|
CEFAZOLIN INJECTION (DISCOGRAPHY)
|
Facility
|
OP
|
$23.43
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
158561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$21.09 |
| Rate for Payer: Aetna Commercial |
$19.92
|
| Rate for Payer: Aetna Medicare |
$6.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.32
|
| Rate for Payer: BCBS Complete |
$9.37
|
| Rate for Payer: BCBS MAPPO |
$5.86
|
| Rate for Payer: BCBS Trust/PPO |
$19.26
|
| Rate for Payer: BCN Commercial |
$18.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.86
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.86
|
| Rate for Payer: Healthscope Commercial |
$21.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.92
|
| Rate for Payer: Nomi Health Commercial |
$19.21
|
| Rate for Payer: PACE Senior Care Partners |
$5.56
|
| Rate for Payer: PACE SWMI |
$5.86
|
| Rate for Payer: PHP Commercial |
$19.92
|
| Rate for Payer: PHP Medicare Advantage |
$5.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.23
|
| Rate for Payer: Priority Health HMO/PPO |
$20.38
|
| Rate for Payer: Priority Health Medicare |
$5.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.70
|
| Rate for Payer: Railroad Medicare Medicare |
$5.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.62
|
| Rate for Payer: UHC Core |
$19.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.86
|
| Rate for Payer: UHC Exchange |
$5.86
|
| Rate for Payer: UHC Medicare Advantage |
$5.86
|
| Rate for Payer: VA VA |
$5.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.57
|
|
|
CEFAZOLIN INJECTION (DISCOGRAPHY)
|
Facility
|
IP
|
$23.43
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
158561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$21.09 |
| Rate for Payer: Aetna Commercial |
$19.92
|
| Rate for Payer: BCBS Trust/PPO |
$19.13
|
| Rate for Payer: BCN Commercial |
$18.11
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.74
|
| Rate for Payer: Healthscope Commercial |
$21.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.92
|
| Rate for Payer: Nomi Health Commercial |
$19.21
|
| Rate for Payer: PHP Commercial |
$19.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.23
|
| Rate for Payer: Priority Health HMO/PPO |
$20.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.62
|
| Rate for Payer: UHC Core |
$19.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.57
|
|
|
CEFAZOLIN IV SYRINGE 1 G PMX
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: BCBS Trust/PPO |
$19.45
|
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: BCN Commercial |
$18.42
|
| Rate for Payer: BCN Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Nomi Health Commercial |
$19.54
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.49
|
| Rate for Payer: Priority Health HMO/PPO |
$2.63
|
| Rate for Payer: Priority Health HMO/PPO |
$20.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.66
|
| Rate for Payer: UHC Core |
$19.90
|
| Rate for Payer: UHC Core |
$2.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
CEFAZOLIN IV SYRINGE 1 G PMX
|
Facility
|
OP
|
$3.02
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: Aetna Medicare |
$6.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.45
|
| Rate for Payer: BCBS Complete |
$9.53
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS MAPPO |
$5.96
|
| Rate for Payer: BCBS MAPPO |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$19.59
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: BCN Commercial |
$18.53
|
| Rate for Payer: BCN Medicare Advantage |
$0.76
|
| Rate for Payer: BCN Medicare Advantage |
$5.96
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.76
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.26
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: Nomi Health Commercial |
$19.54
|
| Rate for Payer: PACE Senior Care Partners |
$0.72
|
| Rate for Payer: PACE Senior Care Partners |
$5.66
|
| Rate for Payer: PACE SWMI |
$0.76
|
| Rate for Payer: PACE SWMI |
$5.96
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: PHP Medicare Advantage |
$5.96
|
| Rate for Payer: PHP Medicare Advantage |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.49
|
| Rate for Payer: Priority Health HMO/PPO |
$20.73
|
| Rate for Payer: Priority Health HMO/PPO |
$2.63
|
| Rate for Payer: Priority Health Medicare |
$0.76
|
| Rate for Payer: Priority Health Medicare |
$6.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.97
|
| Rate for Payer: Railroad Medicare Medicare |
$5.96
|
| Rate for Payer: Railroad Medicare Medicare |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.66
|
| Rate for Payer: UHC Core |
$2.52
|
| Rate for Payer: UHC Core |
$19.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.96
|
| Rate for Payer: UHC Exchange |
$5.96
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Medicare Advantage |
$5.96
|
| Rate for Payer: UHC Medicare Advantage |
$0.76
|
| Rate for Payer: VA VA |
$5.96
|
| Rate for Payer: VA VA |
$0.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.87
|
|
|
CEFAZOLIN IV SYRINGE 2 G PMX
|
Facility
|
OP
|
$6.04
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: Aetna Medicare |
$1.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.89
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS MAPPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$4.97
|
| Rate for Payer: BCN Commercial |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$1.51
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.51
|
| Rate for Payer: Healthscope Commercial |
$5.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.13
|
| Rate for Payer: Nomi Health Commercial |
$4.95
|
| Rate for Payer: PACE Senior Care Partners |
$1.43
|
| Rate for Payer: PACE SWMI |
$1.51
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: PHP Medicare Advantage |
$1.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: Priority Health HMO/PPO |
$5.25
|
| Rate for Payer: Priority Health Medicare |
$1.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.32
|
| Rate for Payer: UHC Core |
$5.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.51
|
| Rate for Payer: UHC Exchange |
$1.51
|
| Rate for Payer: UHC Medicare Advantage |
$1.51
|
| Rate for Payer: VA VA |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.53
|
|
|
CEFAZOLIN IV SYRINGE 2 G PMX
|
Facility
|
IP
|
$6.04
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: BCBS Trust/PPO |
$4.93
|
| Rate for Payer: BCN Commercial |
$4.67
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.83
|
| Rate for Payer: Healthscope Commercial |
$5.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.13
|
| Rate for Payer: Nomi Health Commercial |
$4.95
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: Priority Health HMO/PPO |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.32
|
| Rate for Payer: UHC Core |
$5.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.53
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$218.55
|
|
|
Service Code
|
NDC 67877054798
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.91 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna Medicare |
$56.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.30
|
| Rate for Payer: BCBS Complete |
$87.42
|
| Rate for Payer: BCBS MAPPO |
$54.64
|
| Rate for Payer: BCBS Trust/PPO |
$179.67
|
| Rate for Payer: BCN Commercial |
$169.92
|
| Rate for Payer: BCN Medicare Advantage |
$54.64
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.64
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Nomi Health Commercial |
$179.21
|
| Rate for Payer: PACE Senior Care Partners |
$51.91
|
| Rate for Payer: PACE SWMI |
$54.64
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: PHP Medicare Advantage |
$54.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.06
|
| Rate for Payer: Priority Health HMO/PPO |
$190.14
|
| Rate for Payer: Priority Health Medicare |
$55.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.43
|
| Rate for Payer: Railroad Medicare Medicare |
$54.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.32
|
| Rate for Payer: UHC Core |
$182.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.64
|
| Rate for Payer: UHC Exchange |
$54.64
|
| Rate for Payer: UHC Medicare Advantage |
$54.64
|
| Rate for Payer: VA VA |
$54.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 67877054798
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.06 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: BCBS Trust/PPO |
$178.40
|
| Rate for Payer: BCN Commercial |
$168.90
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Nomi Health Commercial |
$179.21
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.06
|
| Rate for Payer: Priority Health HMO/PPO |
$190.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.32
|
| Rate for Payer: UHC Core |
$182.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$176.70
|
|
|
Service Code
|
NDC 65862021860
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.86 |
| Max. Negotiated Rate |
$159.03 |
| Rate for Payer: Aetna Commercial |
$150.19
|
| Rate for Payer: BCBS Trust/PPO |
$144.24
|
| Rate for Payer: BCN Commercial |
$136.55
|
| Rate for Payer: Cash Price |
$141.36
|
| Rate for Payer: Cofinity Commercial |
$151.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.36
|
| Rate for Payer: Healthscope Commercial |
$159.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.19
|
| Rate for Payer: Nomi Health Commercial |
$144.89
|
| Rate for Payer: PHP Commercial |
$150.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.86
|
| Rate for Payer: Priority Health HMO/PPO |
$153.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.50
|
| Rate for Payer: UHC Core |
$147.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.53
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$176.70
|
|
|
Service Code
|
NDC 68180072204
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.86 |
| Max. Negotiated Rate |
$159.03 |
| Rate for Payer: Aetna Commercial |
$150.19
|
| Rate for Payer: BCBS Trust/PPO |
$144.24
|
| Rate for Payer: BCN Commercial |
$136.55
|
| Rate for Payer: Cash Price |
$141.36
|
| Rate for Payer: Cofinity Commercial |
$151.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.36
|
| Rate for Payer: Healthscope Commercial |
$159.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.19
|
| Rate for Payer: Nomi Health Commercial |
$144.89
|
| Rate for Payer: PHP Commercial |
$150.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.86
|
| Rate for Payer: Priority Health HMO/PPO |
$153.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.50
|
| Rate for Payer: UHC Core |
$147.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.53
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$176.70
|
|
|
Service Code
|
NDC 68180072204
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.97 |
| Max. Negotiated Rate |
$159.03 |
| Rate for Payer: Aetna Commercial |
$150.19
|
| Rate for Payer: Aetna Medicare |
$45.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.22
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS MAPPO |
$44.17
|
| Rate for Payer: BCBS Trust/PPO |
$145.27
|
| Rate for Payer: BCN Commercial |
$137.38
|
| Rate for Payer: BCN Medicare Advantage |
$44.17
|
| Rate for Payer: Cash Price |
$141.36
|
| Rate for Payer: Cofinity Commercial |
$151.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.17
|
| Rate for Payer: Healthscope Commercial |
$159.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.19
|
| Rate for Payer: Nomi Health Commercial |
$144.89
|
| Rate for Payer: PACE Senior Care Partners |
$41.97
|
| Rate for Payer: PACE SWMI |
$44.17
|
| Rate for Payer: PHP Commercial |
$150.19
|
| Rate for Payer: PHP Medicare Advantage |
$44.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.86
|
| Rate for Payer: Priority Health HMO/PPO |
$153.73
|
| Rate for Payer: Priority Health Medicare |
$44.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.39
|
| Rate for Payer: Railroad Medicare Medicare |
$44.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.50
|
| Rate for Payer: UHC Core |
$147.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.17
|
| Rate for Payer: UHC Exchange |
$44.17
|
| Rate for Payer: UHC Medicare Advantage |
$44.17
|
| Rate for Payer: VA VA |
$44.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.53
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$176.70
|
|
|
Service Code
|
NDC 65862021860
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.97 |
| Max. Negotiated Rate |
$159.03 |
| Rate for Payer: Aetna Commercial |
$150.19
|
| Rate for Payer: Aetna Medicare |
$45.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.22
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS MAPPO |
$44.17
|
| Rate for Payer: BCBS Trust/PPO |
$145.27
|
| Rate for Payer: BCN Commercial |
$137.38
|
| Rate for Payer: BCN Medicare Advantage |
$44.17
|
| Rate for Payer: Cash Price |
$141.36
|
| Rate for Payer: Cofinity Commercial |
$151.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.17
|
| Rate for Payer: Healthscope Commercial |
$159.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.19
|
| Rate for Payer: Nomi Health Commercial |
$144.89
|
| Rate for Payer: PACE Senior Care Partners |
$41.97
|
| Rate for Payer: PACE SWMI |
$44.17
|
| Rate for Payer: PHP Commercial |
$150.19
|
| Rate for Payer: PHP Medicare Advantage |
$44.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.86
|
| Rate for Payer: Priority Health HMO/PPO |
$153.73
|
| Rate for Payer: Priority Health Medicare |
$44.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.39
|
| Rate for Payer: Railroad Medicare Medicare |
$44.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.50
|
| Rate for Payer: UHC Core |
$147.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.17
|
| Rate for Payer: UHC Exchange |
$44.17
|
| Rate for Payer: UHC Medicare Advantage |
$44.17
|
| Rate for Payer: VA VA |
$44.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.53
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$163.01
|
|
|
Service Code
|
NDC 65862017760
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.96 |
| Max. Negotiated Rate |
$146.71 |
| Rate for Payer: Aetna Commercial |
$138.56
|
| Rate for Payer: BCBS Trust/PPO |
$133.07
|
| Rate for Payer: BCN Commercial |
$125.97
|
| 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: Healthscope Commercial |
$146.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.56
|
| Rate for Payer: Nomi Health Commercial |
$133.67
|
| Rate for Payer: PHP Commercial |
$138.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.96
|
| Rate for Payer: Priority Health HMO/PPO |
$141.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.45
|
| Rate for Payer: UHC Core |
$136.11
|
| 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
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$348.21
|
|
|
Service Code
|
NDC 60687069921
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.34 |
| Max. Negotiated Rate |
$313.39 |
| Rate for Payer: Aetna Commercial |
$295.98
|
| Rate for Payer: BCBS Trust/PPO |
$284.24
|
| Rate for Payer: BCN Commercial |
$269.10
|
| 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: Healthscope Commercial |
$313.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.98
|
| Rate for Payer: Nomi Health Commercial |
$285.53
|
| Rate for Payer: PHP Commercial |
$295.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.34
|
| Rate for Payer: Priority Health HMO/PPO |
$302.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.42
|
| Rate for Payer: UHC Core |
$290.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.16
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
OP
|
$11.61
|
|
|
Service Code
|
NDC 60687069911
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna Commercial |
$9.87
|
| Rate for Payer: Aetna Medicare |
$3.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.63
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: BCBS MAPPO |
$2.90
|
| Rate for Payer: BCBS Trust/PPO |
$9.54
|
| Rate for Payer: BCN Commercial |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$2.90
|
| Rate for Payer: Cash Price |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$10.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.87
|
| Rate for Payer: Nomi Health Commercial |
$9.52
|
| Rate for Payer: PACE Senior Care Partners |
$2.76
|
| Rate for Payer: PACE SWMI |
$2.90
|
| Rate for Payer: PHP Commercial |
$9.87
|
| Rate for Payer: PHP Medicare Advantage |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health HMO/PPO |
$10.10
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.78
|
| Rate for Payer: Railroad Medicare Medicare |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.22
|
| Rate for Payer: UHC Core |
$9.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.90
|
| Rate for Payer: UHC Exchange |
$2.90
|
| Rate for Payer: UHC Medicare Advantage |
$2.90
|
| Rate for Payer: VA VA |
$2.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.71
|
|
|
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
|
IP
|
$11.61
|
|
|
Service Code
|
NDC 60687069911
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna Commercial |
$9.87
|
| Rate for Payer: BCBS Trust/PPO |
$9.48
|
| Rate for Payer: BCN Commercial |
$8.97
|
| Rate for Payer: Cash Price |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$10.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.87
|
| Rate for Payer: Nomi Health Commercial |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health HMO/PPO |
$10.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.22
|
| Rate for Payer: UHC Core |
$9.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.71
|
|
|
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
|
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 |
$4.25
|
| 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 |
$4.25
|
| 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 |
$4.25
|
| 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 |
$12.77
|
| 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 |
$4.25
|
| 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 |
$4.25
|
| 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 |
$4.25
|
| 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 |
$4.25
|
| Rate for Payer: UHC Exchange |
$5.08
|
| Rate for Payer: UHC Exchange |
$4.25
|
| 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 |
$4.25
|
| Rate for Payer: VA VA |
$4.25
|
| 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 |
$12.77
|
| 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 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 |
$12.77
|
| 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 |
$12.77
|
| 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 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 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 |
$82.03 |
| 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 |
$82.03
|
| 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
|
|
