|
CEFDINIR 300 MG CAPSULE
|
Facility
|
OP
|
$163.01
|
|
|
Service Code
|
NDC 65862017760
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$146.71 |
| Rate for Payer: Aetna Commercial |
$138.56
|
| Rate for Payer: Aetna Medicare |
$42.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.94
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS MAPPO |
$40.75
|
| Rate for Payer: BCBS Trust/PPO |
$134.01
|
| Rate for Payer: BCN Commercial |
$126.74
|
| Rate for Payer: BCN Medicare Advantage |
$40.75
|
| Rate for Payer: Cash Price |
$130.41
|
| Rate for Payer: Cofinity Commercial |
$140.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$146.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.56
|
| Rate for Payer: Nomi Health Commercial |
$133.67
|
| Rate for Payer: PACE Senior Care Partners |
$38.71
|
| Rate for Payer: PACE SWMI |
$40.75
|
| Rate for Payer: PHP Commercial |
$138.56
|
| Rate for Payer: PHP Medicare Advantage |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.96
|
| Rate for Payer: Priority Health HMO/PPO |
$141.82
|
| Rate for Payer: Priority Health Medicare |
$41.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.22
|
| Rate for Payer: Railroad Medicare Medicare |
$40.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.45
|
| Rate for Payer: UHC Core |
$136.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.75
|
| Rate for Payer: UHC Exchange |
$40.75
|
| Rate for Payer: UHC Medicare Advantage |
$40.75
|
| Rate for Payer: VA VA |
$40.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.26
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
OP
|
$348.21
|
|
|
Service Code
|
NDC 60687069921
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.70 |
| Max. Negotiated Rate |
$313.39 |
| Rate for Payer: Aetna Commercial |
$295.98
|
| Rate for Payer: Aetna Medicare |
$90.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.82
|
| Rate for Payer: BCBS Complete |
$139.28
|
| Rate for Payer: BCBS MAPPO |
$87.05
|
| Rate for Payer: BCBS Trust/PPO |
$286.26
|
| Rate for Payer: BCN Commercial |
$270.73
|
| Rate for Payer: BCN Medicare Advantage |
$87.05
|
| Rate for Payer: Cash Price |
$278.57
|
| Rate for Payer: Cofinity Commercial |
$299.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.05
|
| Rate for Payer: Healthscope Commercial |
$313.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.98
|
| Rate for Payer: Nomi Health Commercial |
$285.53
|
| Rate for Payer: PACE Senior Care Partners |
$82.70
|
| Rate for Payer: PACE SWMI |
$87.05
|
| Rate for Payer: PHP Commercial |
$295.98
|
| Rate for Payer: PHP Medicare Advantage |
$87.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.34
|
| Rate for Payer: Priority Health HMO/PPO |
$302.94
|
| Rate for Payer: Priority Health Medicare |
$87.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.30
|
| Rate for Payer: Railroad Medicare Medicare |
$87.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.42
|
| Rate for Payer: UHC Core |
$290.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.05
|
| Rate for Payer: UHC Exchange |
$87.05
|
| Rate for Payer: UHC Medicare Advantage |
$87.05
|
| Rate for Payer: VA VA |
$87.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.16
|
|
|
CEFEPIME 1 GRAM/50 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$64.77
|
|
|
Service Code
|
HCPCS J0703
|
| Hospital Charge Code |
105551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Aetna Commercial |
$55.05
|
| Rate for Payer: Aetna Medicare |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.24
|
| Rate for Payer: BCBS Complete |
$25.91
|
| Rate for Payer: BCBS MAPPO |
$16.19
|
| Rate for Payer: BCBS Trust/PPO |
$53.25
|
| Rate for Payer: BCN Commercial |
$50.36
|
| Rate for Payer: BCN Medicare Advantage |
$16.19
|
| Rate for Payer: Cash Price |
$51.82
|
| Rate for Payer: Cofinity Commercial |
$55.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.19
|
| Rate for Payer: Healthscope Commercial |
$58.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.05
|
| Rate for Payer: Nomi Health Commercial |
$53.11
|
| Rate for Payer: PACE Senior Care Partners |
$15.38
|
| Rate for Payer: PACE SWMI |
$16.19
|
| Rate for Payer: PHP Commercial |
$55.05
|
| Rate for Payer: PHP Medicare Advantage |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.10
|
| Rate for Payer: Priority Health HMO/PPO |
$56.35
|
| Rate for Payer: Priority Health Medicare |
$16.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.40
|
| Rate for Payer: Railroad Medicare Medicare |
$16.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.00
|
| Rate for Payer: UHC Core |
$54.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.19
|
| Rate for Payer: UHC Exchange |
$16.19
|
| Rate for Payer: UHC Medicare Advantage |
$16.19
|
| Rate for Payer: VA VA |
$16.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.58
|
|
|
CEFEPIME 1 GRAM/50 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$64.77
|
|
|
Service Code
|
HCPCS J0703
|
| Hospital Charge Code |
105551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.10 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Aetna Commercial |
$55.05
|
| Rate for Payer: BCBS Trust/PPO |
$52.87
|
| Rate for Payer: BCN Commercial |
$50.05
|
| Rate for Payer: Cash Price |
$51.82
|
| Rate for Payer: Cofinity Commercial |
$55.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.82
|
| Rate for Payer: Healthscope Commercial |
$58.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.05
|
| Rate for Payer: Nomi Health Commercial |
$53.11
|
| Rate for Payer: PHP Commercial |
$55.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.10
|
| Rate for Payer: Priority Health HMO/PPO |
$56.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.00
|
| Rate for Payer: UHC Core |
$54.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.58
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$18.08
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Aetna Commercial |
$14.47
|
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Commercial |
$17.26
|
| Rate for Payer: BCBS Trust/PPO |
$14.76
|
| Rate for Payer: BCBS Trust/PPO |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$13.89
|
| Rate for Payer: BCBS Trust/PPO |
$13.88
|
| Rate for Payer: BCN Commercial |
$13.97
|
| Rate for Payer: BCN Commercial |
$13.14
|
| Rate for Payer: BCN Commercial |
$15.70
|
| Rate for Payer: BCN Commercial |
$13.15
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$17.47
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.25
|
| Rate for Payer: Healthscope Commercial |
$18.28
|
| Rate for Payer: Healthscope Commercial |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$16.27
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.26
|
| Rate for Payer: Nomi Health Commercial |
$13.94
|
| Rate for Payer: Nomi Health Commercial |
$13.96
|
| Rate for Payer: Nomi Health Commercial |
$16.65
|
| Rate for Payer: Nomi Health Commercial |
$14.83
|
| Rate for Payer: PHP Commercial |
$14.47
|
| Rate for Payer: PHP Commercial |
$14.45
|
| Rate for Payer: PHP Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$17.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health HMO/PPO |
$15.73
|
| Rate for Payer: Priority Health HMO/PPO |
$17.67
|
| Rate for Payer: Priority Health HMO/PPO |
$14.79
|
| Rate for Payer: Priority Health HMO/PPO |
$14.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.91
|
| Rate for Payer: UHC Core |
$15.10
|
| Rate for Payer: UHC Core |
$16.96
|
| Rate for Payer: UHC Core |
$14.21
|
| Rate for Payer: UHC Core |
$14.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.56
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Commercial |
$17.26
|
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Aetna Commercial |
$14.47
|
| Rate for Payer: Aetna Medicare |
$4.43
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: Aetna Medicare |
$4.70
|
| Rate for Payer: Aetna Medicare |
$5.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.31
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS Complete |
$6.81
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS MAPPO |
$4.25
|
| Rate for Payer: BCBS MAPPO |
$4.26
|
| Rate for Payer: BCBS MAPPO |
$5.08
|
| Rate for Payer: BCBS MAPPO |
$4.52
|
| Rate for Payer: BCBS Trust/PPO |
$13.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.70
|
| Rate for Payer: BCBS Trust/PPO |
$13.99
|
| Rate for Payer: BCBS Trust/PPO |
$14.86
|
| Rate for Payer: BCN Commercial |
$13.22
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$13.23
|
| Rate for Payer: BCN Commercial |
$15.79
|
| Rate for Payer: BCN Medicare Advantage |
$4.26
|
| Rate for Payer: BCN Medicare Advantage |
$5.08
|
| Rate for Payer: BCN Medicare Advantage |
$4.25
|
| Rate for Payer: BCN Medicare Advantage |
$4.52
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cofinity Commercial |
$17.47
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$18.28
|
| Rate for Payer: Healthscope Commercial |
$16.27
|
| Rate for Payer: Healthscope Commercial |
$15.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: Nomi Health Commercial |
$14.83
|
| Rate for Payer: Nomi Health Commercial |
$16.65
|
| Rate for Payer: Nomi Health Commercial |
$13.94
|
| Rate for Payer: Nomi Health Commercial |
$13.96
|
| Rate for Payer: PACE Senior Care Partners |
$4.04
|
| Rate for Payer: PACE Senior Care Partners |
$4.29
|
| Rate for Payer: PACE Senior Care Partners |
$4.82
|
| Rate for Payer: PACE Senior Care Partners |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.26
|
| Rate for Payer: PACE SWMI |
$4.25
|
| Rate for Payer: PACE SWMI |
$4.52
|
| Rate for Payer: PACE SWMI |
$5.08
|
| Rate for Payer: PHP Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$17.26
|
| Rate for Payer: PHP Commercial |
$14.47
|
| Rate for Payer: PHP Commercial |
$14.45
|
| Rate for Payer: PHP Medicare Advantage |
$4.26
|
| Rate for Payer: PHP Medicare Advantage |
$4.25
|
| Rate for Payer: PHP Medicare Advantage |
$5.08
|
| Rate for Payer: PHP Medicare Advantage |
$4.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health HMO/PPO |
$14.81
|
| Rate for Payer: Priority Health HMO/PPO |
$17.67
|
| Rate for Payer: Priority Health HMO/PPO |
$15.73
|
| Rate for Payer: Priority Health HMO/PPO |
$14.79
|
| Rate for Payer: Priority Health Medicare |
$4.57
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: Priority Health Medicare |
$4.30
|
| Rate for Payer: Priority Health Medicare |
$5.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.39
|
| Rate for Payer: Railroad Medicare Medicare |
$4.26
|
| Rate for Payer: Railroad Medicare Medicare |
$4.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4.25
|
| Rate for Payer: Railroad Medicare Medicare |
$5.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.98
|
| Rate for Payer: UHC Core |
$14.20
|
| Rate for Payer: UHC Core |
$16.96
|
| Rate for Payer: UHC Core |
$14.21
|
| Rate for Payer: UHC Core |
$15.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.26
|
| Rate for Payer: UHC Exchange |
$5.08
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.25
|
| Rate for Payer: UHC Exchange |
$4.52
|
| Rate for Payer: UHC Medicare Advantage |
$5.08
|
| Rate for Payer: UHC Medicare Advantage |
$4.25
|
| Rate for Payer: UHC Medicare Advantage |
$4.52
|
| Rate for Payer: UHC Medicare Advantage |
$4.26
|
| Rate for Payer: VA VA |
$4.26
|
| Rate for Payer: VA VA |
$5.08
|
| Rate for Payer: VA VA |
$4.52
|
| Rate for Payer: VA VA |
$4.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.56
|
|
|
CEFEPIME 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$18.08
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: BCBS Trust/PPO |
$14.76
|
| Rate for Payer: BCN Commercial |
$13.97
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$16.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: Nomi Health Commercial |
$14.83
|
| Rate for Payer: PHP Commercial |
$15.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health HMO/PPO |
$15.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.91
|
| Rate for Payer: UHC Core |
$15.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.56
|
|
|
CEFEPIME 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$18.08
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Aetna Medicare |
$4.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.65
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS MAPPO |
$4.52
|
| Rate for Payer: BCBS Trust/PPO |
$14.86
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$4.52
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$16.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: Nomi Health Commercial |
$14.83
|
| Rate for Payer: PACE Senior Care Partners |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.52
|
| Rate for Payer: PHP Commercial |
$15.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health HMO/PPO |
$15.73
|
| Rate for Payer: Priority Health Medicare |
$4.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.11
|
| Rate for Payer: Railroad Medicare Medicare |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.91
|
| Rate for Payer: UHC Core |
$15.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.52
|
| Rate for Payer: UHC Exchange |
$4.52
|
| Rate for Payer: UHC Medicare Advantage |
$4.52
|
| Rate for Payer: VA VA |
$4.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.56
|
|
|
CEFEPIME 2 GRAM/50 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$91.15
|
|
|
Service Code
|
HCPCS J0703
|
| Hospital Charge Code |
105552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$82.04 |
| Rate for Payer: Aetna Commercial |
$77.48
|
| Rate for Payer: Aetna Medicare |
$23.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.48
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$22.79
|
| Rate for Payer: BCBS Trust/PPO |
$74.93
|
| Rate for Payer: BCN Commercial |
$70.87
|
| Rate for Payer: BCN Medicare Advantage |
$22.79
|
| Rate for Payer: Cash Price |
$72.92
|
| Rate for Payer: Cofinity Commercial |
$78.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.79
|
| Rate for Payer: Healthscope Commercial |
$82.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.48
|
| Rate for Payer: Nomi Health Commercial |
$74.74
|
| Rate for Payer: PACE Senior Care Partners |
$21.65
|
| Rate for Payer: PACE SWMI |
$22.79
|
| Rate for Payer: PHP Commercial |
$77.48
|
| Rate for Payer: PHP Medicare Advantage |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.25
|
| Rate for Payer: Priority Health HMO/PPO |
$79.30
|
| Rate for Payer: Priority Health Medicare |
$23.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.07
|
| Rate for Payer: Railroad Medicare Medicare |
$22.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.21
|
| Rate for Payer: UHC Core |
$76.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.79
|
| Rate for Payer: UHC Exchange |
$22.79
|
| Rate for Payer: UHC Medicare Advantage |
$22.79
|
| Rate for Payer: VA VA |
$22.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.36
|
|
|
CEFEPIME 2 GRAM/50 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$91.15
|
|
|
Service Code
|
HCPCS J0703
|
| Hospital Charge Code |
105552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$82.04 |
| Rate for Payer: Aetna Commercial |
$77.48
|
| Rate for Payer: BCBS Trust/PPO |
$74.41
|
| Rate for Payer: BCN Commercial |
$70.44
|
| Rate for Payer: Cash Price |
$72.92
|
| Rate for Payer: Cofinity Commercial |
$78.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.92
|
| Rate for Payer: Healthscope Commercial |
$82.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.48
|
| Rate for Payer: Nomi Health Commercial |
$74.74
|
| Rate for Payer: PHP Commercial |
$77.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.25
|
| Rate for Payer: Priority Health HMO/PPO |
$79.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.21
|
| Rate for Payer: UHC Core |
$76.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.36
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$25.19
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$22.67 |
| Rate for Payer: Aetna Commercial |
$21.41
|
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Commercial |
$27.57
|
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Medicare |
$8.43
|
| Rate for Payer: Aetna Medicare |
$6.55
|
| Rate for Payer: Aetna Medicare |
$4.99
|
| Rate for Payer: Aetna Medicare |
$4.98
|
| Rate for Payer: Aetna Medicare |
$6.67
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.99
|
| Rate for Payer: BCBS Complete |
$10.08
|
| Rate for Payer: BCBS Complete |
$12.97
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS Complete |
$10.26
|
| Rate for Payer: BCBS Complete |
$13.21
|
| Rate for Payer: BCBS MAPPO |
$6.42
|
| Rate for Payer: BCBS MAPPO |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCBS MAPPO |
$8.11
|
| Rate for Payer: BCBS MAPPO |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$21.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCBS Trust/PPO |
$15.76
|
| Rate for Payer: BCBS Trust/PPO |
$26.66
|
| Rate for Payer: BCBS Trust/PPO |
$27.15
|
| Rate for Payer: BCBS Trust/PPO |
$20.71
|
| Rate for Payer: BCN Commercial |
$19.95
|
| Rate for Payer: BCN Commercial |
$14.91
|
| Rate for Payer: BCN Commercial |
$14.90
|
| Rate for Payer: BCN Commercial |
$25.68
|
| Rate for Payer: BCN Commercial |
$25.21
|
| Rate for Payer: BCN Commercial |
$19.59
|
| Rate for Payer: BCN Medicare Advantage |
$6.30
|
| Rate for Payer: BCN Medicare Advantage |
$6.42
|
| Rate for Payer: BCN Medicare Advantage |
$4.80
|
| Rate for Payer: BCN Medicare Advantage |
$4.79
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: BCN Medicare Advantage |
$8.11
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Cofinity Commercial |
$21.66
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$22.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.11
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$22.67
|
| Rate for Payer: Healthscope Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.74
|
| 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 |
$5.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.81
|
| Rate for Payer: Nomi Health Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$26.59
|
| Rate for Payer: Nomi Health Commercial |
$15.73
|
| Rate for Payer: Nomi Health Commercial |
$20.66
|
| Rate for Payer: Nomi Health Commercial |
$27.08
|
| Rate for Payer: Nomi Health Commercial |
$21.04
|
| Rate for Payer: PACE Senior Care Partners |
$7.84
|
| Rate for Payer: PACE Senior Care Partners |
$6.09
|
| Rate for Payer: PACE Senior Care Partners |
$4.56
|
| Rate for Payer: PACE Senior Care Partners |
$4.55
|
| Rate for Payer: PACE Senior Care Partners |
$5.98
|
| Rate for Payer: PACE Senior Care Partners |
$7.70
|
| Rate for Payer: PACE SWMI |
$6.42
|
| Rate for Payer: PACE SWMI |
$6.30
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PACE SWMI |
$4.80
|
| Rate for Payer: PACE SWMI |
$8.11
|
| Rate for Payer: PACE SWMI |
$4.79
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$21.41
|
| Rate for Payer: PHP Commercial |
$27.57
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: PHP Commercial |
$21.81
|
| Rate for Payer: PHP Medicare Advantage |
$4.79
|
| Rate for Payer: PHP Medicare Advantage |
$6.42
|
| Rate for Payer: PHP Medicare Advantage |
$8.11
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: PHP Medicare Advantage |
$6.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.47
|
| Rate for Payer: Priority Health HMO/PPO |
$21.92
|
| Rate for Payer: Priority Health HMO/PPO |
$16.69
|
| Rate for Payer: Priority Health HMO/PPO |
$28.74
|
| Rate for Payer: Priority Health HMO/PPO |
$22.32
|
| Rate for Payer: Priority Health HMO/PPO |
$16.68
|
| Rate for Payer: Priority Health HMO/PPO |
$28.21
|
| Rate for Payer: Priority Health Medicare |
$8.34
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health Medicare |
$4.84
|
| Rate for Payer: Priority Health Medicare |
$4.84
|
| Rate for Payer: Priority Health Medicare |
$6.36
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$8.11
|
| Rate for Payer: Railroad Medicare Medicare |
$6.30
|
| Rate for Payer: Railroad Medicare Medicare |
$8.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4.80
|
| Rate for Payer: Railroad Medicare Medicare |
$4.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.88
|
| Rate for Payer: UHC Core |
$27.08
|
| Rate for Payer: UHC Core |
$21.43
|
| Rate for Payer: UHC Core |
$16.02
|
| Rate for Payer: UHC Core |
$16.01
|
| Rate for Payer: UHC Core |
$21.03
|
| Rate for Payer: UHC Core |
$27.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.79
|
| Rate for Payer: UHC Exchange |
$8.11
|
| Rate for Payer: UHC Exchange |
$4.80
|
| Rate for Payer: UHC Exchange |
$6.30
|
| Rate for Payer: UHC Exchange |
$4.79
|
| Rate for Payer: UHC Exchange |
$8.26
|
| Rate for Payer: UHC Exchange |
$6.42
|
| Rate for Payer: UHC Medicare Advantage |
$6.30
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$4.80
|
| Rate for Payer: UHC Medicare Advantage |
$8.11
|
| Rate for Payer: UHC Medicare Advantage |
$4.79
|
| Rate for Payer: UHC Medicare Advantage |
$6.42
|
| Rate for Payer: VA VA |
$6.42
|
| Rate for Payer: VA VA |
$4.79
|
| Rate for Payer: VA VA |
$6.30
|
| Rate for Payer: VA VA |
$4.80
|
| Rate for Payer: VA VA |
$8.26
|
| Rate for Payer: VA VA |
$8.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.32
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Commercial |
$21.41
|
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Commercial |
$27.57
|
| Rate for Payer: BCBS Trust/PPO |
$26.96
|
| Rate for Payer: BCBS Trust/PPO |
$20.95
|
| Rate for Payer: BCBS Trust/PPO |
$26.47
|
| Rate for Payer: BCBS Trust/PPO |
$15.66
|
| Rate for Payer: BCBS Trust/PPO |
$15.65
|
| Rate for Payer: BCBS Trust/PPO |
$20.56
|
| Rate for Payer: BCN Commercial |
$25.06
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Commercial |
$14.81
|
| Rate for Payer: BCN Commercial |
$19.47
|
| Rate for Payer: BCN Commercial |
$25.53
|
| Rate for Payer: BCN Commercial |
$14.82
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$21.66
|
| Rate for Payer: Cofinity Commercial |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Healthscope Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$22.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.41
|
| Rate for Payer: Nomi Health Commercial |
$26.59
|
| Rate for Payer: Nomi Health Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.73
|
| Rate for Payer: Nomi Health Commercial |
$21.04
|
| Rate for Payer: Nomi Health Commercial |
$20.66
|
| Rate for Payer: Nomi Health Commercial |
$27.08
|
| Rate for Payer: PHP Commercial |
$27.57
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$21.41
|
| Rate for Payer: PHP Commercial |
$21.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.37
|
| Rate for Payer: Priority Health HMO/PPO |
$16.68
|
| Rate for Payer: Priority Health HMO/PPO |
$16.69
|
| Rate for Payer: Priority Health HMO/PPO |
$22.32
|
| Rate for Payer: Priority Health HMO/PPO |
$28.21
|
| Rate for Payer: Priority Health HMO/PPO |
$21.92
|
| Rate for Payer: Priority Health HMO/PPO |
$28.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.07
|
| Rate for Payer: UHC Core |
$27.58
|
| Rate for Payer: UHC Core |
$16.02
|
| Rate for Payer: UHC Core |
$21.03
|
| Rate for Payer: UHC Core |
$27.08
|
| Rate for Payer: UHC Core |
$21.43
|
| Rate for Payer: UHC Core |
$16.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
|
|
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 |
$6.09 |
| 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 |
$10.26
|
| Rate for Payer: BCBS MAPPO |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$21.10
|
| Rate for Payer: BCN Commercial |
$19.95
|
| 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 |
$19.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.81
|
| Rate for Payer: Nomi Health Commercial |
$21.04
|
| 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 Cigna Priority Health |
$16.68
|
| Rate for Payer: Priority Health HMO/PPO |
$22.32
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.19
|
| 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 Dual Complete DSNP |
$6.42
|
| Rate for Payer: UHC Exchange |
$6.42
|
| Rate for Payer: UHC Medicare Advantage |
$6.42
|
| Rate for Payer: VA VA |
$6.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.24
|
|
|
CEFEPIME 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$25.66
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.68 |
| Max. Negotiated Rate |
$23.09 |
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: BCBS Trust/PPO |
$20.95
|
| Rate for Payer: BCN Commercial |
$19.83
|
| 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: Healthscope Commercial |
$23.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.81
|
| Rate for Payer: Nomi Health Commercial |
$21.04
|
| Rate for Payer: PHP Commercial |
$21.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.68
|
| Rate for Payer: Priority Health HMO/PPO |
$22.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.58
|
| Rate for Payer: UHC Core |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.24
|
|
|
CEFOXITIN 1 GRAM/50 ML IN DEXTROSE, ISO-OSMOTIC INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$66.38
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
91039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.15 |
| Max. Negotiated Rate |
$59.74 |
| Rate for Payer: Aetna Commercial |
$56.42
|
| Rate for Payer: BCBS Trust/PPO |
$54.19
|
| Rate for Payer: BCN Commercial |
$51.30
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cofinity Commercial |
$57.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.10
|
| Rate for Payer: Healthscope Commercial |
$59.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.42
|
| Rate for Payer: Nomi Health Commercial |
$54.43
|
| Rate for Payer: PHP Commercial |
$56.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.15
|
| Rate for Payer: Priority Health HMO/PPO |
$57.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.41
|
| Rate for Payer: UHC Core |
$55.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.78
|
|
|
CEFOXITIN 1 GRAM/50 ML IN DEXTROSE, ISO-OSMOTIC INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$66.38
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
91039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$59.74 |
| Rate for Payer: Aetna Commercial |
$56.42
|
| Rate for Payer: Aetna Medicare |
$17.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.74
|
| Rate for Payer: BCBS Complete |
$26.55
|
| Rate for Payer: BCBS MAPPO |
$16.60
|
| Rate for Payer: BCBS Trust/PPO |
$54.57
|
| Rate for Payer: BCN Commercial |
$51.61
|
| Rate for Payer: BCN Medicare Advantage |
$16.60
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cofinity Commercial |
$57.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.60
|
| Rate for Payer: Healthscope Commercial |
$59.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.42
|
| Rate for Payer: Nomi Health Commercial |
$54.43
|
| Rate for Payer: PACE Senior Care Partners |
$15.77
|
| Rate for Payer: PACE SWMI |
$16.60
|
| Rate for Payer: PHP Commercial |
$56.42
|
| Rate for Payer: PHP Medicare Advantage |
$16.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.15
|
| Rate for Payer: Priority Health HMO/PPO |
$57.75
|
| Rate for Payer: Priority Health Medicare |
$16.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.47
|
| Rate for Payer: Railroad Medicare Medicare |
$16.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.41
|
| Rate for Payer: UHC Core |
$55.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.60
|
| Rate for Payer: UHC Exchange |
$16.60
|
| Rate for Payer: UHC Medicare Advantage |
$16.60
|
| Rate for Payer: VA VA |
$16.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.78
|
|
|
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 |
$5.64 |
| Max. Negotiated Rate |
$21.38 |
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna Medicare |
$6.18
|
| 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 |
$9.50
|
| Rate for Payer: BCBS MAPPO |
$5.94
|
| Rate for Payer: BCBS Trust/PPO |
$19.52
|
| Rate for Payer: BCN Commercial |
$18.47
|
| Rate for Payer: BCN Medicare Advantage |
$5.94
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: Nomi Health Commercial |
$19.48
|
| 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 Cigna Priority Health |
$15.44
|
| Rate for Payer: Priority Health HMO/PPO |
$20.66
|
| Rate for Payer: Priority Health Medicare |
$6.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.91
|
| 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 Dual Complete DSNP |
$5.94
|
| Rate for Payer: UHC Exchange |
$5.94
|
| Rate for Payer: UHC Medicare Advantage |
$5.94
|
| Rate for Payer: VA VA |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
|
|
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 |
$15.44 |
| Max. Negotiated Rate |
$21.38 |
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$19.39
|
| Rate for Payer: BCN Commercial |
$18.35
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| 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: PHP Commercial |
$20.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: Priority Health HMO/PPO |
$20.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.91
|
| 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 SOLUTION
|
Facility
|
OP
|
$23.75
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$21.38 |
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Medicare |
$6.18
|
| Rate for Payer: Aetna Medicare |
$4.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.38
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$9.50
|
| Rate for Payer: BCBS MAPPO |
$4.30
|
| Rate for Payer: BCBS MAPPO |
$5.94
|
| Rate for Payer: BCBS Trust/PPO |
$19.52
|
| Rate for Payer: BCBS Trust/PPO |
$14.15
|
| Rate for Payer: BCN Commercial |
$18.47
|
| Rate for Payer: BCN Commercial |
$13.38
|
| Rate for Payer: BCN Medicare Advantage |
$5.94
|
| Rate for Payer: BCN Medicare Advantage |
$4.30
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| 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 |
$4.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.94
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.83
|
| 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: 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 |
$20.19
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Medicare Advantage |
$4.30
|
| Rate for Payer: PHP Medicare Advantage |
$5.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health HMO/PPO |
$14.97
|
| Rate for Payer: Priority Health HMO/PPO |
$20.66
|
| Rate for Payer: Priority Health Medicare |
$6.00
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.53
|
| 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 Dual Complete DSNP |
$5.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.30
|
| Rate for Payer: UHC Exchange |
$4.30
|
| Rate for Payer: UHC Exchange |
$5.94
|
| Rate for Payer: UHC Medicare Advantage |
$4.30
|
| Rate for Payer: UHC Medicare Advantage |
$5.94
|
| 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 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.21
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.19 |
| 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 |
$14.05
|
| Rate for Payer: BCBS Trust/PPO |
$19.39
|
| Rate for Payer: BCN Commercial |
$13.30
|
| Rate for Payer: BCN Commercial |
$18.35
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| 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: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health HMO/PPO |
$20.66
|
| Rate for Payer: Priority Health HMO/PPO |
$14.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.91
|
| 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 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 |
$24.56 |
| 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 |
$41.37
|
| Rate for Payer: BCBS MAPPO |
$25.86
|
| Rate for Payer: BCBS Trust/PPO |
$85.02
|
| Rate for Payer: BCN Commercial |
$80.41
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.91
|
| Rate for Payer: Nomi Health Commercial |
$84.80
|
| 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 Cigna Priority Health |
$67.22
|
| Rate for Payer: Priority Health HMO/PPO |
$89.98
|
| Rate for Payer: Priority Health Medicare |
$26.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.29
|
| 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 Dual Complete DSNP |
$25.86
|
| Rate for Payer: UHC Exchange |
$25.86
|
| Rate for Payer: UHC Medicare Advantage |
$25.86
|
| 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 |
$67.22 |
| Max. Negotiated Rate |
$93.08 |
| Rate for Payer: Aetna Commercial |
$87.91
|
| Rate for Payer: BCBS Trust/PPO |
$84.42
|
| Rate for Payer: BCN Commercial |
$79.92
|
| 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: PHP Commercial |
$87.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.22
|
| Rate for Payer: Priority Health HMO/PPO |
$89.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.29
|
| 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
|
$23.18
|
|
|
Service Code
|
NDC 00143987725
|
| Hospital Charge Code |
301722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$20.86 |
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.24
|
| Rate for Payer: BCBS Complete |
$9.27
|
| Rate for Payer: BCBS MAPPO |
$5.80
|
| Rate for Payer: BCBS Trust/PPO |
$19.06
|
| Rate for Payer: BCN Commercial |
$18.02
|
| Rate for Payer: BCN Medicare Advantage |
$5.80
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Cofinity Commercial |
$19.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.80
|
| Rate for Payer: Healthscope Commercial |
$20.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.70
|
| Rate for Payer: Nomi Health Commercial |
$19.01
|
| Rate for Payer: PACE Senior Care Partners |
$5.51
|
| Rate for Payer: PACE SWMI |
$5.80
|
| Rate for Payer: PHP Commercial |
$19.70
|
| Rate for Payer: PHP Medicare Advantage |
$5.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.07
|
| Rate for Payer: Priority Health HMO/PPO |
$20.17
|
| Rate for Payer: Priority Health Medicare |
$5.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.53
|
| Rate for Payer: Railroad Medicare Medicare |
$5.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.40
|
| Rate for Payer: UHC Core |
$19.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.80
|
| Rate for Payer: UHC Exchange |
$5.80
|
| Rate for Payer: UHC Medicare Advantage |
$5.80
|
| Rate for Payer: VA VA |
$5.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.38
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$23.18
|
|
|
Service Code
|
NDC 00143987725
|
| Hospital Charge Code |
301722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$20.86 |
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: BCBS Trust/PPO |
$18.92
|
| Rate for Payer: BCN Commercial |
$17.91
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Cofinity Commercial |
$19.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.54
|
| Rate for Payer: Healthscope Commercial |
$20.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.70
|
| Rate for Payer: Nomi Health Commercial |
$19.01
|
| Rate for Payer: PHP Commercial |
$19.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.07
|
| Rate for Payer: Priority Health HMO/PPO |
$20.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.40
|
| Rate for Payer: UHC Core |
$19.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.38
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.74
|
|
|
Service Code
|
NDC 63323034225
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.71 |
| 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 |
$23.10
|
| Rate for Payer: BCBS MAPPO |
$14.44
|
| Rate for Payer: BCBS Trust/PPO |
$47.47
|
| Rate for Payer: BCN Commercial |
$44.89
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.08
|
| Rate for Payer: Nomi Health Commercial |
$47.35
|
| 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 Cigna Priority Health |
$37.53
|
| Rate for Payer: Priority Health HMO/PPO |
$50.23
|
| Rate for Payer: Priority Health Medicare |
$14.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.69
|
| 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 Dual Complete DSNP |
$14.44
|
| Rate for Payer: UHC Exchange |
$14.44
|
| Rate for Payer: UHC Medicare Advantage |
$14.44
|
| Rate for Payer: VA VA |
$14.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.30
|
|
