|
CEFEPIME 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Aetna American Axle |
$21.47
|
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cofinity Advantage |
$23.12
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.77
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: Priority Health SBD |
$20.81
|
| Rate for Payer: UMR Bronson Commercial |
$14.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
|
|
CEFEPIME 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Aetna American Axle |
$21.47
|
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Medicare |
$16.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: BCBS Complete |
$13.21
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cofinity Advantage |
$23.12
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.77
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: Priority Health SBD |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
|
|
CEFEPIME IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$1.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna American Axle |
$1.14
|
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: BCBS Complete |
$0.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Advantage |
$1.23
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.31
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health SBD |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.31
|
|
|
CEFEPIME IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$1.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna American Axle |
$1.14
|
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Advantage |
$1.23
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.31
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health SBD |
$1.10
|
| Rate for Payer: UMR Bronson Commercial |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.31
|
|
|
CEFEPIME IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$16.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$15.07 |
| Rate for Payer: Aetna American Axle |
$10.89
|
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna Medicare |
$8.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.89
|
| Rate for Payer: BCBS Complete |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cofinity Advantage |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.56
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$6.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.56
|
|
|
CEFEPIME IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$16.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$15.07 |
| Rate for Payer: Aetna American Axle |
$10.89
|
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.89
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cofinity Advantage |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.56
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$7.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.56
|
|
|
CEFEPIME (MAXIPIME) 4 GRAM /540 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
IP
|
$45.66
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna American Axle |
$29.68
|
| Rate for Payer: Aetna Commercial |
$38.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.68
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cofinity Advantage |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.53
|
| Rate for Payer: Healthscope Commercial |
$41.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.24
|
| Rate for Payer: PHP Commercial |
$38.81
|
| Rate for Payer: Priority Health SBD |
$28.77
|
| Rate for Payer: UMR Bronson Commercial |
$20.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.24
|
|
|
CEFEPIME (MAXIPIME) 4 GRAM /540 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
OP
|
$45.66
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna American Axle |
$29.68
|
| Rate for Payer: Aetna Commercial |
$38.81
|
| Rate for Payer: Aetna Medicare |
$22.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.68
|
| Rate for Payer: BCBS Complete |
$18.26
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cofinity Advantage |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.53
|
| Rate for Payer: Healthscope Commercial |
$41.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.24
|
| Rate for Payer: PHP Commercial |
$38.81
|
| Rate for Payer: Priority Health SBD |
$28.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$16.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.24
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$814.85
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
192885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$733.37 |
| Rate for Payer: Aetna American Axle |
$529.65
|
| Rate for Payer: Aetna Commercial |
$692.62
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$529.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.02
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$7.83
|
| Rate for Payer: BCN Commercial |
$7.83
|
| Rate for Payer: BCN Medicare Advantage |
$2.42
|
| Rate for Payer: Cash Price |
$651.88
|
| Rate for Payer: Cash Price |
$651.88
|
| Rate for Payer: Cofinity Advantage |
$570.39
|
| Rate for Payer: Cofinity Commercial |
$700.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$651.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$733.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$570.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$611.14
|
| Rate for Payer: Mclaren Medicaid |
$2.42
|
| Rate for Payer: Mclaren Medicare |
$2.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.54
|
| Rate for Payer: Meridian Medicaid |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$692.62
|
| Rate for Payer: Nomi Health Commercial |
$7.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$611.14
|
| Rate for Payer: PACE Medicare |
$2.30
|
| Rate for Payer: PACE SWMI |
$2.42
|
| Rate for Payer: PHP Commercial |
$692.62
|
| Rate for Payer: PHP Medicare Advantage |
$2.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.64
|
| Rate for Payer: Priority Health Medicare |
$2.42
|
| Rate for Payer: Priority Health SBD |
$513.36
|
| Rate for Payer: Priority Health Tiered Network |
$6.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.99
|
| Rate for Payer: UHC Core |
$3.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.42
|
| Rate for Payer: UHC Exchange |
$3.99
|
| Rate for Payer: UHC Medicaid |
$1.27
|
| Rate for Payer: UHCCP Medicaid |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$301.49
|
| Rate for Payer: VA VA |
$2.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$611.14
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$814.85
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
192885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$358.53 |
| Max. Negotiated Rate |
$733.37 |
| Rate for Payer: Aetna American Axle |
$529.65
|
| Rate for Payer: Aetna Commercial |
$692.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$529.65
|
| Rate for Payer: Cash Price |
$651.88
|
| Rate for Payer: Cofinity Advantage |
$570.39
|
| Rate for Payer: Cofinity Commercial |
$700.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$651.88
|
| Rate for Payer: Healthscope Commercial |
$733.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$570.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$611.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$692.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$611.14
|
| Rate for Payer: PHP Commercial |
$692.62
|
| Rate for Payer: Priority Health SBD |
$513.36
|
| Rate for Payer: UMR Bronson Commercial |
$358.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$611.14
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$119.86
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$107.87 |
| Rate for Payer: Aetna American Axle |
$77.91
|
| Rate for Payer: Aetna Commercial |
$101.88
|
| Rate for Payer: Aetna Medicare |
$59.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.91
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: Cash Price |
$95.89
|
| Rate for Payer: Cash Price |
$95.89
|
| Rate for Payer: Cofinity Advantage |
$83.90
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.89
|
| Rate for Payer: Healthscope Commercial |
$107.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.88
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.82
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Exchange |
$7.82
|
| Rate for Payer: UMR Bronson Commercial |
$44.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$119.86
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.74 |
| Max. Negotiated Rate |
$107.87 |
| Rate for Payer: Aetna American Axle |
$77.91
|
| Rate for Payer: Aetna Commercial |
$101.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.91
|
| Rate for Payer: Cash Price |
$95.89
|
| Rate for Payer: Cofinity Advantage |
$83.90
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.89
|
| Rate for Payer: Healthscope Commercial |
$107.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.88
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$52.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$23.75
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
301721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$21.38 |
| Rate for Payer: Aetna American Axle |
$15.44
|
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.44
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Advantage |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.81
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: UMR Bronson Commercial |
$10.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$23.75
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
301721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$21.38 |
| Rate for Payer: Aetna American Axle |
$15.44
|
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna Medicare |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.44
|
| Rate for Payer: BCBS Complete |
$9.50
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Advantage |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.81
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.82
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Exchange |
$7.82
|
| Rate for Payer: UMR Bronson Commercial |
$8.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.89
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna American Axle |
$18.78
|
| Rate for Payer: Aetna American Axle |
$15.44
|
| Rate for Payer: Aetna American Axle |
$19.06
|
| Rate for Payer: Aetna American Axle |
$11.41
|
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna Commercial |
$24.56
|
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.06
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cash Price |
$23.11
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Advantage |
$12.05
|
| Rate for Payer: Cofinity Advantage |
$20.53
|
| Rate for Payer: Cofinity Advantage |
$12.29
|
| Rate for Payer: Cofinity Advantage |
$20.22
|
| Rate for Payer: Cofinity Advantage |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Cofinity Commercial |
$24.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$26.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.67
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$24.56
|
| Rate for Payer: PHP Commercial |
$24.93
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: Priority Health SBD |
$18.20
|
| Rate for Payer: Priority Health SBD |
$18.48
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: UMR Bronson Commercial |
$7.73
|
| Rate for Payer: UMR Bronson Commercial |
$12.91
|
| Rate for Payer: UMR Bronson Commercial |
$10.45
|
| Rate for Payer: UMR Bronson Commercial |
$7.57
|
| Rate for Payer: UMR Bronson Commercial |
$12.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.17
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.21
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna American Axle |
$18.78
|
| Rate for Payer: Aetna American Axle |
$15.44
|
| Rate for Payer: Aetna American Axle |
$11.41
|
| Rate for Payer: Aetna American Axle |
$19.06
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: Aetna Commercial |
$24.56
|
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna Medicare |
$14.66
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Aetna Medicare |
$11.88
|
| Rate for Payer: Aetna Medicare |
$14.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.06
|
| Rate for Payer: BCBS Complete |
$11.56
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Complete |
$9.50
|
| Rate for Payer: BCBS Complete |
$11.73
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: Cash Price |
$23.11
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$23.11
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Advantage |
$20.22
|
| Rate for Payer: Cofinity Advantage |
$12.29
|
| Rate for Payer: Cofinity Advantage |
$16.62
|
| Rate for Payer: Cofinity Advantage |
$20.53
|
| Rate for Payer: Cofinity Advantage |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$24.85
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$26.40
|
| Rate for Payer: Healthscope Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.00
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: PHP Commercial |
$24.93
|
| Rate for Payer: PHP Commercial |
$24.56
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$18.20
|
| Rate for Payer: Priority Health SBD |
$18.48
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.82
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Exchange |
$7.82
|
| Rate for Payer: UHC Exchange |
$7.82
|
| Rate for Payer: UHC Exchange |
$7.82
|
| Rate for Payer: UHC Exchange |
$7.82
|
| Rate for Payer: UHC Exchange |
$7.82
|
| Rate for Payer: UMR Bronson Commercial |
$6.37
|
| Rate for Payer: UMR Bronson Commercial |
$10.69
|
| Rate for Payer: UMR Bronson Commercial |
$8.79
|
| Rate for Payer: UMR Bronson Commercial |
$10.85
|
| Rate for Payer: UMR Bronson Commercial |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$25.91
|
|
|
Service Code
|
NDC 44567024625
|
| Hospital Charge Code |
301722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$12.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: Cash Price |
$20.73
|
| Rate for Payer: Cofinity Advantage |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$22.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.73
|
| Rate for Payer: Healthscope Commercial |
$23.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.84
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Exchange |
$10.18
|
| Rate for Payer: UMR Bronson Commercial |
$9.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$25.91
|
|
|
Service Code
|
NDC 44567024625
|
| Hospital Charge Code |
301722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.73
|
| Rate for Payer: Cofinity Advantage |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$22.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.73
|
| Rate for Payer: Healthscope Commercial |
$23.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.90
|
|
|
Service Code
|
NDC 00143987701
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Aetna American Axle |
$14.23
|
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: Aetna Medicare |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.23
|
| Rate for Payer: BCBS Complete |
$8.76
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Cofinity Advantage |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.52
|
| Rate for Payer: Healthscope Commercial |
$19.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.43
|
| Rate for Payer: PHP Commercial |
$18.61
|
| Rate for Payer: Priority Health SBD |
$13.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
| Rate for Payer: UHC Core |
$11.41
|
| Rate for Payer: UHC Exchange |
$8.61
|
| Rate for Payer: UMR Bronson Commercial |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.43
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.39
|
|
|
Service Code
|
NDC 25021011020
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna American Axle |
$19.10
|
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Advantage |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.04
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UMR Bronson Commercial |
$12.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.04
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
NDC 25021011020
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna American Axle |
$19.10
|
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna Medicare |
$14.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Advantage |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.04
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.10
|
| Rate for Payer: UHC Core |
$15.31
|
| Rate for Payer: UHC Exchange |
$11.55
|
| Rate for Payer: UMR Bronson Commercial |
$10.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.04
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.90
|
|
|
Service Code
|
NDC 00143987725
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Aetna American Axle |
$14.23
|
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: Aetna Medicare |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.23
|
| Rate for Payer: BCBS Complete |
$8.76
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Cofinity Advantage |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.52
|
| Rate for Payer: Healthscope Commercial |
$19.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.43
|
| Rate for Payer: PHP Commercial |
$18.61
|
| Rate for Payer: Priority Health SBD |
$13.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
| Rate for Payer: UHC Core |
$11.41
|
| Rate for Payer: UHC Exchange |
$8.61
|
| Rate for Payer: UMR Bronson Commercial |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.43
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.90
|
|
|
Service Code
|
NDC 00143987725
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Aetna American Axle |
$14.23
|
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.23
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Cofinity Advantage |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.52
|
| Rate for Payer: Healthscope Commercial |
$19.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.43
|
| Rate for Payer: PHP Commercial |
$18.61
|
| Rate for Payer: Priority Health SBD |
$13.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.43
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.91
|
|
|
Service Code
|
NDC 44567024625
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.73
|
| Rate for Payer: Cofinity Advantage |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$22.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.73
|
| Rate for Payer: Healthscope Commercial |
$23.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.91
|
|
|
Service Code
|
NDC 44567024625
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$12.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: Cash Price |
$20.73
|
| Rate for Payer: Cofinity Advantage |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$22.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.73
|
| Rate for Payer: Healthscope Commercial |
$23.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.84
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Exchange |
$10.18
|
| Rate for Payer: UMR Bronson Commercial |
$9.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
