|
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
|
$41.83
|
|
|
Service Code
|
NDC 09900001044
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Aetna American Axle |
$27.19
|
| Rate for Payer: Aetna Commercial |
$35.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.19
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Advantage |
$29.28
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$37.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.37
|
| Rate for Payer: PHP Commercial |
$35.56
|
| Rate for Payer: Priority Health SBD |
$26.35
|
| Rate for Payer: UMR Bronson Commercial |
$18.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.37
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.74
|
|
|
Service Code
|
NDC 63323034225
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$51.97 |
| Rate for Payer: Aetna American Axle |
$37.53
|
| Rate for Payer: Aetna Commercial |
$49.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.53
|
| Rate for Payer: Cash Price |
$46.19
|
| Rate for Payer: Cofinity Advantage |
$40.42
|
| Rate for Payer: Cofinity Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.19
|
| Rate for Payer: Healthscope Commercial |
$51.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.30
|
| Rate for Payer: PHP Commercial |
$49.08
|
| Rate for Payer: Priority Health SBD |
$36.38
|
| Rate for Payer: UMR Bronson Commercial |
$25.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.30
|
|
|
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
|
$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
|
|
|
CEFPODOXIME 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$534.24
|
|
|
Service Code
|
NDC 64980040310
|
| Hospital Charge Code |
9466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.07 |
| Max. Negotiated Rate |
$480.82 |
| Rate for Payer: Aetna American Axle |
$347.26
|
| Rate for Payer: Aetna Commercial |
$454.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.26
|
| Rate for Payer: Cash Price |
$427.39
|
| Rate for Payer: Cofinity Advantage |
$373.97
|
| Rate for Payer: Cofinity Commercial |
$459.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.39
|
| Rate for Payer: Healthscope Commercial |
$480.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$373.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$400.68
|
| Rate for Payer: PHP Commercial |
$454.10
|
| Rate for Payer: Priority Health SBD |
$336.57
|
| Rate for Payer: UMR Bronson Commercial |
$235.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.68
|
|
|
CEFPODOXIME 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$534.24
|
|
|
Service Code
|
NDC 64980040310
|
| Hospital Charge Code |
9466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.67 |
| Max. Negotiated Rate |
$480.82 |
| Rate for Payer: Aetna American Axle |
$347.26
|
| Rate for Payer: Aetna Commercial |
$454.10
|
| Rate for Payer: Aetna Medicare |
$267.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.26
|
| Rate for Payer: BCBS Complete |
$213.70
|
| Rate for Payer: Cash Price |
$427.39
|
| Rate for Payer: Cofinity Advantage |
$373.97
|
| Rate for Payer: Cofinity Commercial |
$459.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.39
|
| Rate for Payer: Healthscope Commercial |
$480.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$373.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$400.68
|
| Rate for Payer: PHP Commercial |
$454.10
|
| Rate for Payer: Priority Health SBD |
$336.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.26
|
| Rate for Payer: UHC Core |
$278.34
|
| Rate for Payer: UHC Exchange |
$209.96
|
| Rate for Payer: UMR Bronson Commercial |
$197.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.68
|
|
|
CEFPODOXIME 200 MG TABLET
|
Facility
|
OP
|
$374.37
|
|
|
Service Code
|
NDC 00781543920
|
| Hospital Charge Code |
9469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.52 |
| Max. Negotiated Rate |
$336.93 |
| Rate for Payer: Aetna American Axle |
$243.34
|
| Rate for Payer: Aetna Commercial |
$318.21
|
| Rate for Payer: Aetna Medicare |
$187.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.34
|
| Rate for Payer: BCBS Complete |
$149.75
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cofinity Advantage |
$262.06
|
| Rate for Payer: Cofinity Commercial |
$321.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.50
|
| Rate for Payer: Healthscope Commercial |
$336.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.78
|
| Rate for Payer: PHP Commercial |
$318.21
|
| Rate for Payer: Priority Health SBD |
$235.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.34
|
| Rate for Payer: UHC Core |
$195.05
|
| Rate for Payer: UHC Exchange |
$147.13
|
| Rate for Payer: UMR Bronson Commercial |
$138.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.78
|
|
|
CEFPODOXIME 200 MG TABLET
|
Facility
|
IP
|
$374.37
|
|
|
Service Code
|
NDC 00781543920
|
| Hospital Charge Code |
9469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.72 |
| Max. Negotiated Rate |
$336.93 |
| Rate for Payer: Aetna American Axle |
$243.34
|
| Rate for Payer: Aetna Commercial |
$318.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.34
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cofinity Advantage |
$262.06
|
| Rate for Payer: Cofinity Commercial |
$321.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.50
|
| Rate for Payer: Healthscope Commercial |
$336.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.78
|
| Rate for Payer: PHP Commercial |
$318.21
|
| Rate for Payer: Priority Health SBD |
$235.85
|
| Rate for Payer: UMR Bronson Commercial |
$164.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.78
|
|
|
CEFPODOXIME 200 MG TABLET
|
Facility
|
IP
|
$192.63
|
|
|
Service Code
|
NDC 65862009620
|
| Hospital Charge Code |
9469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.76 |
| Max. Negotiated Rate |
$173.37 |
| Rate for Payer: Aetna American Axle |
$125.21
|
| Rate for Payer: Aetna Commercial |
$163.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.21
|
| Rate for Payer: Cash Price |
$154.10
|
| Rate for Payer: Cofinity Advantage |
$134.84
|
| Rate for Payer: Cofinity Commercial |
$165.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.10
|
| Rate for Payer: Healthscope Commercial |
$173.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.47
|
| Rate for Payer: PHP Commercial |
$163.74
|
| Rate for Payer: Priority Health SBD |
$121.36
|
| Rate for Payer: UMR Bronson Commercial |
$84.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.47
|
|
|
CEFPODOXIME 200 MG TABLET
|
Facility
|
OP
|
$192.63
|
|
|
Service Code
|
NDC 65862009620
|
| Hospital Charge Code |
9469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.27 |
| Max. Negotiated Rate |
$173.37 |
| Rate for Payer: Aetna American Axle |
$125.21
|
| Rate for Payer: Aetna Commercial |
$163.74
|
| Rate for Payer: Aetna Medicare |
$96.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.21
|
| Rate for Payer: BCBS Complete |
$77.05
|
| Rate for Payer: Cash Price |
$154.10
|
| Rate for Payer: Cofinity Advantage |
$134.84
|
| Rate for Payer: Cofinity Commercial |
$165.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.10
|
| Rate for Payer: Healthscope Commercial |
$173.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.47
|
| Rate for Payer: PHP Commercial |
$163.74
|
| Rate for Payer: Priority Health SBD |
$121.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.21
|
| Rate for Payer: UHC Core |
$100.36
|
| Rate for Payer: UHC Exchange |
$75.70
|
| Rate for Payer: UMR Bronson Commercial |
$71.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.47
|
|
|
CEFTAROLINE FOSAMIL 0.06 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 09900000955
|
| Hospital Charge Code |
180576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna American Axle |
$0.03
|
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Advantage |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health SBD |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$0.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.04
|
|
|
CEFTAROLINE FOSAMIL 0.06 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 09900000955
|
| Hospital Charge Code |
180576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna American Axle |
$0.03
|
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Advantage |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health SBD |
$0.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.04
|
|
|
CEFTAROLINE FOSAMIL 0.6 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 09900000956
|
| Hospital Charge Code |
180577
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna American Axle |
$0.03
|
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Advantage |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health SBD |
$0.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.04
|
|
|
CEFTAROLINE FOSAMIL 0.6 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 09900000956
|
| Hospital Charge Code |
180577
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna American Axle |
$0.03
|
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Advantage |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health SBD |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$0.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.04
|
|
|
CEFTAROLINE FOSAMIL 600 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 09900000958
|
| Hospital Charge Code |
180579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna American Axle |
$2.34
|
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Advantage |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.70
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.70
|
|
|
CEFTAROLINE FOSAMIL 600 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 09900000958
|
| Hospital Charge Code |
180579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna American Axle |
$2.34
|
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Advantage |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.70
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.34
|
| Rate for Payer: UHC Core |
$1.88
|
| Rate for Payer: UHC Exchange |
$1.41
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.70
|
|
|
CEFTAROLINE FOSAMIL 600 MG CUSTOM INTRAVENOUS SOLUTION FOR DESENSITIZATION
|
Facility
|
OP
|
$513.76
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
180582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$462.38 |
| Rate for Payer: Aetna American Axle |
$333.94
|
| Rate for Payer: Aetna Commercial |
$436.70
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.31
|
| Rate for Payer: BCBS Complete |
$2.33
|
| Rate for Payer: BCBS MAPPO |
$4.25
|
| Rate for Payer: BCBS Trust/PPO |
$13.72
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$4.25
|
| Rate for Payer: Cash Price |
$411.01
|
| Rate for Payer: Cash Price |
$411.01
|
| Rate for Payer: Cofinity Advantage |
$359.63
|
| Rate for Payer: Cofinity Commercial |
$441.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.25
|
| Rate for Payer: Healthscope Commercial |
$462.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.32
|
| Rate for Payer: Mclaren Medicaid |
$4.25
|
| Rate for Payer: Mclaren Medicare |
$4.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.46
|
| Rate for Payer: Meridian Medicaid |
$4.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.70
|
| Rate for Payer: Nomi Health Commercial |
$12.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$385.32
|
| Rate for Payer: PACE Medicare |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.25
|
| Rate for Payer: PHP Commercial |
$436.70
|
| Rate for Payer: PHP Medicare Advantage |
$4.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.35
|
| Rate for Payer: Priority Health Medicare |
$4.25
|
| Rate for Payer: Priority Health SBD |
$323.67
|
| Rate for Payer: Priority Health Tiered Network |
$10.68
|
| Rate for Payer: Railroad Medicare Medicare |
$4.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.00
|
| Rate for Payer: UHC Core |
$7.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.25
|
| Rate for Payer: UHC Exchange |
$7.00
|
| Rate for Payer: UHC Medicaid |
$2.22
|
| Rate for Payer: UHCCP Medicaid |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$190.09
|
| Rate for Payer: VA VA |
$4.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.32
|
|
|
CEFTAROLINE FOSAMIL 600 MG CUSTOM INTRAVENOUS SOLUTION FOR DESENSITIZATION
|
Facility
|
IP
|
$513.76
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
180582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.05 |
| Max. Negotiated Rate |
$462.38 |
| Rate for Payer: Aetna American Axle |
$333.94
|
| Rate for Payer: Aetna Commercial |
$436.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.94
|
| Rate for Payer: Cash Price |
$411.01
|
| Rate for Payer: Cofinity Advantage |
$359.63
|
| Rate for Payer: Cofinity Commercial |
$441.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.01
|
| Rate for Payer: Healthscope Commercial |
$462.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$385.32
|
| Rate for Payer: PHP Commercial |
$436.70
|
| Rate for Payer: Priority Health SBD |
$323.67
|
| Rate for Payer: UMR Bronson Commercial |
$226.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.32
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$705.08
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$634.57 |
| Rate for Payer: Aetna American Axle |
$458.30
|
| Rate for Payer: Aetna Commercial |
$599.32
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.31
|
| Rate for Payer: BCBS Complete |
$2.33
|
| Rate for Payer: BCBS MAPPO |
$4.25
|
| Rate for Payer: BCBS Trust/PPO |
$13.72
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$4.25
|
| Rate for Payer: Cash Price |
$564.06
|
| Rate for Payer: Cash Price |
$564.06
|
| Rate for Payer: Cofinity Advantage |
$493.56
|
| Rate for Payer: Cofinity Commercial |
$606.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.25
|
| Rate for Payer: Healthscope Commercial |
$634.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.81
|
| Rate for Payer: Mclaren Medicaid |
$4.25
|
| Rate for Payer: Mclaren Medicare |
$4.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.46
|
| Rate for Payer: Meridian Medicaid |
$4.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.32
|
| Rate for Payer: Nomi Health Commercial |
$12.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.81
|
| Rate for Payer: PACE Medicare |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.25
|
| Rate for Payer: PHP Commercial |
$599.32
|
| Rate for Payer: PHP Medicare Advantage |
$4.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.35
|
| Rate for Payer: Priority Health Medicare |
$4.25
|
| Rate for Payer: Priority Health SBD |
$444.20
|
| Rate for Payer: Priority Health Tiered Network |
$10.68
|
| Rate for Payer: Railroad Medicare Medicare |
$4.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.00
|
| Rate for Payer: UHC Core |
$7.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.25
|
| Rate for Payer: UHC Exchange |
$7.00
|
| Rate for Payer: UHC Medicaid |
$2.22
|
| Rate for Payer: UHCCP Medicaid |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$260.88
|
| Rate for Payer: VA VA |
$4.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.81
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$705.08
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$634.57 |
| Rate for Payer: Aetna American Axle |
$458.30
|
| Rate for Payer: Aetna Commercial |
$599.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.30
|
| Rate for Payer: Cash Price |
$564.06
|
| Rate for Payer: Cofinity Advantage |
$493.56
|
| Rate for Payer: Cofinity Commercial |
$606.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.06
|
| Rate for Payer: Healthscope Commercial |
$634.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.81
|
| Rate for Payer: PHP Commercial |
$599.32
|
| Rate for Payer: Priority Health SBD |
$444.20
|
| Rate for Payer: UMR Bronson Commercial |
$310.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.81
|
|
|
CEFTAROLINE FOSAMIL 600 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$705.08
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
301724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$634.57 |
| Rate for Payer: Aetna American Axle |
$458.30
|
| Rate for Payer: Aetna Commercial |
$599.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.30
|
| Rate for Payer: Cash Price |
$564.06
|
| Rate for Payer: Cofinity Advantage |
$493.56
|
| Rate for Payer: Cofinity Commercial |
$606.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.06
|
| Rate for Payer: Healthscope Commercial |
$634.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.81
|
| Rate for Payer: PHP Commercial |
$599.32
|
| Rate for Payer: Priority Health SBD |
$444.20
|
| Rate for Payer: UMR Bronson Commercial |
$310.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.81
|
|
|
CEFTAROLINE FOSAMIL 600 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$705.08
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
301724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$634.57 |
| Rate for Payer: Aetna American Axle |
$458.30
|
| Rate for Payer: Aetna Commercial |
$599.32
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.31
|
| Rate for Payer: BCBS Complete |
$2.33
|
| Rate for Payer: BCBS MAPPO |
$4.25
|
| Rate for Payer: BCBS Trust/PPO |
$13.72
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$4.25
|
| Rate for Payer: Cash Price |
$564.06
|
| Rate for Payer: Cash Price |
$564.06
|
| Rate for Payer: Cofinity Advantage |
$493.56
|
| Rate for Payer: Cofinity Commercial |
$606.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.25
|
| Rate for Payer: Healthscope Commercial |
$634.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.81
|
| Rate for Payer: Mclaren Medicaid |
$4.25
|
| Rate for Payer: Mclaren Medicare |
$4.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.46
|
| Rate for Payer: Meridian Medicaid |
$4.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.32
|
| Rate for Payer: Nomi Health Commercial |
$12.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.81
|
| Rate for Payer: PACE Medicare |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.25
|
| Rate for Payer: PHP Commercial |
$599.32
|
| Rate for Payer: PHP Medicare Advantage |
$4.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.35
|
| Rate for Payer: Priority Health Medicare |
$4.25
|
| Rate for Payer: Priority Health SBD |
$444.20
|
| Rate for Payer: Priority Health Tiered Network |
$10.68
|
| Rate for Payer: Railroad Medicare Medicare |
$4.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.00
|
| Rate for Payer: UHC Core |
$7.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.25
|
| Rate for Payer: UHC Exchange |
$7.00
|
| Rate for Payer: UHC Medicaid |
$2.22
|
| Rate for Payer: UHCCP Medicaid |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$260.88
|
| Rate for Payer: VA VA |
$4.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.81
|
|
|
CEFTAROLINE FOSAMIL 60 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 09900000954
|
| Hospital Charge Code |
168966
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna American Axle |
$0.23
|
| Rate for Payer: Aetna Commercial |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.23
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cofinity Advantage |
$0.25
|
| Rate for Payer: Cofinity Commercial |
$0.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.28
|
| Rate for Payer: Healthscope Commercial |
$0.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.26
|
| Rate for Payer: PHP Commercial |
$0.30
|
| Rate for Payer: Priority Health SBD |
$0.22
|
| Rate for Payer: UMR Bronson Commercial |
$0.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.26
|
|
|
CEFTAROLINE FOSAMIL 60 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 09900000954
|
| Hospital Charge Code |
168966
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna American Axle |
$0.23
|
| Rate for Payer: Aetna Commercial |
$0.30
|
| Rate for Payer: Aetna Medicare |
$0.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.14
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cofinity Advantage |
$0.25
|
| Rate for Payer: Cofinity Commercial |
$0.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.28
|
| Rate for Payer: Healthscope Commercial |
$0.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.26
|
| Rate for Payer: PHP Commercial |
$0.30
|
| Rate for Payer: Priority Health SBD |
$0.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.14
|
| Rate for Payer: UMR Bronson Commercial |
$0.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.26
|
|
