|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$27.21
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$24.49 |
| Rate for Payer: Aetna American Axle |
$17.69
|
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna American Axle |
$14.35
|
| Rate for Payer: Aetna American Axle |
$16.25
|
| Rate for Payer: Aetna American Axle |
$16.54
|
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna American Axle |
$29.78
|
| Rate for Payer: Aetna Commercial |
$18.77
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Commercial |
$21.63
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Commercial |
$23.13
|
| Rate for Payer: Aetna Commercial |
$38.95
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Medicare |
$11.04
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna Medicare |
$13.61
|
| Rate for Payer: Aetna Medicare |
$8.23
|
| Rate for Payer: Aetna Medicare |
$12.72
|
| Rate for Payer: Aetna Medicare |
$12.50
|
| Rate for Payer: Aetna Medicare |
$22.91
|
| Rate for Payer: Aetna Medicare |
$12.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.54
|
| Rate for Payer: BCBS Complete |
$18.33
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Complete |
$8.83
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$10.88
|
| Rate for Payer: BCBS Complete |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$21.77
|
| Rate for Payer: Cash Price |
$21.77
|
| Rate for Payer: Cash Price |
$36.66
|
| Rate for Payer: Cash Price |
$36.66
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Advantage |
$32.07
|
| Rate for Payer: Cofinity Advantage |
$15.46
|
| Rate for Payer: Cofinity Advantage |
$17.82
|
| Rate for Payer: Cofinity Advantage |
$19.05
|
| Rate for Payer: Cofinity Advantage |
$17.50
|
| Rate for Payer: Cofinity Advantage |
$11.53
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$39.41
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Cofinity Commercial |
$21.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.77
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$41.24
|
| Rate for Payer: Healthscope Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Healthscope Commercial |
$24.49
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$22.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.56
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Commercial |
$18.77
|
| Rate for Payer: PHP Commercial |
$38.95
|
| Rate for Payer: PHP Commercial |
$23.13
|
| Rate for Payer: PHP Commercial |
$21.63
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$28.87
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health SBD |
$17.14
|
| Rate for Payer: Priority Health SBD |
$13.91
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: Priority Health SBD |
$16.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UMR Bronson Commercial |
$10.07
|
| Rate for Payer: UMR Bronson Commercial |
$16.95
|
| Rate for Payer: UMR Bronson Commercial |
$9.42
|
| Rate for Payer: UMR Bronson Commercial |
$8.17
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: UMR Bronson Commercial |
$6.09
|
| Rate for Payer: UMR Bronson Commercial |
$7.66
|
| Rate for Payer: UMR Bronson Commercial |
$9.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.41
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$16.47
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Advantage |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: UMR Bronson Commercial |
$7.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$16.47
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Medicare |
$8.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Advantage |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UMR Bronson Commercial |
$6.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna American Axle |
$2.73
|
| Rate for Payer: Aetna American Axle |
$5.04
|
| Rate for Payer: Aetna American Axle |
$5.59
|
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$8.02
|
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Commercial |
$6.59
|
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna Medicare |
$4.72
|
| Rate for Payer: Aetna Medicare |
$4.30
|
| Rate for Payer: Aetna Medicare |
$3.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.04
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS Complete |
$3.44
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cofinity Advantage |
$5.42
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Advantage |
$6.61
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Advantage |
$2.94
|
| Rate for Payer: Cofinity Advantage |
$6.02
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$6.67
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.88
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$7.74
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$6.97
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$3.57
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$6.59
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$7.31
|
| Rate for Payer: PHP Commercial |
$8.02
|
| Rate for Payer: Priority Health SBD |
$4.88
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: Priority Health SBD |
$5.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UMR Bronson Commercial |
$2.87
|
| Rate for Payer: UMR Bronson Commercial |
$3.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.15
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$9.44
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna American Axle |
$5.59
|
| Rate for Payer: Aetna American Axle |
$5.04
|
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna American Axle |
$2.73
|
| Rate for Payer: Aetna Commercial |
$8.02
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Commercial |
$6.59
|
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cofinity Advantage |
$5.42
|
| Rate for Payer: Cofinity Advantage |
$2.94
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Advantage |
$6.02
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Advantage |
$6.61
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$6.67
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.55
|
| Rate for Payer: Healthscope Commercial |
$7.74
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$6.97
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$8.02
|
| Rate for Payer: PHP Commercial |
$7.31
|
| Rate for Payer: PHP Commercial |
$6.59
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.57
|
| Rate for Payer: Priority Health SBD |
$5.42
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: Priority Health SBD |
$4.88
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: UMR Bronson Commercial |
$3.78
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$3.41
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: UMR Bronson Commercial |
$4.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
CEFTRIAXONE IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Aetna Medicare |
$0.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Advantage |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.19
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health SBD |
$0.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UMR Bronson Commercial |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.19
|
|
|
CEFTRIAXONE IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Advantage |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.19
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health SBD |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$0.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.19
|
|
|
CEFTRIAXONE IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$3.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna American Axle |
$2.11
|
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Advantage |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.44
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.44
|
|
|
CEFTRIAXONE IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna American Axle |
$2.11
|
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Advantage |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.44
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.05
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.44
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
OP
|
$241.06
|
|
|
Service Code
|
NDC 57237005860
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.19 |
| Max. Negotiated Rate |
$216.95 |
| Rate for Payer: Aetna American Axle |
$156.69
|
| Rate for Payer: Aetna Commercial |
$204.90
|
| Rate for Payer: Aetna Medicare |
$120.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.69
|
| Rate for Payer: BCBS Complete |
$96.42
|
| Rate for Payer: Cash Price |
$192.85
|
| Rate for Payer: Cofinity Advantage |
$168.74
|
| Rate for Payer: Cofinity Commercial |
$207.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.85
|
| Rate for Payer: Healthscope Commercial |
$216.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.79
|
| Rate for Payer: PHP Commercial |
$204.90
|
| Rate for Payer: Priority Health SBD |
$151.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.69
|
| Rate for Payer: UHC Core |
$125.59
|
| Rate for Payer: UHC Exchange |
$94.74
|
| Rate for Payer: UMR Bronson Commercial |
$89.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.79
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
IP
|
$241.06
|
|
|
Service Code
|
NDC 57237005860
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.07 |
| Max. Negotiated Rate |
$216.95 |
| Rate for Payer: Aetna American Axle |
$156.69
|
| Rate for Payer: Aetna Commercial |
$204.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.69
|
| Rate for Payer: Cash Price |
$192.85
|
| Rate for Payer: Cofinity Advantage |
$168.74
|
| Rate for Payer: Cofinity Commercial |
$207.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.85
|
| Rate for Payer: Healthscope Commercial |
$216.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.79
|
| Rate for Payer: PHP Commercial |
$204.90
|
| Rate for Payer: Priority Health SBD |
$151.87
|
| Rate for Payer: UMR Bronson Commercial |
$106.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.79
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
IP
|
$451.88
|
|
|
Service Code
|
NDC 68180030260
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.83 |
| Max. Negotiated Rate |
$406.69 |
| Rate for Payer: Aetna American Axle |
$293.72
|
| Rate for Payer: Aetna Commercial |
$384.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.72
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cofinity Advantage |
$316.32
|
| Rate for Payer: Cofinity Commercial |
$388.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.50
|
| Rate for Payer: Healthscope Commercial |
$406.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.91
|
| Rate for Payer: PHP Commercial |
$384.10
|
| Rate for Payer: Priority Health SBD |
$284.68
|
| Rate for Payer: UMR Bronson Commercial |
$198.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.91
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
OP
|
$451.88
|
|
|
Service Code
|
NDC 68180030260
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$406.69 |
| Rate for Payer: Aetna American Axle |
$293.72
|
| Rate for Payer: Aetna Commercial |
$384.10
|
| Rate for Payer: Aetna Medicare |
$225.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.72
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cofinity Advantage |
$316.32
|
| Rate for Payer: Cofinity Commercial |
$388.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.50
|
| Rate for Payer: Healthscope Commercial |
$406.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$361.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.91
|
| Rate for Payer: PHP Commercial |
$384.10
|
| Rate for Payer: Priority Health SBD |
$284.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.72
|
| Rate for Payer: UHC Core |
$235.43
|
| Rate for Payer: UHC Exchange |
$177.59
|
| Rate for Payer: UMR Bronson Commercial |
$167.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.91
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
OP
|
$147.06
|
|
|
Service Code
|
NDC 65862069960
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.41 |
| Max. Negotiated Rate |
$132.35 |
| Rate for Payer: Aetna American Axle |
$95.59
|
| Rate for Payer: Aetna Commercial |
$125.00
|
| Rate for Payer: Aetna Medicare |
$73.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.59
|
| Rate for Payer: BCBS Complete |
$58.82
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cofinity Advantage |
$102.94
|
| Rate for Payer: Cofinity Commercial |
$126.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.65
|
| Rate for Payer: Healthscope Commercial |
$132.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.30
|
| Rate for Payer: PHP Commercial |
$125.00
|
| Rate for Payer: Priority Health SBD |
$92.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.59
|
| Rate for Payer: UHC Core |
$76.62
|
| Rate for Payer: UHC Exchange |
$57.79
|
| Rate for Payer: UMR Bronson Commercial |
$54.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.30
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
IP
|
$147.06
|
|
|
Service Code
|
NDC 65862069960
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.71 |
| Max. Negotiated Rate |
$132.35 |
| Rate for Payer: Aetna American Axle |
$95.59
|
| Rate for Payer: Aetna Commercial |
$125.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.59
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cofinity Advantage |
$102.94
|
| Rate for Payer: Cofinity Commercial |
$126.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.65
|
| Rate for Payer: Healthscope Commercial |
$132.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.30
|
| Rate for Payer: PHP Commercial |
$125.00
|
| Rate for Payer: Priority Health SBD |
$92.65
|
| Rate for Payer: UMR Bronson Commercial |
$64.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.30
|
|
|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.57
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$6.65
|
| Rate for Payer: BCN Commercial |
$6.65
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Advantage |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.38
|
| Rate for Payer: UHC Core |
$3.38
|
| Rate for Payer: UHC Exchange |
$3.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.57
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Advantage |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.60 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna American Axle |
$180.25
|
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna Medicare |
$138.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.25
|
| Rate for Payer: BCBS Complete |
$110.92
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Advantage |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health SBD |
$174.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.25
|
| Rate for Payer: UHC Core |
$144.47
|
| Rate for Payer: UHC Exchange |
$108.98
|
| Rate for Payer: UMR Bronson Commercial |
$102.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 62332014131
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.28
|
| Rate for Payer: UHC Core |
$138.09
|
| Rate for Payer: UHC Exchange |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 69367030101
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.73 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Advantage |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UMR Bronson Commercial |
$143.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$365.28
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$328.75 |
| Rate for Payer: Aetna American Axle |
$237.43
|
| Rate for Payer: Aetna Commercial |
$310.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.43
|
| Rate for Payer: Cash Price |
$292.22
|
| Rate for Payer: Cofinity Advantage |
$255.70
|
| Rate for Payer: Cofinity Commercial |
$314.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.22
|
| Rate for Payer: Healthscope Commercial |
$328.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.96
|
| Rate for Payer: PHP Commercial |
$310.49
|
| Rate for Payer: Priority Health SBD |
$230.13
|
| Rate for Payer: UMR Bronson Commercial |
$160.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.96
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$345.10
|
|
|
Service Code
|
NDC 00025152034
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.69 |
| Max. Negotiated Rate |
$310.59 |
| Rate for Payer: Aetna American Axle |
$224.31
|
| Rate for Payer: Aetna Commercial |
$293.33
|
| Rate for Payer: Aetna Medicare |
$172.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.31
|
| Rate for Payer: BCBS Complete |
$138.04
|
| Rate for Payer: Cash Price |
$276.08
|
| Rate for Payer: Cofinity Advantage |
$241.57
|
| Rate for Payer: Cofinity Commercial |
$296.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.08
|
| Rate for Payer: Healthscope Commercial |
$310.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.82
|
| Rate for Payer: PHP Commercial |
$293.33
|
| Rate for Payer: Priority Health SBD |
$217.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.31
|
| Rate for Payer: UHC Core |
$179.80
|
| Rate for Payer: UHC Exchange |
$135.62
|
| Rate for Payer: UMR Bronson Commercial |
$127.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.82
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$345.10
|
|
|
Service Code
|
NDC 00025152034
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.84 |
| Max. Negotiated Rate |
$310.59 |
| Rate for Payer: Aetna American Axle |
$224.31
|
| Rate for Payer: Aetna Commercial |
$293.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.31
|
| Rate for Payer: Cash Price |
$276.08
|
| Rate for Payer: Cofinity Advantage |
$241.57
|
| Rate for Payer: Cofinity Commercial |
$296.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.08
|
| Rate for Payer: Healthscope Commercial |
$310.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.82
|
| Rate for Payer: PHP Commercial |
$293.33
|
| Rate for Payer: Priority Health SBD |
$217.41
|
| Rate for Payer: UMR Bronson Commercial |
$151.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.82
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 69367030101
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.86 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Advantage |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.32
|
| Rate for Payer: UHC Core |
$170.18
|
| Rate for Payer: UHC Exchange |
$128.37
|
| Rate for Payer: UMR Bronson Commercial |
$120.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 33342015611
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.81
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Advantage |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.81
|
| Rate for Payer: UHC Core |
$80.81
|
| Rate for Payer: UHC Exchange |
$60.95
|
| Rate for Payer: UMR Bronson Commercial |
$57.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
