|
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
|
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 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 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 |
$74.03
|
| 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 |
$65.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.03
|
| Rate for Payer: Nomi Health Commercial |
$71.42
|
| Rate for Payer: PHP Commercial |
$74.03
|
| 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 |
$65.33
|
|
|
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 |
$74.03
|
| 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 |
$21.77
|
| Rate for Payer: BCBS Trust/PPO |
$71.60
|
| Rate for Payer: BCN Commercial |
$67.72
|
| Rate for Payer: BCN Medicare Advantage |
$21.77
|
| 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 |
$21.77
|
| Rate for Payer: Healthscope Commercial |
$78.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.33
|
| 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 |
$74.03
|
| Rate for Payer: Nomi Health Commercial |
$71.42
|
| Rate for Payer: PACE Senior Care Partners |
$20.69
|
| Rate for Payer: PACE SWMI |
$21.77
|
| Rate for Payer: PHP Commercial |
$74.03
|
| Rate for Payer: PHP Medicare Advantage |
$21.77
|
| 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 |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.65
|
| Rate for Payer: UHC Core |
$72.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.77
|
| Rate for Payer: UHC Exchange |
$21.77
|
| Rate for Payer: UHC Medicare Advantage |
$21.77
|
| Rate for Payer: VA VA |
$21.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.33
|
|
|
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
|
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 |
$34.37
|
| 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 |
$34.37
|
|
|
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 |
$34.37
|
| 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 |
$34.37
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Commercial |
$10.16
|
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.88
|
| Rate for Payer: BCBS Trust/PPO |
$7.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$9.75
|
| Rate for Payer: BCN Commercial |
$3.67
|
| Rate for Payer: BCN Commercial |
$9.23
|
| Rate for Payer: BCN Commercial |
$6.65
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cofinity Commercial |
$10.28
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.88
|
| Rate for Payer: Healthscope Commercial |
$7.74
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$10.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.31
|
| Rate for Payer: Nomi Health Commercial |
$9.80
|
| Rate for Payer: Nomi Health Commercial |
$2.49
|
| Rate for Payer: Nomi Health Commercial |
$7.05
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$10.16
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$7.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health HMO/PPO |
$7.48
|
| Rate for Payer: Priority Health HMO/PPO |
$10.40
|
| Rate for Payer: Priority Health HMO/PPO |
$2.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Core |
$7.18
|
| Rate for Payer: UHC Core |
$2.54
|
| Rate for Payer: UHC Core |
$9.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$11.95
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: Aetna Commercial |
$10.16
|
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: Aetna Medicare |
$3.11
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna Medicare |
$2.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.73
|
| Rate for Payer: BCBS Complete |
$4.78
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS Complete |
$3.44
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$2.99
|
| Rate for Payer: BCBS MAPPO |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$2.15
|
| Rate for Payer: BCBS MAPPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$9.82
|
| Rate for Payer: BCBS Trust/PPO |
$7.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$9.29
|
| Rate for Payer: BCN Commercial |
$3.69
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Commercial |
$6.69
|
| Rate for Payer: BCN Medicare Advantage |
$0.76
|
| Rate for Payer: BCN Medicare Advantage |
$2.15
|
| Rate for Payer: BCN Medicare Advantage |
$2.99
|
| Rate for Payer: BCN Medicare Advantage |
$1.19
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Commercial |
$10.28
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$10.76
|
| Rate for Payer: Healthscope Commercial |
$7.74
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$7.05
|
| Rate for Payer: Nomi Health Commercial |
$9.80
|
| Rate for Payer: Nomi Health Commercial |
$2.49
|
| Rate for Payer: PACE Senior Care Partners |
$2.84
|
| Rate for Payer: PACE Senior Care Partners |
$1.13
|
| Rate for Payer: PACE Senior Care Partners |
$2.04
|
| Rate for Payer: PACE Senior Care Partners |
$0.72
|
| Rate for Payer: PACE SWMI |
$0.76
|
| Rate for Payer: PACE SWMI |
$2.99
|
| Rate for Payer: PACE SWMI |
$1.19
|
| Rate for Payer: PACE SWMI |
$2.15
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$7.31
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$10.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.76
|
| Rate for Payer: PHP Medicare Advantage |
$2.99
|
| Rate for Payer: PHP Medicare Advantage |
$2.15
|
| Rate for Payer: PHP Medicare Advantage |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2.64
|
| Rate for Payer: Priority Health HMO/PPO |
$7.48
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health HMO/PPO |
$10.40
|
| Rate for Payer: Priority Health Medicare |
$1.20
|
| Rate for Payer: Priority Health Medicare |
$3.02
|
| Rate for Payer: Priority Health Medicare |
$0.77
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1.19
|
| Rate for Payer: Railroad Medicare Medicare |
$2.99
|
| Rate for Payer: Railroad Medicare Medicare |
$2.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC Core |
$9.98
|
| Rate for Payer: UHC Core |
$7.18
|
| Rate for Payer: UHC Core |
$2.54
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.76
|
| Rate for Payer: UHC Exchange |
$2.15
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$1.19
|
| Rate for Payer: UHC Medicare Advantage |
$2.15
|
| Rate for Payer: UHC Medicare Advantage |
$2.99
|
| Rate for Payer: UHC Medicare Advantage |
$1.19
|
| Rate for Payer: UHC Medicare Advantage |
$0.76
|
| Rate for Payer: VA VA |
$0.76
|
| Rate for Payer: VA VA |
$2.15
|
| Rate for Payer: VA VA |
$1.19
|
| Rate for Payer: VA VA |
$2.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$365.28
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.75 |
| Max. Negotiated Rate |
$328.75 |
| Rate for Payer: Aetna Commercial |
$310.49
|
| Rate for Payer: Aetna Medicare |
$94.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.15
|
| Rate for Payer: BCBS Complete |
$146.11
|
| Rate for Payer: BCBS MAPPO |
$91.32
|
| Rate for Payer: BCBS Trust/PPO |
$300.30
|
| Rate for Payer: BCN Commercial |
$284.01
|
| Rate for Payer: BCN Medicare Advantage |
$91.32
|
| Rate for Payer: Cash Price |
$292.22
|
| Rate for Payer: Cofinity Commercial |
$314.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.32
|
| Rate for Payer: Healthscope Commercial |
$328.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: Nomi Health Commercial |
$299.53
|
| Rate for Payer: PACE Senior Care Partners |
$86.75
|
| Rate for Payer: PACE SWMI |
$91.32
|
| Rate for Payer: PHP Commercial |
$310.49
|
| Rate for Payer: PHP Medicare Advantage |
$91.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.43
|
| Rate for Payer: Priority Health HMO/PPO |
$317.79
|
| Rate for Payer: Priority Health Medicare |
$92.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.74
|
| Rate for Payer: Railroad Medicare Medicare |
$91.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.45
|
| Rate for Payer: UHC Core |
$305.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.32
|
| Rate for Payer: UHC Exchange |
$91.32
|
| Rate for Payer: UHC Medicare Advantage |
$91.32
|
| Rate for Payer: VA VA |
$91.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.96
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.72 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: BCBS Trust/PPO |
$224.44
|
| Rate for Payer: BCN Commercial |
$212.48
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$365.28
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.43 |
| Max. Negotiated Rate |
$328.75 |
| Rate for Payer: Aetna Commercial |
$310.49
|
| Rate for Payer: BCBS Trust/PPO |
$298.18
|
| Rate for Payer: BCN Commercial |
$282.29
|
| Rate for Payer: Cash Price |
$292.22
|
| Rate for Payer: Cofinity Commercial |
$314.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.22
|
| Rate for Payer: Healthscope Commercial |
$328.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: Nomi Health Commercial |
$299.53
|
| Rate for Payer: PHP Commercial |
$310.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.43
|
| Rate for Payer: Priority Health HMO/PPO |
$317.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.45
|
| Rate for Payer: UHC Core |
$305.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.96
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.30 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$71.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.92
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: BCBS MAPPO |
$68.74
|
| Rate for Payer: BCBS Trust/PPO |
$226.04
|
| Rate for Payer: BCN Commercial |
$213.77
|
| Rate for Payer: BCN Medicare Advantage |
$68.74
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.74
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: PACE Senior Care Partners |
$65.30
|
| Rate for Payer: PACE SWMI |
$68.74
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Medicare |
$69.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.22
|
| Rate for Payer: Railroad Medicare Medicare |
$68.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.74
|
| Rate for Payer: UHC Exchange |
$68.74
|
| Rate for Payer: UHC Medicare Advantage |
$68.74
|
| Rate for Payer: VA VA |
$68.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$506.40
|
|
|
Service Code
|
NDC 00904650361
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.16 |
| Max. Negotiated Rate |
$455.76 |
| Rate for Payer: Aetna Commercial |
$430.44
|
| Rate for Payer: BCBS Trust/PPO |
$413.37
|
| Rate for Payer: BCN Commercial |
$391.35
|
| Rate for Payer: Cash Price |
$405.12
|
| Rate for Payer: Cofinity Commercial |
$435.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.12
|
| Rate for Payer: Healthscope Commercial |
$455.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.44
|
| Rate for Payer: Nomi Health Commercial |
$415.25
|
| Rate for Payer: PHP Commercial |
$430.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.16
|
| Rate for Payer: Priority Health HMO/PPO |
$440.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$445.63
|
| Rate for Payer: UHC Core |
$422.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.80
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$506.40
|
|
|
Service Code
|
NDC 00904650361
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.27 |
| Max. Negotiated Rate |
$455.76 |
| Rate for Payer: Aetna Commercial |
$430.44
|
| Rate for Payer: Aetna Medicare |
$131.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$158.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$158.25
|
| Rate for Payer: BCBS Complete |
$202.56
|
| Rate for Payer: BCBS MAPPO |
$126.60
|
| Rate for Payer: BCBS Trust/PPO |
$416.31
|
| Rate for Payer: BCN Commercial |
$393.73
|
| Rate for Payer: BCN Medicare Advantage |
$126.60
|
| Rate for Payer: Cash Price |
$405.12
|
| Rate for Payer: Cofinity Commercial |
$435.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.60
|
| Rate for Payer: Healthscope Commercial |
$455.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.44
|
| Rate for Payer: Nomi Health Commercial |
$415.25
|
| Rate for Payer: PACE Senior Care Partners |
$120.27
|
| Rate for Payer: PACE SWMI |
$126.60
|
| Rate for Payer: PHP Commercial |
$430.44
|
| Rate for Payer: PHP Medicare Advantage |
$126.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.16
|
| Rate for Payer: Priority Health HMO/PPO |
$440.57
|
| Rate for Payer: Priority Health Medicare |
$127.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.29
|
| Rate for Payer: Railroad Medicare Medicare |
$126.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$445.63
|
| Rate for Payer: UHC Core |
$422.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.60
|
| Rate for Payer: UHC Exchange |
$126.60
|
| Rate for Payer: UHC Medicare Advantage |
$126.60
|
| Rate for Payer: VA VA |
$126.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.80
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
IP
|
$159.91
|
|
|
Service Code
|
NDC 09900000603
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: BCBS Trust/PPO |
$130.53
|
| Rate for Payer: BCN Commercial |
$123.58
|
| Rate for Payer: Cash Price |
$127.93
|
| Rate for Payer: Cofinity Commercial |
$137.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.93
|
| Rate for Payer: Healthscope Commercial |
$143.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.92
|
| Rate for Payer: Nomi Health Commercial |
$131.13
|
| Rate for Payer: PHP Commercial |
$135.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.94
|
| Rate for Payer: Priority Health HMO/PPO |
$139.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.72
|
| Rate for Payer: UHC Core |
$133.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.93
|
|
