|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.18
|
|
|
Service Code
|
NDC 00143987725
|
| Hospital Charge Code |
9463
|
|
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 SOLUTION
|
Facility
|
IP
|
$23.18
|
|
|
Service Code
|
NDC 00143987701
|
| Hospital Charge Code |
9463
|
|
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
|
$23.18
|
|
|
Service Code
|
NDC 00143987701
|
| Hospital Charge Code |
9463
|
|
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 SOLUTION
|
Facility
|
IP
|
$57.74
|
|
|
Service Code
|
NDC 63323034225
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.53 |
| Max. Negotiated Rate |
$51.97 |
| Rate for Payer: Aetna Commercial |
$49.08
|
| Rate for Payer: BCBS Trust/PPO |
$47.13
|
| Rate for Payer: BCN Commercial |
$44.62
|
| Rate for Payer: Cash Price |
$46.19
|
| Rate for Payer: Cofinity Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.19
|
| Rate for Payer: Healthscope Commercial |
$51.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.08
|
| Rate for Payer: Nomi Health Commercial |
$47.35
|
| Rate for Payer: PHP Commercial |
$49.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.53
|
| Rate for Payer: Priority Health HMO/PPO |
$50.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.81
|
| Rate for Payer: UHC Core |
$48.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.30
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.18
|
|
|
Service Code
|
NDC 00143987725
|
| Hospital Charge Code |
9463
|
|
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
|
|
|
CEFPODOXIME 100 MG TABLET
|
Facility
|
OP
|
$304.44
|
|
|
Service Code
|
NDC 00781543820
|
| Hospital Charge Code |
9468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.30 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna Commercial |
$258.77
|
| Rate for Payer: Aetna Medicare |
$79.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.14
|
| Rate for Payer: BCBS Complete |
$121.78
|
| Rate for Payer: BCBS MAPPO |
$76.11
|
| Rate for Payer: BCBS Trust/PPO |
$250.28
|
| Rate for Payer: BCN Commercial |
$236.70
|
| Rate for Payer: BCN Medicare Advantage |
$76.11
|
| Rate for Payer: Cash Price |
$243.55
|
| Rate for Payer: Cofinity Commercial |
$261.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.11
|
| Rate for Payer: Healthscope Commercial |
$274.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.77
|
| Rate for Payer: Nomi Health Commercial |
$249.64
|
| Rate for Payer: PACE Senior Care Partners |
$72.30
|
| Rate for Payer: PACE SWMI |
$76.11
|
| Rate for Payer: PHP Commercial |
$258.77
|
| Rate for Payer: PHP Medicare Advantage |
$76.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.89
|
| Rate for Payer: Priority Health HMO/PPO |
$264.86
|
| Rate for Payer: Priority Health Medicare |
$76.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.97
|
| Rate for Payer: Railroad Medicare Medicare |
$76.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.91
|
| Rate for Payer: UHC Core |
$254.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.11
|
| Rate for Payer: UHC Exchange |
$76.11
|
| Rate for Payer: UHC Medicare Advantage |
$76.11
|
| Rate for Payer: VA VA |
$76.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.33
|
|
|
CEFPODOXIME 100 MG TABLET
|
Facility
|
IP
|
$185.96
|
|
|
Service Code
|
NDC 65862009520
|
| Hospital Charge Code |
9468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.87 |
| Max. Negotiated Rate |
$167.36 |
| Rate for Payer: Aetna Commercial |
$158.07
|
| Rate for Payer: BCBS Trust/PPO |
$151.80
|
| Rate for Payer: BCN Commercial |
$143.71
|
| Rate for Payer: Cash Price |
$148.77
|
| Rate for Payer: Cofinity Commercial |
$159.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.77
|
| Rate for Payer: Healthscope Commercial |
$167.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.07
|
| Rate for Payer: Nomi Health Commercial |
$152.49
|
| Rate for Payer: PHP Commercial |
$158.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.87
|
| Rate for Payer: Priority Health HMO/PPO |
$161.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.64
|
| Rate for Payer: UHC Core |
$155.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.47
|
|
|
CEFPODOXIME 100 MG TABLET
|
Facility
|
OP
|
$185.96
|
|
|
Service Code
|
NDC 65862009520
|
| Hospital Charge Code |
9468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$167.36 |
| Rate for Payer: Aetna Commercial |
$158.07
|
| Rate for Payer: Aetna Medicare |
$48.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.11
|
| Rate for Payer: BCBS Complete |
$74.38
|
| Rate for Payer: BCBS MAPPO |
$46.49
|
| Rate for Payer: BCBS Trust/PPO |
$152.88
|
| Rate for Payer: BCN Commercial |
$144.58
|
| Rate for Payer: BCN Medicare Advantage |
$46.49
|
| Rate for Payer: Cash Price |
$148.77
|
| Rate for Payer: Cofinity Commercial |
$159.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.49
|
| Rate for Payer: Healthscope Commercial |
$167.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.07
|
| Rate for Payer: Nomi Health Commercial |
$152.49
|
| Rate for Payer: PACE Senior Care Partners |
$44.17
|
| Rate for Payer: PACE SWMI |
$46.49
|
| Rate for Payer: PHP Commercial |
$158.07
|
| Rate for Payer: PHP Medicare Advantage |
$46.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.87
|
| Rate for Payer: Priority Health HMO/PPO |
$161.79
|
| Rate for Payer: Priority Health Medicare |
$46.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.59
|
| Rate for Payer: Railroad Medicare Medicare |
$46.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.64
|
| Rate for Payer: UHC Core |
$155.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.49
|
| Rate for Payer: UHC Exchange |
$46.49
|
| Rate for Payer: UHC Medicare Advantage |
$46.49
|
| Rate for Payer: VA VA |
$46.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.47
|
|
|
CEFPODOXIME 100 MG TABLET
|
Facility
|
IP
|
$304.44
|
|
|
Service Code
|
NDC 00781543820
|
| Hospital Charge Code |
9468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.89 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna Commercial |
$258.77
|
| Rate for Payer: BCBS Trust/PPO |
$248.51
|
| Rate for Payer: BCN Commercial |
$235.27
|
| Rate for Payer: Cash Price |
$243.55
|
| Rate for Payer: Cofinity Commercial |
$261.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.55
|
| Rate for Payer: Healthscope Commercial |
$274.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.77
|
| Rate for Payer: Nomi Health Commercial |
$249.64
|
| Rate for Payer: PHP Commercial |
$258.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.89
|
| Rate for Payer: Priority Health HMO/PPO |
$264.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.91
|
| Rate for Payer: UHC Core |
$254.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.33
|
|
|
CEFTRIAXONE 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
78580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,413.75 |
| Max. Negotiated Rate |
$1,957.50 |
| Rate for Payer: Aetna Commercial |
$1,848.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,775.45
|
| Rate for Payer: BCN Commercial |
$1,680.84
|
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Cofinity Commercial |
$1,870.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.00
|
| Rate for Payer: Healthscope Commercial |
$1,957.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,631.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,848.75
|
| Rate for Payer: Nomi Health Commercial |
$1,783.50
|
| Rate for Payer: PHP Commercial |
$1,848.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,413.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,892.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,457.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,914.00
|
| Rate for Payer: UHC Core |
$1,816.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,631.25
|
|
|
CEFTRIAXONE 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
78580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$516.56 |
| Max. Negotiated Rate |
$1,957.50 |
| Rate for Payer: Aetna Commercial |
$1,848.75
|
| Rate for Payer: Aetna Medicare |
$565.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$679.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$679.69
|
| Rate for Payer: BCBS Complete |
$870.00
|
| Rate for Payer: BCBS MAPPO |
$543.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,788.07
|
| Rate for Payer: BCN Commercial |
$1,691.06
|
| Rate for Payer: BCN Medicare Advantage |
$543.75
|
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Cofinity Commercial |
$1,870.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$543.75
|
| Rate for Payer: Healthscope Commercial |
$1,957.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,631.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$625.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,848.75
|
| Rate for Payer: Nomi Health Commercial |
$1,783.50
|
| Rate for Payer: PACE Senior Care Partners |
$516.56
|
| Rate for Payer: PACE SWMI |
$543.75
|
| Rate for Payer: PHP Commercial |
$1,848.75
|
| Rate for Payer: PHP Medicare Advantage |
$543.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,413.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,892.25
|
| Rate for Payer: Priority Health Medicare |
$549.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,457.25
|
| Rate for Payer: Railroad Medicare Medicare |
$543.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,914.00
|
| Rate for Payer: UHC Core |
$1,816.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$543.75
|
| Rate for Payer: UHC Exchange |
$543.75
|
| Rate for Payer: UHC Medicare Advantage |
$543.75
|
| Rate for Payer: VA VA |
$543.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,631.25
|
|
|
CEFTRIAXONE 1 GM IV SYRINGE
|
Facility
|
IP
|
$17.98
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
500542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: BCBS Trust/PPO |
$14.68
|
| Rate for Payer: BCN Commercial |
$13.89
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Nomi Health Commercial |
$14.74
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health HMO/PPO |
$15.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.82
|
| Rate for Payer: UHC Core |
$15.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
|
|
CEFTRIAXONE 1 GM IV SYRINGE
|
Facility
|
OP
|
$17.98
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
500542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.62
|
| Rate for Payer: BCBS Complete |
$7.19
|
| Rate for Payer: BCBS MAPPO |
$4.50
|
| Rate for Payer: BCBS Trust/PPO |
$14.78
|
| Rate for Payer: BCN Commercial |
$13.98
|
| Rate for Payer: BCN Medicare Advantage |
$4.50
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Nomi Health Commercial |
$14.74
|
| Rate for Payer: PACE Senior Care Partners |
$4.27
|
| Rate for Payer: PACE SWMI |
$4.50
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: PHP Medicare Advantage |
$4.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health HMO/PPO |
$15.64
|
| Rate for Payer: Priority Health Medicare |
$4.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.05
|
| Rate for Payer: Railroad Medicare Medicare |
$4.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.82
|
| Rate for Payer: UHC Core |
$15.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.50
|
| Rate for Payer: UHC Exchange |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: VA VA |
$4.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
150848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: BCBS Trust/PPO |
$10.83
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Nomi Health Commercial |
$10.88
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health HMO/PPO |
$11.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.68
|
| Rate for Payer: UHC Core |
$11.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION
|
Facility
|
OP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
150848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Medicare |
$3.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.15
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS MAPPO |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$10.91
|
| Rate for Payer: BCN Commercial |
$10.32
|
| Rate for Payer: BCN Medicare Advantage |
$3.32
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Nomi Health Commercial |
$10.88
|
| Rate for Payer: PACE Senior Care Partners |
$3.15
|
| Rate for Payer: PACE SWMI |
$3.32
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Medicare Advantage |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health HMO/PPO |
$11.54
|
| Rate for Payer: Priority Health Medicare |
$3.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.89
|
| Rate for Payer: Railroad Medicare Medicare |
$3.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.68
|
| Rate for Payer: UHC Core |
$11.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.32
|
| Rate for Payer: UHC Exchange |
$3.32
|
| Rate for Payer: UHC Medicare Advantage |
$3.32
|
| Rate for Payer: VA VA |
$3.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Commercial |
$15.13
|
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.53
|
| Rate for Payer: BCBS Trust/PPO |
$10.83
|
| Rate for Payer: BCBS Trust/PPO |
$18.94
|
| Rate for Payer: BCN Commercial |
$13.76
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: BCN Commercial |
$17.93
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Healthscope Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.72
|
| Rate for Payer: Nomi Health Commercial |
$10.88
|
| Rate for Payer: Nomi Health Commercial |
$14.60
|
| Rate for Payer: Nomi Health Commercial |
$19.02
|
| Rate for Payer: PHP Commercial |
$15.13
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.57
|
| Rate for Payer: Priority Health HMO/PPO |
$20.18
|
| Rate for Payer: Priority Health HMO/PPO |
$15.49
|
| Rate for Payer: Priority Health HMO/PPO |
$11.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.68
|
| Rate for Payer: UHC Core |
$11.08
|
| Rate for Payer: UHC Core |
$19.37
|
| Rate for Payer: UHC Core |
$14.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.35
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: Aetna Commercial |
$15.13
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Aetna Medicare |
$3.45
|
| Rate for Payer: Aetna Medicare |
$4.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.25
|
| Rate for Payer: BCBS Complete |
$7.12
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS Complete |
$9.28
|
| Rate for Payer: BCBS MAPPO |
$5.80
|
| Rate for Payer: BCBS MAPPO |
$3.32
|
| Rate for Payer: BCBS MAPPO |
$4.45
|
| Rate for Payer: BCBS Trust/PPO |
$14.63
|
| Rate for Payer: BCBS Trust/PPO |
$10.91
|
| Rate for Payer: BCBS Trust/PPO |
$19.07
|
| Rate for Payer: BCN Commercial |
$13.84
|
| Rate for Payer: BCN Commercial |
$18.04
|
| Rate for Payer: BCN Commercial |
$10.32
|
| Rate for Payer: BCN Medicare Advantage |
$3.32
|
| Rate for Payer: BCN Medicare Advantage |
$4.45
|
| Rate for Payer: BCN Medicare Advantage |
$5.80
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Nomi Health Commercial |
$19.02
|
| Rate for Payer: Nomi Health Commercial |
$10.88
|
| Rate for Payer: Nomi Health Commercial |
$14.60
|
| Rate for Payer: PACE Senior Care Partners |
$5.51
|
| Rate for Payer: PACE Senior Care Partners |
$3.15
|
| Rate for Payer: PACE Senior Care Partners |
$4.23
|
| Rate for Payer: PACE SWMI |
$4.45
|
| Rate for Payer: PACE SWMI |
$3.32
|
| Rate for Payer: PACE SWMI |
$5.80
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$15.13
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Medicare Advantage |
$4.45
|
| Rate for Payer: PHP Medicare Advantage |
$5.80
|
| Rate for Payer: PHP Medicare Advantage |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.57
|
| Rate for Payer: Priority Health HMO/PPO |
$20.18
|
| Rate for Payer: Priority Health HMO/PPO |
$11.54
|
| Rate for Payer: Priority Health HMO/PPO |
$15.49
|
| Rate for Payer: Priority Health Medicare |
$3.35
|
| Rate for Payer: Priority Health Medicare |
$5.86
|
| Rate for Payer: Priority Health Medicare |
$4.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.89
|
| Rate for Payer: Railroad Medicare Medicare |
$4.45
|
| Rate for Payer: Railroad Medicare Medicare |
$5.80
|
| Rate for Payer: Railroad Medicare Medicare |
$3.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.68
|
| Rate for Payer: UHC Core |
$19.37
|
| Rate for Payer: UHC Core |
$14.86
|
| Rate for Payer: UHC Core |
$11.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.45
|
| Rate for Payer: UHC Exchange |
$4.45
|
| Rate for Payer: UHC Exchange |
$3.32
|
| Rate for Payer: UHC Exchange |
$5.80
|
| Rate for Payer: UHC Medicare Advantage |
$3.32
|
| Rate for Payer: UHC Medicare Advantage |
$4.45
|
| Rate for Payer: UHC Medicare Advantage |
$5.80
|
| Rate for Payer: VA VA |
$4.45
|
| Rate for Payer: VA VA |
$5.80
|
| Rate for Payer: VA VA |
$3.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.35
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Medicare |
$3.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.15
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS MAPPO |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$10.91
|
| Rate for Payer: BCN Commercial |
$10.32
|
| Rate for Payer: BCN Medicare Advantage |
$3.32
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Nomi Health Commercial |
$10.88
|
| Rate for Payer: PACE Senior Care Partners |
$3.15
|
| Rate for Payer: PACE SWMI |
$3.32
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Medicare Advantage |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health HMO/PPO |
$11.54
|
| Rate for Payer: Priority Health Medicare |
$3.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.89
|
| Rate for Payer: Railroad Medicare Medicare |
$3.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.68
|
| Rate for Payer: UHC Core |
$11.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.32
|
| Rate for Payer: UHC Exchange |
$3.32
|
| Rate for Payer: UHC Medicare Advantage |
$3.32
|
| Rate for Payer: VA VA |
$3.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: BCBS Trust/PPO |
$10.83
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Nomi Health Commercial |
$10.88
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health HMO/PPO |
$11.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.68
|
| Rate for Payer: UHC Core |
$11.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
CEFTRIAXONE 2 GRAM/50 ML IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$87.10
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.62 |
| Max. Negotiated Rate |
$78.39 |
| Rate for Payer: Aetna Commercial |
$74.04
|
| Rate for Payer: BCBS Trust/PPO |
$71.10
|
| Rate for Payer: BCN Commercial |
$67.31
|
| Rate for Payer: Cash Price |
$69.68
|
| Rate for Payer: Cofinity Commercial |
$74.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.68
|
| Rate for Payer: Healthscope Commercial |
$78.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.04
|
| Rate for Payer: Nomi Health Commercial |
$71.42
|
| Rate for Payer: PHP Commercial |
$74.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.62
|
| Rate for Payer: Priority Health HMO/PPO |
$75.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.65
|
| Rate for Payer: UHC Core |
$72.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.32
|
|
|
CEFTRIAXONE 2 GRAM/50 ML IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$87.10
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.69 |
| Max. Negotiated Rate |
$78.39 |
| Rate for Payer: Aetna Commercial |
$74.04
|
| Rate for Payer: Aetna Medicare |
$22.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.22
|
| Rate for Payer: BCBS Complete |
$34.84
|
| Rate for Payer: BCBS MAPPO |
$21.78
|
| Rate for Payer: BCBS Trust/PPO |
$71.60
|
| Rate for Payer: BCN Commercial |
$67.72
|
| Rate for Payer: BCN Medicare Advantage |
$21.78
|
| Rate for Payer: Cash Price |
$69.68
|
| Rate for Payer: Cofinity Commercial |
$74.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.78
|
| Rate for Payer: Healthscope Commercial |
$78.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.04
|
| Rate for Payer: Nomi Health Commercial |
$71.42
|
| Rate for Payer: PACE Senior Care Partners |
$20.69
|
| Rate for Payer: PACE SWMI |
$21.78
|
| Rate for Payer: PHP Commercial |
$74.04
|
| Rate for Payer: PHP Medicare Advantage |
$21.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.62
|
| Rate for Payer: Priority Health HMO/PPO |
$75.78
|
| Rate for Payer: Priority Health Medicare |
$21.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.36
|
| Rate for Payer: Railroad Medicare Medicare |
$21.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.65
|
| Rate for Payer: UHC Core |
$72.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.78
|
| Rate for Payer: UHC Exchange |
$21.78
|
| Rate for Payer: UHC Medicare Advantage |
$21.78
|
| Rate for Payer: VA VA |
$21.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.32
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$16.47
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Aetna Medicare |
$4.28
|
| Rate for Payer: Aetna Medicare |
$4.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.81
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$6.25
|
| Rate for Payer: BCBS MAPPO |
$4.12
|
| Rate for Payer: BCBS MAPPO |
$4.16
|
| Rate for Payer: BCBS Trust/PPO |
$13.69
|
| Rate for Payer: BCBS Trust/PPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$20.55
|
| Rate for Payer: BCN Commercial |
$12.95
|
| Rate for Payer: BCN Commercial |
$19.44
|
| Rate for Payer: BCN Commercial |
$12.81
|
| Rate for Payer: BCN Medicare Advantage |
$4.12
|
| Rate for Payer: BCN Medicare Advantage |
$4.16
|
| Rate for Payer: BCN Medicare Advantage |
$6.25
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.12
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Nomi Health Commercial |
$20.50
|
| Rate for Payer: Nomi Health Commercial |
$13.51
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: PACE Senior Care Partners |
$5.94
|
| Rate for Payer: PACE Senior Care Partners |
$3.91
|
| Rate for Payer: PACE Senior Care Partners |
$3.95
|
| Rate for Payer: PACE SWMI |
$4.16
|
| Rate for Payer: PACE SWMI |
$4.12
|
| Rate for Payer: PACE SWMI |
$6.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: PHP Medicare Advantage |
$4.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.25
|
| Rate for Payer: PHP Medicare Advantage |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health HMO/PPO |
$21.75
|
| Rate for Payer: Priority Health HMO/PPO |
$14.33
|
| Rate for Payer: Priority Health HMO/PPO |
$14.49
|
| Rate for Payer: Priority Health Medicare |
$4.16
|
| Rate for Payer: Priority Health Medicare |
$6.31
|
| Rate for Payer: Priority Health Medicare |
$4.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.03
|
| Rate for Payer: Railroad Medicare Medicare |
$4.16
|
| Rate for Payer: Railroad Medicare Medicare |
$6.25
|
| Rate for Payer: Railroad Medicare Medicare |
$4.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.49
|
| Rate for Payer: UHC Core |
$20.88
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: UHC Core |
$13.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.12
|
| Rate for Payer: UHC Exchange |
$6.25
|
| Rate for Payer: UHC Medicare Advantage |
$4.12
|
| Rate for Payer: UHC Medicare Advantage |
$4.16
|
| Rate for Payer: UHC Medicare Advantage |
$6.25
|
| Rate for Payer: VA VA |
$4.16
|
| Rate for Payer: VA VA |
$6.25
|
| Rate for Payer: VA VA |
$4.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$16.47
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$13.59
|
| Rate for Payer: BCBS Trust/PPO |
$13.44
|
| Rate for Payer: BCBS Trust/PPO |
$20.41
|
| Rate for Payer: BCN Commercial |
$12.87
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$19.32
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Nomi Health Commercial |
$13.51
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Nomi Health Commercial |
$20.50
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health HMO/PPO |
$21.75
|
| Rate for Payer: Priority Health HMO/PPO |
$14.49
|
| Rate for Payer: Priority Health HMO/PPO |
$14.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.49
|
| Rate for Payer: UHC Core |
$13.75
|
| Rate for Payer: UHC Core |
$20.88
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$45.82
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$41.24 |
| Rate for Payer: Aetna Commercial |
$38.95
|
| Rate for Payer: BCBS Trust/PPO |
$37.40
|
| Rate for Payer: BCN Commercial |
$35.41
|
| Rate for Payer: Cash Price |
$36.66
|
| Rate for Payer: Cofinity Commercial |
$39.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.66
|
| Rate for Payer: Healthscope Commercial |
$41.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.95
|
| Rate for Payer: Nomi Health Commercial |
$37.57
|
| Rate for Payer: PHP Commercial |
$38.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.78
|
| Rate for Payer: Priority Health HMO/PPO |
$39.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.32
|
| Rate for Payer: UHC Core |
$38.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.36
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$45.82
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$41.24 |
| Rate for Payer: Aetna Commercial |
$38.95
|
| Rate for Payer: Aetna Medicare |
$11.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.32
|
| Rate for Payer: BCBS Complete |
$18.33
|
| Rate for Payer: BCBS MAPPO |
$11.46
|
| Rate for Payer: BCBS Trust/PPO |
$37.67
|
| Rate for Payer: BCN Commercial |
$35.63
|
| Rate for Payer: BCN Medicare Advantage |
$11.46
|
| Rate for Payer: Cash Price |
$36.66
|
| Rate for Payer: Cofinity Commercial |
$39.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.46
|
| Rate for Payer: Healthscope Commercial |
$41.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.95
|
| Rate for Payer: Nomi Health Commercial |
$37.57
|
| Rate for Payer: PACE Senior Care Partners |
$10.88
|
| Rate for Payer: PACE SWMI |
$11.46
|
| Rate for Payer: PHP Commercial |
$38.95
|
| Rate for Payer: PHP Medicare Advantage |
$11.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.78
|
| Rate for Payer: Priority Health HMO/PPO |
$39.86
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.70
|
| Rate for Payer: Railroad Medicare Medicare |
$11.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.32
|
| Rate for Payer: UHC Core |
$38.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.46
|
| Rate for Payer: UHC Exchange |
$11.46
|
| Rate for Payer: UHC Medicare Advantage |
$11.46
|
| Rate for Payer: VA VA |
$11.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.36
|
|
