|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$136.23
|
|
|
Service Code
|
NDC 62332025230
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.41 |
| Max. Negotiated Rate |
$122.61 |
| Rate for Payer: Aetna American Axle |
$88.55
|
| Rate for Payer: Aetna Commercial |
$115.80
|
| Rate for Payer: Aetna Medicare |
$68.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.55
|
| Rate for Payer: BCBS Complete |
$54.49
|
| Rate for Payer: Cash Price |
$108.98
|
| Rate for Payer: Cofinity Commercial |
$117.16
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.98
|
| Rate for Payer: Healthscope Commercial |
$122.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.80
|
| Rate for Payer: PHP Commercial |
$115.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.55
|
| Rate for Payer: Priority Health SBD |
$85.82
|
| Rate for Payer: UMR Bronson Commercial |
$50.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.17
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$306.48
|
|
|
Service Code
|
NDC 60687075321
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$275.83 |
| Rate for Payer: Aetna American Axle |
$199.21
|
| Rate for Payer: Aetna Commercial |
$260.51
|
| Rate for Payer: Aetna Medicare |
$153.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.21
|
| Rate for Payer: BCBS Complete |
$122.59
|
| Rate for Payer: Cash Price |
$245.18
|
| Rate for Payer: Cofinity Commercial |
$214.54
|
| Rate for Payer: Cofinity Commercial |
$263.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.18
|
| Rate for Payer: Healthscope Commercial |
$275.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.51
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.21
|
| Rate for Payer: Priority Health SBD |
$193.08
|
| Rate for Payer: UMR Bronson Commercial |
$113.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.86
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$306.48
|
|
|
Service Code
|
NDC 60687075321
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.85 |
| Max. Negotiated Rate |
$275.83 |
| Rate for Payer: Aetna American Axle |
$199.21
|
| Rate for Payer: Aetna Commercial |
$260.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.21
|
| Rate for Payer: Cash Price |
$245.18
|
| Rate for Payer: Cofinity Commercial |
$214.54
|
| Rate for Payer: Cofinity Commercial |
$263.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.18
|
| Rate for Payer: Healthscope Commercial |
$275.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.51
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.21
|
| Rate for Payer: Priority Health SBD |
$193.08
|
| Rate for Payer: UMR Bronson Commercial |
$134.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.86
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$10.22
|
|
|
Service Code
|
NDC 60687075311
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna American Axle |
$6.64
|
| Rate for Payer: Aetna Commercial |
$8.69
|
| Rate for Payer: Aetna Medicare |
$5.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.64
|
| Rate for Payer: BCBS Complete |
$4.09
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$7.15
|
| Rate for Payer: Cofinity Commercial |
$8.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: PHP Commercial |
$8.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| Rate for Payer: Priority Health SBD |
$6.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.67
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$10.22
|
|
|
Service Code
|
NDC 60687075311
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna American Axle |
$6.64
|
| Rate for Payer: Aetna Commercial |
$8.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.64
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$7.15
|
| Rate for Payer: Cofinity Commercial |
$8.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: PHP Commercial |
$8.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| Rate for Payer: Priority Health SBD |
$6.44
|
| Rate for Payer: UMR Bronson Commercial |
$4.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.67
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$8.35
|
|
|
Service Code
|
NDC 50268009911
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$7.51 |
| Rate for Payer: Aetna American Axle |
$5.43
|
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.43
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$5.84
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$7.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: PHP Commercial |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.43
|
| Rate for Payer: Priority Health SBD |
$5.26
|
| Rate for Payer: UMR Bronson Commercial |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.26
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$498.06
|
|
|
Service Code
|
NDC 50111078810
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.15 |
| Max. Negotiated Rate |
$448.25 |
| Rate for Payer: Aetna American Axle |
$323.74
|
| Rate for Payer: Aetna Commercial |
$423.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.74
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Commercial |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$448.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.35
|
| Rate for Payer: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.74
|
| Rate for Payer: Priority Health SBD |
$313.78
|
| Rate for Payer: UMR Bronson Commercial |
$219.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.55
|
|
|
AZTREONAM 1 GM IVPB (INTRA-OP)
|
Facility
|
OP
|
$25.30
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
165983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna American Axle |
$16.45
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.45
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health SBD |
$15.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
AZTREONAM 1 GM IVPB (INTRA-OP)
|
Facility
|
IP
|
$25.30
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
165983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna American Axle |
$16.45
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.45
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health SBD |
$15.94
|
| Rate for Payer: UMR Bronson Commercial |
$11.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.02 |
| Max. Negotiated Rate |
$92.08 |
| Rate for Payer: Aetna American Axle |
$66.50
|
| Rate for Payer: Aetna American Axle |
$79.96
|
| Rate for Payer: Aetna American Axle |
$59.37
|
| Rate for Payer: Aetna Commercial |
$104.57
|
| Rate for Payer: Aetna Commercial |
$86.96
|
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.96
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cash Price |
$98.42
|
| Rate for Payer: Cash Price |
$81.85
|
| Rate for Payer: Cofinity Commercial |
$87.99
|
| Rate for Payer: Cofinity Commercial |
$86.11
|
| Rate for Payer: Cofinity Commercial |
$105.80
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Commercial |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$71.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.42
|
| Rate for Payer: Healthscope Commercial |
$110.72
|
| Rate for Payer: Healthscope Commercial |
$92.08
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.57
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: PHP Commercial |
$104.57
|
| Rate for Payer: PHP Commercial |
$86.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health SBD |
$57.54
|
| Rate for Payer: Priority Health SBD |
$77.50
|
| Rate for Payer: Priority Health SBD |
$64.46
|
| Rate for Payer: UMR Bronson Commercial |
$45.02
|
| Rate for Payer: UMR Bronson Commercial |
$40.19
|
| Rate for Payer: UMR Bronson Commercial |
$54.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.27
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$91.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna American Axle |
$59.37
|
| Rate for Payer: Aetna American Axle |
$66.50
|
| Rate for Payer: Aetna American Axle |
$79.96
|
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna Commercial |
$104.57
|
| Rate for Payer: Aetna Commercial |
$86.96
|
| Rate for Payer: Aetna Medicare |
$45.67
|
| Rate for Payer: Aetna Medicare |
$61.51
|
| Rate for Payer: Aetna Medicare |
$51.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.50
|
| Rate for Payer: BCBS Complete |
$40.92
|
| Rate for Payer: BCBS Complete |
$49.21
|
| Rate for Payer: BCBS Complete |
$36.54
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cash Price |
$98.42
|
| Rate for Payer: Cash Price |
$81.85
|
| Rate for Payer: Cofinity Commercial |
$86.11
|
| Rate for Payer: Cofinity Commercial |
$71.62
|
| Rate for Payer: Cofinity Commercial |
$87.99
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Commercial |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$105.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$92.08
|
| Rate for Payer: Healthscope Commercial |
$110.72
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: PHP Commercial |
$86.96
|
| Rate for Payer: PHP Commercial |
$104.57
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health SBD |
$77.50
|
| Rate for Payer: Priority Health SBD |
$64.46
|
| Rate for Payer: Priority Health SBD |
$57.54
|
| Rate for Payer: UMR Bronson Commercial |
$33.80
|
| Rate for Payer: UMR Bronson Commercial |
$37.85
|
| Rate for Payer: UMR Bronson Commercial |
$45.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.50
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS CUSTOM
|
Facility
|
IP
|
$91.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna American Axle |
$59.37
|
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Commercial |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health SBD |
$57.54
|
| Rate for Payer: UMR Bronson Commercial |
$40.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.50
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS CUSTOM
|
Facility
|
OP
|
$91.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna American Axle |
$59.37
|
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna Medicare |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: BCBS Complete |
$36.54
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Commercial |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health SBD |
$57.54
|
| Rate for Payer: UMR Bronson Commercial |
$33.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.50
|
|
|
AZTREONAM 2 GM IVPB (INTRA-OP)
|
Facility
|
IP
|
$50.60
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
168909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.26 |
| Max. Negotiated Rate |
$45.54 |
| Rate for Payer: Aetna American Axle |
$32.89
|
| Rate for Payer: Aetna Commercial |
$43.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.89
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cofinity Commercial |
$35.42
|
| Rate for Payer: Cofinity Commercial |
$43.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.48
|
| Rate for Payer: Healthscope Commercial |
$45.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.01
|
| Rate for Payer: PHP Commercial |
$43.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.89
|
| Rate for Payer: Priority Health SBD |
$31.88
|
| Rate for Payer: UMR Bronson Commercial |
$22.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.95
|
|
|
AZTREONAM 2 GM IVPB (INTRA-OP)
|
Facility
|
OP
|
$50.60
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
168909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$45.54 |
| Rate for Payer: Aetna American Axle |
$32.89
|
| Rate for Payer: Aetna Commercial |
$43.01
|
| Rate for Payer: Aetna Medicare |
$25.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.89
|
| Rate for Payer: BCBS Complete |
$20.24
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cofinity Commercial |
$35.42
|
| Rate for Payer: Cofinity Commercial |
$43.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.48
|
| Rate for Payer: Healthscope Commercial |
$45.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.01
|
| Rate for Payer: PHP Commercial |
$43.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.89
|
| Rate for Payer: Priority Health SBD |
$31.88
|
| Rate for Payer: UMR Bronson Commercial |
$18.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.95
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.07 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna American Axle |
$121.24
|
| Rate for Payer: Aetna American Axle |
$127.58
|
| Rate for Payer: Aetna American Axle |
$135.77
|
| Rate for Payer: Aetna Commercial |
$166.84
|
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Commercial |
$177.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.58
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Cofinity Commercial |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$137.40
|
| Rate for Payer: Cofinity Commercial |
$179.63
|
| Rate for Payer: Cofinity Commercial |
$146.21
|
| Rate for Payer: Cofinity Commercial |
$130.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Healthscope Commercial |
$176.65
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Healthscope Commercial |
$187.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.84
|
| Rate for Payer: PHP Commercial |
$177.54
|
| Rate for Payer: PHP Commercial |
$166.84
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health SBD |
$131.59
|
| Rate for Payer: Priority Health SBD |
$123.66
|
| Rate for Payer: Priority Health SBD |
$117.51
|
| Rate for Payer: UMR Bronson Commercial |
$82.07
|
| Rate for Payer: UMR Bronson Commercial |
$91.90
|
| Rate for Payer: UMR Bronson Commercial |
$86.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.21
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$208.87
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$187.98 |
| Rate for Payer: Aetna American Axle |
$135.77
|
| Rate for Payer: Aetna American Axle |
$121.24
|
| Rate for Payer: Aetna American Axle |
$127.58
|
| Rate for Payer: Aetna Commercial |
$177.54
|
| Rate for Payer: Aetna Commercial |
$166.84
|
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Medicare |
$104.44
|
| Rate for Payer: Aetna Medicare |
$98.14
|
| Rate for Payer: Aetna Medicare |
$93.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: BCBS Complete |
$74.61
|
| Rate for Payer: BCBS Complete |
$78.51
|
| Rate for Payer: BCBS Complete |
$83.55
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Commercial |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$130.57
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Cofinity Commercial |
$179.63
|
| Rate for Payer: Cofinity Commercial |
$146.21
|
| Rate for Payer: Cofinity Commercial |
$137.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Healthscope Commercial |
$176.65
|
| Rate for Payer: Healthscope Commercial |
$187.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: PHP Commercial |
$166.84
|
| Rate for Payer: PHP Commercial |
$177.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health SBD |
$123.66
|
| Rate for Payer: Priority Health SBD |
$117.51
|
| Rate for Payer: Priority Health SBD |
$131.59
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
| Rate for Payer: UMR Bronson Commercial |
$69.02
|
| Rate for Payer: UMR Bronson Commercial |
$72.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.65
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.02 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna American Axle |
$121.24
|
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Medicare |
$93.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: BCBS Complete |
$74.61
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Commercial |
$130.57
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health SBD |
$117.51
|
| Rate for Payer: UMR Bronson Commercial |
$69.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.07 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna American Axle |
$121.24
|
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Commercial |
$130.57
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health SBD |
$117.51
|
| Rate for Payer: UMR Bronson Commercial |
$82.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
|
|
BACITRACIN 500 UNIT/GRAM EYE OINTMENT
|
Facility
|
OP
|
$353.86
|
|
|
Service Code
|
NDC 00574402235
|
| Hospital Charge Code |
852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.93 |
| Max. Negotiated Rate |
$318.47 |
| Rate for Payer: Aetna American Axle |
$230.01
|
| Rate for Payer: Aetna Commercial |
$300.78
|
| Rate for Payer: Aetna Medicare |
$176.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.01
|
| Rate for Payer: BCBS Complete |
$141.54
|
| Rate for Payer: Cash Price |
$283.09
|
| Rate for Payer: Cofinity Commercial |
$247.70
|
| Rate for Payer: Cofinity Commercial |
$304.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.09
|
| Rate for Payer: Healthscope Commercial |
$318.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.78
|
| Rate for Payer: PHP Commercial |
$300.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.01
|
| Rate for Payer: Priority Health SBD |
$222.93
|
| Rate for Payer: UMR Bronson Commercial |
$130.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.39
|
|
|
BACITRACIN 500 UNIT/GRAM EYE OINTMENT
|
Facility
|
IP
|
$353.86
|
|
|
Service Code
|
NDC 00574402235
|
| Hospital Charge Code |
852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.70 |
| Max. Negotiated Rate |
$318.47 |
| Rate for Payer: Aetna American Axle |
$230.01
|
| Rate for Payer: Aetna Commercial |
$300.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.01
|
| Rate for Payer: Cash Price |
$283.09
|
| Rate for Payer: Cofinity Commercial |
$247.70
|
| Rate for Payer: Cofinity Commercial |
$304.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.09
|
| Rate for Payer: Healthscope Commercial |
$318.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.78
|
| Rate for Payer: PHP Commercial |
$300.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.01
|
| Rate for Payer: Priority Health SBD |
$222.93
|
| Rate for Payer: UMR Bronson Commercial |
$155.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.39
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 14428000888
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 14428000888
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$4.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$65.45
|
|
|
Service Code
|
NDC 67777022007
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$58.91 |
| Rate for Payer: Aetna American Axle |
$42.54
|
| Rate for Payer: Aetna Commercial |
$55.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.54
|
| Rate for Payer: Cash Price |
$52.36
|
| Rate for Payer: Cofinity Commercial |
$45.81
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.36
|
| Rate for Payer: Healthscope Commercial |
$58.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.63
|
| Rate for Payer: PHP Commercial |
$55.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.54
|
| Rate for Payer: Priority Health SBD |
$41.23
|
| Rate for Payer: UMR Bronson Commercial |
$28.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.09
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$9.72
|
|
|
Service Code
|
NDC 51672207501
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$8.75 |
| Rate for Payer: Aetna American Axle |
$6.32
|
| Rate for Payer: Aetna Commercial |
$8.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.32
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$8.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$8.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.26
|
| Rate for Payer: PHP Commercial |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.32
|
| Rate for Payer: Priority Health SBD |
$6.12
|
| Rate for Payer: UMR Bronson Commercial |
$4.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.29
|
|
