|
CASTOR OIL
|
Facility
|
IP
|
$16.43
|
|
|
Service Code
|
NDC 00395051592
|
| Hospital Charge Code |
15209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$14.79 |
| Rate for Payer: Aetna American Axle |
$10.68
|
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.68
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cofinity Advantage |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$14.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.14
|
| Rate for Payer: Healthscope Commercial |
$14.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.32
|
| Rate for Payer: PHP Commercial |
$13.97
|
| Rate for Payer: Priority Health SBD |
$10.35
|
| Rate for Payer: UMR Bronson Commercial |
$7.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.32
|
|
|
CASTOR OIL
|
Facility
|
IP
|
$8.30
|
|
|
Service Code
|
NDC 09629513775
|
| Hospital Charge Code |
15209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Aetna American Axle |
$5.39
|
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.39
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cofinity Advantage |
$5.81
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.64
|
| Rate for Payer: Healthscope Commercial |
$7.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.22
|
| Rate for Payer: PHP Commercial |
$7.05
|
| Rate for Payer: Priority Health SBD |
$5.23
|
| Rate for Payer: UMR Bronson Commercial |
$3.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.22
|
|
|
CAUTERY OF CERVIX; ELECTRO OR THERMAL
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$91.19 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$91.19
|
| Rate for Payer: BCN Commercial |
$91.19
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
CAUTERY OF CERVIX; LASER ABLATION
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57513
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,006.33
|
| Rate for Payer: BCN Commercial |
$2,006.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
CEFAZOLIN 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$301.75
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
31086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$271.57 |
| Rate for Payer: Aetna American Axle |
$196.14
|
| Rate for Payer: Aetna Commercial |
$256.49
|
| Rate for Payer: Aetna Medicare |
$150.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.14
|
| Rate for Payer: BCBS Complete |
$120.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cofinity Advantage |
$211.22
|
| Rate for Payer: Cofinity Commercial |
$259.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.40
|
| Rate for Payer: Healthscope Commercial |
$271.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.31
|
| Rate for Payer: PHP Commercial |
$256.49
|
| Rate for Payer: Priority Health SBD |
$190.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$111.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.31
|
|
|
CEFAZOLIN 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$301.75
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
31086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$271.57 |
| Rate for Payer: Aetna American Axle |
$196.14
|
| Rate for Payer: Aetna Commercial |
$256.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.14
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cofinity Advantage |
$211.22
|
| Rate for Payer: Cofinity Commercial |
$259.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.40
|
| Rate for Payer: Healthscope Commercial |
$271.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.31
|
| Rate for Payer: PHP Commercial |
$256.49
|
| Rate for Payer: Priority Health SBD |
$190.10
|
| Rate for Payer: UMR Bronson Commercial |
$132.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.31
|
|
|
CEFAZOLIN 100 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
OP
|
$191.84
|
|
|
Service Code
|
NDC 09900000151
|
| Hospital Charge Code |
500642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Aetna American Axle |
$124.70
|
| Rate for Payer: Aetna Commercial |
$163.06
|
| Rate for Payer: Aetna Medicare |
$95.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.70
|
| Rate for Payer: BCBS Complete |
$76.74
|
| Rate for Payer: Cash Price |
$153.47
|
| Rate for Payer: Cofinity Advantage |
$134.29
|
| Rate for Payer: Cofinity Commercial |
$164.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.47
|
| Rate for Payer: Healthscope Commercial |
$172.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.88
|
| Rate for Payer: PHP Commercial |
$163.06
|
| Rate for Payer: Priority Health SBD |
$120.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.70
|
| Rate for Payer: UHC Core |
$99.95
|
| Rate for Payer: UHC Exchange |
$75.39
|
| Rate for Payer: UMR Bronson Commercial |
$70.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.88
|
|
|
CEFAZOLIN 100 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
IP
|
$191.84
|
|
|
Service Code
|
NDC 09900000151
|
| Hospital Charge Code |
500642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Aetna American Axle |
$124.70
|
| Rate for Payer: Aetna Commercial |
$163.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.70
|
| Rate for Payer: Cash Price |
$153.47
|
| Rate for Payer: Cofinity Advantage |
$134.29
|
| Rate for Payer: Cofinity Commercial |
$164.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.47
|
| Rate for Payer: Healthscope Commercial |
$172.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.88
|
| Rate for Payer: PHP Commercial |
$163.06
|
| Rate for Payer: Priority Health SBD |
$120.86
|
| Rate for Payer: UMR Bronson Commercial |
$84.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.88
|
|
|
CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$29.07
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$26.16 |
| Rate for Payer: Aetna American Axle |
$18.90
|
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna American Axle |
$22.47
|
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Commercial |
$24.71
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.47
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cash Price |
$23.26
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cofinity Advantage |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$20.35
|
| Rate for Payer: Cofinity Advantage |
$24.20
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: PHP Commercial |
$24.71
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: Priority Health SBD |
$21.78
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: UMR Bronson Commercial |
$12.79
|
| Rate for Payer: UMR Bronson Commercial |
$21.85
|
| Rate for Payer: UMR Bronson Commercial |
$15.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
|
|
CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$34.57
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Aetna American Axle |
$22.47
|
| Rate for Payer: Aetna American Axle |
$18.90
|
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Commercial |
$24.71
|
| Rate for Payer: Aetna Medicare |
$17.29
|
| Rate for Payer: Aetna Medicare |
$14.54
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: BCBS Complete |
$11.63
|
| Rate for Payer: BCBS Complete |
$13.83
|
| Rate for Payer: BCBS Complete |
$19.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$23.26
|
| Rate for Payer: Cash Price |
$23.26
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cofinity Advantage |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$24.20
|
| Rate for Payer: Cofinity Advantage |
$20.35
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: PHP Commercial |
$24.71
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$21.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$18.38
|
| Rate for Payer: UMR Bronson Commercial |
$10.76
|
| Rate for Payer: UMR Bronson Commercial |
$12.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna American Axle |
$14.38
|
| Rate for Payer: Aetna American Axle |
$12.62
|
| Rate for Payer: Aetna American Axle |
$9.11
|
| Rate for Payer: Aetna American Axle |
$15.17
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Commercial |
$18.80
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna Medicare |
$11.67
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Aetna Medicare |
$9.71
|
| Rate for Payer: Aetna Medicare |
$11.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.17
|
| Rate for Payer: BCBS Complete |
$8.85
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$7.76
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cofinity Advantage |
$15.48
|
| Rate for Payer: Cofinity Advantage |
$9.81
|
| Rate for Payer: Cofinity Advantage |
$13.59
|
| Rate for Payer: Cofinity Advantage |
$16.34
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$19.02
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$12.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.50
|
| Rate for Payer: PHP Commercial |
$11.91
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$19.84
|
| Rate for Payer: PHP Commercial |
$18.80
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health SBD |
$12.23
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$13.94
|
| Rate for Payer: Priority Health SBD |
$14.70
|
| Rate for Payer: Priority Health SBD |
$8.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$5.16
|
| Rate for Payer: UMR Bronson Commercial |
$8.18
|
| Rate for Payer: UMR Bronson Commercial |
$7.18
|
| Rate for Payer: UMR Bronson Commercial |
$8.64
|
| Rate for Payer: UMR Bronson Commercial |
$5.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$23.34
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$21.01 |
| Rate for Payer: Aetna American Axle |
$15.17
|
| Rate for Payer: Aetna American Axle |
$12.62
|
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna American Axle |
$9.11
|
| Rate for Payer: Aetna American Axle |
$14.38
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna Commercial |
$18.80
|
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.38
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cofinity Advantage |
$16.34
|
| Rate for Payer: Cofinity Advantage |
$13.59
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Advantage |
$9.81
|
| Rate for Payer: Cofinity Advantage |
$15.48
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$19.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.61
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.50
|
| Rate for Payer: PHP Commercial |
$11.91
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$18.80
|
| Rate for Payer: PHP Commercial |
$19.84
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$8.83
|
| Rate for Payer: Priority Health SBD |
$13.94
|
| Rate for Payer: Priority Health SBD |
$12.23
|
| Rate for Payer: Priority Health SBD |
$14.70
|
| Rate for Payer: UMR Bronson Commercial |
$8.54
|
| Rate for Payer: UMR Bronson Commercial |
$10.27
|
| Rate for Payer: UMR Bronson Commercial |
$9.73
|
| Rate for Payer: UMR Bronson Commercial |
$6.14
|
| Rate for Payer: UMR Bronson Commercial |
$6.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.59
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$5.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: UMR Bronson Commercial |
$6.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
|
|
CEFAZOLIN 300 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$798.75
|
|
|
Service Code
|
NDC 66288130001
|
| Hospital Charge Code |
31087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$351.45 |
| Max. Negotiated Rate |
$718.88 |
| Rate for Payer: Aetna American Axle |
$519.19
|
| Rate for Payer: Aetna Commercial |
$678.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.19
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cofinity Advantage |
$559.12
|
| Rate for Payer: Cofinity Commercial |
$686.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.00
|
| Rate for Payer: Healthscope Commercial |
$718.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$559.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$678.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$599.06
|
| Rate for Payer: PHP Commercial |
$678.94
|
| Rate for Payer: Priority Health SBD |
$503.21
|
| Rate for Payer: UMR Bronson Commercial |
$351.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$599.06
|
|
|
CEFAZOLIN 300 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$798.75
|
|
|
Service Code
|
NDC 66288130001
|
| Hospital Charge Code |
31087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$295.54 |
| Max. Negotiated Rate |
$718.88 |
| Rate for Payer: Aetna American Axle |
$519.19
|
| Rate for Payer: Aetna Commercial |
$678.94
|
| Rate for Payer: Aetna Medicare |
$399.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.19
|
| Rate for Payer: BCBS Complete |
$319.50
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cofinity Advantage |
$559.12
|
| Rate for Payer: Cofinity Commercial |
$686.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.00
|
| Rate for Payer: Healthscope Commercial |
$718.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$559.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$639.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$678.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$599.06
|
| Rate for Payer: PHP Commercial |
$678.94
|
| Rate for Payer: Priority Health SBD |
$503.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.19
|
| Rate for Payer: UHC Core |
$416.15
|
| Rate for Payer: UHC Exchange |
$313.91
|
| Rate for Payer: UMR Bronson Commercial |
$295.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$599.06
|
|
|
CEFAZOLIN 3 GM IVPB 50 ML (IV PREMIX)
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Medicare |
$31.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Advantage |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.85
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.47
|
| Rate for Payer: UHC Core |
$33.24
|
| Rate for Payer: UHC Exchange |
$25.07
|
| Rate for Payer: UMR Bronson Commercial |
$23.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
CEFAZOLIN 3 GM IVPB 50 ML (IV PREMIX)
|
Facility
|
IP
|
$63.80
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Advantage |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.85
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: UMR Bronson Commercial |
$28.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
CEFAZOLIN 50 MG/0.5 ML IN NS FOR DISCOGRAM
|
Facility
|
IP
|
$7.81
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna American Axle |
$5.08
|
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Advantage |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.86
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health SBD |
$4.92
|
| Rate for Payer: UMR Bronson Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.86
|
|
|
CEFAZOLIN 50 MG/0.5 ML IN NS FOR DISCOGRAM
|
Facility
|
OP
|
$7.81
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna American Axle |
$5.08
|
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: BCBS Complete |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Advantage |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.86
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health SBD |
$4.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$2.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.86
|
|
|
CEFAZOLIN 50 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
IP
|
$191.84
|
|
|
Service Code
|
NDC 09900000150
|
| Hospital Charge Code |
500641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Aetna American Axle |
$124.70
|
| Rate for Payer: Aetna Commercial |
$163.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.70
|
| Rate for Payer: Cash Price |
$153.47
|
| Rate for Payer: Cofinity Advantage |
$134.29
|
| Rate for Payer: Cofinity Commercial |
$164.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.47
|
| Rate for Payer: Healthscope Commercial |
$172.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.88
|
| Rate for Payer: PHP Commercial |
$163.06
|
| Rate for Payer: Priority Health SBD |
$120.86
|
| Rate for Payer: UMR Bronson Commercial |
$84.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.88
|
|
|
CEFAZOLIN 50 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
OP
|
$191.84
|
|
|
Service Code
|
NDC 09900000150
|
| Hospital Charge Code |
500641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Aetna American Axle |
$124.70
|
| Rate for Payer: Aetna Commercial |
$163.06
|
| Rate for Payer: Aetna Medicare |
$95.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.70
|
| Rate for Payer: BCBS Complete |
$76.74
|
| Rate for Payer: Cash Price |
$153.47
|
| Rate for Payer: Cofinity Advantage |
$134.29
|
| Rate for Payer: Cofinity Commercial |
$164.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.47
|
| Rate for Payer: Healthscope Commercial |
$172.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.88
|
| Rate for Payer: PHP Commercial |
$163.06
|
| Rate for Payer: Priority Health SBD |
$120.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.70
|
| Rate for Payer: UHC Core |
$99.95
|
| Rate for Payer: UHC Exchange |
$75.39
|
| Rate for Payer: UMR Bronson Commercial |
$70.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.88
|
|
|
CEFAZOLIN IV SYRINGE
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
400102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna American Axle |
$15.49
|
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Advantage |
$2.11
|
| Rate for Payer: Cofinity Advantage |
$16.68
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: Priority Health SBD |
$15.01
|
| Rate for Payer: UMR Bronson Commercial |
$10.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
CEFAZOLIN IV SYRINGE
|
Facility
|
OP
|
$23.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
400102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna American Axle |
$15.49
|
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Medicare |
$11.91
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS Complete |
$9.53
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Advantage |
$16.68
|
| Rate for Payer: Cofinity Advantage |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.87
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health SBD |
$15.01
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$8.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
CEFAZOLIN IV SYRINGE 1 G PMX
|
Facility
|
IP
|
$3.02
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Advantage |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
