Commercial |
$10.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.95
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.68
|
| Rate for Payer: UHC Core |
$11.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
