|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
OP
|
$245.24
|
|
|
Service Code
|
NDC 63713091953
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$90.74 |
| Max. Negotiated Rate |
$220.72 |
| Rate for Payer: Aetna American Axle |
$159.41
|
| Rate for Payer: Aetna Commercial |
$208.45
|
| Rate for Payer: Aetna Medicare |
$122.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.41
|
| Rate for Payer: BCBS Complete |
$98.10
|
| Rate for Payer: Cash Price |
$196.19
|
| Rate for Payer: Cofinity Advantage |
$171.67
|
| Rate for Payer: Cofinity Commercial |
$210.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.19
|
| Rate for Payer: Healthscope Commercial |
$220.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.93
|
| Rate for Payer: PHP Commercial |
$208.45
|
| Rate for Payer: Priority Health SBD |
$154.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.41
|
| Rate for Payer: UHC Core |
$127.77
|
| Rate for Payer: UHC Exchange |
$96.38
|
| Rate for Payer: UMR Bronson Commercial |
$90.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.93
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
OP
|
$159.91
|
|
|
Service Code
|
NDC 09900000603
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.17 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna American Axle |
$103.94
|
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Aetna Medicare |
$79.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.94
|
| Rate for Payer: BCBS Complete |
$63.96
|
| Rate for Payer: Cash Price |
$127.93
|
| Rate for Payer: Cofinity Advantage |
$111.94
|
| Rate for Payer: Cofinity Commercial |
$137.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.93
|
| Rate for Payer: Healthscope Commercial |
$143.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.93
|
| Rate for Payer: PHP Commercial |
$135.92
|
| Rate for Payer: Priority Health SBD |
$100.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.94
|
| Rate for Payer: UHC Core |
$83.31
|
| Rate for Payer: UHC Exchange |
$62.84
|
| Rate for Payer: UMR Bronson Commercial |
$59.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.93
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
IP
|
$279.50
|
|
|
Service Code
|
NDC 09900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$122.98 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna American Axle |
$181.68
|
| Rate for Payer: Aetna Commercial |
$237.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Advantage |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.62
|
| Rate for Payer: PHP Commercial |
$237.57
|
| Rate for Payer: Priority Health SBD |
$176.09
|
| Rate for Payer: UMR Bronson Commercial |
$122.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.62
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
OP
|
$279.50
|
|
|
Service Code
|
NDC 09900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.42 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna American Axle |
$181.68
|
| Rate for Payer: Aetna Commercial |
$237.57
|
| Rate for Payer: Aetna Medicare |
$139.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: BCBS Complete |
$111.80
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Advantage |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.62
|
| Rate for Payer: PHP Commercial |
$237.57
|
| Rate for Payer: Priority Health SBD |
$176.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.68
|
| Rate for Payer: UHC Core |
$145.62
|
| Rate for Payer: UHC Exchange |
$109.84
|
| Rate for Payer: UMR Bronson Commercial |
$103.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.62
|
|
|
CELLULOSE,OXIDIZED-COLLAGEN 4.34" X 4.34" 45 %-55 % BANDAGE
|
Facility
|
IP
|
$38.41
|
|
|
Service Code
|
NDC 09900000605
|
| Hospital Charge Code |
169205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Aetna American Axle |
$24.97
|
| Rate for Payer: Aetna Commercial |
$32.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.97
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Cofinity Advantage |
$26.89
|
| Rate for Payer: Cofinity Commercial |
$33.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.73
|
| Rate for Payer: Healthscope Commercial |
$34.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.81
|
| Rate for Payer: PHP Commercial |
$32.65
|
| Rate for Payer: Priority Health SBD |
$24.20
|
| Rate for Payer: UMR Bronson Commercial |
$16.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.81
|
|
|
CELLULOSE,OXIDIZED-COLLAGEN 4.34" X 4.34" 45 %-55 % BANDAGE
|
Facility
|
OP
|
$38.41
|
|
|
Service Code
|
NDC 09900000605
|
| Hospital Charge Code |
169205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Aetna American Axle |
$24.97
|
| Rate for Payer: Aetna Commercial |
$32.65
|
| Rate for Payer: Aetna Medicare |
$19.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.97
|
| Rate for Payer: BCBS Complete |
$15.36
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Cofinity Advantage |
$26.89
|
| Rate for Payer: Cofinity Commercial |
$33.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.73
|
| Rate for Payer: Healthscope Commercial |
$34.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.81
|
| Rate for Payer: PHP Commercial |
$32.65
|
| Rate for Payer: Priority Health SBD |
$24.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.97
|
| Rate for Payer: UHC Core |
$20.01
|
| Rate for Payer: UHC Exchange |
$15.10
|
| Rate for Payer: UMR Bronson Commercial |
$14.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.81
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$50,892.59
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22,392.74 |
| Max. Negotiated Rate |
$45,803.33 |
| Rate for Payer: Aetna American Axle |
$33,080.18
|
| Rate for Payer: Aetna Commercial |
$43,258.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,080.18
|
| Rate for Payer: Cash Price |
$40,714.07
|
| Rate for Payer: Cofinity Advantage |
$35,624.81
|
| Rate for Payer: Cofinity Commercial |
$43,767.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,714.07
|
| Rate for Payer: Healthscope Commercial |
$45,803.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,624.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38,169.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,258.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38,169.44
|
| Rate for Payer: PHP Commercial |
$43,258.70
|
| Rate for Payer: Priority Health SBD |
$32,062.33
|
| Rate for Payer: UMR Bronson Commercial |
$22,392.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38,169.44
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$50,892.59
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$45,803.33 |
| Rate for Payer: Aetna American Axle |
$33,080.18
|
| Rate for Payer: Aetna Commercial |
$43,258.70
|
| Rate for Payer: Aetna Medicare |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,080.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.20
|
| Rate for Payer: BCBS Complete |
$16.34
|
| Rate for Payer: BCBS MAPPO |
$29.76
|
| Rate for Payer: BCBS Trust/PPO |
$93.03
|
| Rate for Payer: BCN Commercial |
$93.03
|
| Rate for Payer: BCN Medicare Advantage |
$29.76
|
| Rate for Payer: Cash Price |
$40,714.07
|
| Rate for Payer: Cash Price |
$40,714.07
|
| Rate for Payer: Cofinity Advantage |
$35,624.81
|
| Rate for Payer: Cofinity Commercial |
$43,767.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,714.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.76
|
| Rate for Payer: Healthscope Commercial |
$45,803.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,624.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38,169.44
|
| Rate for Payer: Mclaren Medicaid |
$29.76
|
| Rate for Payer: Mclaren Medicare |
$29.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.25
|
| Rate for Payer: Meridian Medicaid |
$31.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,258.70
|
| Rate for Payer: Nomi Health Commercial |
$89.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38,169.44
|
| Rate for Payer: PACE Medicare |
$28.27
|
| Rate for Payer: PACE SWMI |
$29.76
|
| Rate for Payer: PHP Commercial |
$43,258.70
|
| Rate for Payer: PHP Medicare Advantage |
$29.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.38
|
| Rate for Payer: Priority Health Medicare |
$29.76
|
| Rate for Payer: Priority Health SBD |
$32,062.33
|
| Rate for Payer: Priority Health Tiered Network |
$73.90
|
| Rate for Payer: Railroad Medicare Medicare |
$29.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.34
|
| Rate for Payer: UHC Core |
$47.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.76
|
| Rate for Payer: UHC Exchange |
$47.34
|
| Rate for Payer: UHC Medicaid |
$15.56
|
| Rate for Payer: UHCCP Medicaid |
$15.56
|
| Rate for Payer: UMR Bronson Commercial |
$18,830.26
|
| Rate for Payer: VA VA |
$29.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38,169.44
|
|
|
CENOBAMATE 200 MG TABLET
|
Facility
|
OP
|
$4,182.15
|
|
|
Service Code
|
NDC 71699020030
|
| Hospital Charge Code |
192891
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,547.40 |
| Max. Negotiated Rate |
$3,763.93 |
| Rate for Payer: Aetna American Axle |
$2,718.40
|
| Rate for Payer: Aetna Commercial |
$3,554.83
|
| Rate for Payer: Aetna Medicare |
$2,091.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,718.40
|
| Rate for Payer: BCBS Complete |
$1,672.86
|
| Rate for Payer: Cash Price |
$3,345.72
|
| Rate for Payer: Cofinity Advantage |
$2,927.51
|
| Rate for Payer: Cofinity Commercial |
$3,596.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,345.72
|
| Rate for Payer: Healthscope Commercial |
$3,763.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,927.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,136.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,345.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,554.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,136.61
|
| Rate for Payer: PHP Commercial |
$3,554.83
|
| Rate for Payer: Priority Health SBD |
$2,634.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,718.40
|
| Rate for Payer: UHC Core |
$2,178.90
|
| Rate for Payer: UHC Exchange |
$1,643.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,547.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,136.61
|
|
|
CENOBAMATE 200 MG TABLET
|
Facility
|
IP
|
$4,182.15
|
|
|
Service Code
|
NDC 71699020030
|
| Hospital Charge Code |
192891
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,840.15 |
| Max. Negotiated Rate |
$3,763.93 |
| Rate for Payer: Aetna American Axle |
$2,718.40
|
| Rate for Payer: Aetna Commercial |
$3,554.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,718.40
|
| Rate for Payer: Cash Price |
$3,345.72
|
| Rate for Payer: Cofinity Advantage |
$2,927.51
|
| Rate for Payer: Cofinity Commercial |
$3,596.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,345.72
|
| Rate for Payer: Healthscope Commercial |
$3,763.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,927.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,554.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,136.61
|
| Rate for Payer: PHP Commercial |
$3,554.83
|
| Rate for Payer: Priority Health SBD |
$2,634.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,840.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,136.61
|
|
|
CENOBAMATE 50 MG TABLET
|
Facility
|
IP
|
$4,182.15
|
|
|
Service Code
|
NDC 71699005030
|
| Hospital Charge Code |
192888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,840.15 |
| Max. Negotiated Rate |
$3,763.93 |
| Rate for Payer: Aetna American Axle |
$2,718.40
|
| Rate for Payer: Aetna Commercial |
$3,554.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,718.40
|
| Rate for Payer: Cash Price |
$3,345.72
|
| Rate for Payer: Cofinity Advantage |
$2,927.51
|
| Rate for Payer: Cofinity Commercial |
$3,596.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,345.72
|
| Rate for Payer: Healthscope Commercial |
$3,763.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,927.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,554.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,136.61
|
| Rate for Payer: PHP Commercial |
$3,554.83
|
| Rate for Payer: Priority Health SBD |
$2,634.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,840.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,136.61
|
|
|
CENOBAMATE 50 MG TABLET
|
Facility
|
OP
|
$4,182.15
|
|
|
Service Code
|
NDC 71699005030
|
| Hospital Charge Code |
192888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,547.40 |
| Max. Negotiated Rate |
$3,763.93 |
| Rate for Payer: Aetna American Axle |
$2,718.40
|
| Rate for Payer: Aetna Commercial |
$3,554.83
|
| Rate for Payer: Aetna Medicare |
$2,091.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,718.40
|
| Rate for Payer: BCBS Complete |
$1,672.86
|
| Rate for Payer: Cash Price |
$3,345.72
|
| Rate for Payer: Cofinity Advantage |
$2,927.51
|
| Rate for Payer: Cofinity Commercial |
$3,596.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,345.72
|
| Rate for Payer: Healthscope Commercial |
$3,763.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,927.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,136.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,345.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,554.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,136.61
|
| Rate for Payer: PHP Commercial |
$3,554.83
|
| Rate for Payer: Priority Health SBD |
$2,634.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,718.40
|
| Rate for Payer: UHC Core |
$2,178.90
|
| Rate for Payer: UHC Exchange |
$1,643.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,547.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,136.61
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$568.70
|
|
|
Service Code
|
NDC 67877054568
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.42 |
| Max. Negotiated Rate |
$511.83 |
| Rate for Payer: Aetna American Axle |
$369.65
|
| Rate for Payer: Aetna Commercial |
$483.39
|
| Rate for Payer: Aetna Medicare |
$284.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.65
|
| Rate for Payer: BCBS Complete |
$227.48
|
| Rate for Payer: Cash Price |
$454.96
|
| Rate for Payer: Cofinity Advantage |
$398.09
|
| Rate for Payer: Cofinity Commercial |
$489.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.96
|
| Rate for Payer: Healthscope Commercial |
$511.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$426.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$454.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$426.52
|
| Rate for Payer: PHP Commercial |
$483.39
|
| Rate for Payer: Priority Health SBD |
$358.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.65
|
| Rate for Payer: UHC Core |
$296.29
|
| Rate for Payer: UHC Exchange |
$223.50
|
| Rate for Payer: UMR Bronson Commercial |
$210.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$426.52
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,032.30
|
|
|
Service Code
|
NDC 62135048142
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$454.21 |
| Max. Negotiated Rate |
$929.07 |
| Rate for Payer: Aetna American Axle |
$671.00
|
| Rate for Payer: Aetna Commercial |
$877.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.00
|
| Rate for Payer: Cash Price |
$825.84
|
| Rate for Payer: Cofinity Advantage |
$722.61
|
| Rate for Payer: Cofinity Commercial |
$887.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.84
|
| Rate for Payer: Healthscope Commercial |
$929.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$722.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$774.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$774.23
|
| Rate for Payer: PHP Commercial |
$877.46
|
| Rate for Payer: Priority Health SBD |
$650.35
|
| Rate for Payer: UMR Bronson Commercial |
$454.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$774.23
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$203.30
|
|
|
Service Code
|
NDC 00093417773
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.45 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna American Axle |
$132.15
|
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Advantage |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.47
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UMR Bronson Commercial |
$89.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.47
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$354.85
|
|
|
Service Code
|
NDC 68180044101
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$319.37 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Advantage |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.14
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UMR Bronson Commercial |
$156.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$354.85
|
|
|
Service Code
|
NDC 68180044101
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.29 |
| Max. Negotiated Rate |
$319.37 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna Medicare |
$177.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: BCBS Complete |
$141.94
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Advantage |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.14
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.65
|
| Rate for Payer: UHC Core |
$184.88
|
| Rate for Payer: UHC Exchange |
$139.46
|
| Rate for Payer: UMR Bronson Commercial |
$131.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$568.70
|
|
|
Service Code
|
NDC 67877054568
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.23 |
| Max. Negotiated Rate |
$511.83 |
| Rate for Payer: Aetna American Axle |
$369.65
|
| Rate for Payer: Aetna Commercial |
$483.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.65
|
| Rate for Payer: Cash Price |
$454.96
|
| Rate for Payer: Cofinity Advantage |
$398.09
|
| Rate for Payer: Cofinity Commercial |
$489.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.96
|
| Rate for Payer: Healthscope Commercial |
$511.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$426.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$426.52
|
| Rate for Payer: PHP Commercial |
$483.39
|
| Rate for Payer: Priority Health SBD |
$358.28
|
| Rate for Payer: UMR Bronson Commercial |
$250.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$426.52
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$465.30
|
|
|
Service Code
|
NDC 68180044102
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.73 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna American Axle |
$302.44
|
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Advantage |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.98
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health SBD |
$293.14
|
| Rate for Payer: UMR Bronson Commercial |
$204.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.98
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,032.30
|
|
|
Service Code
|
NDC 62135048142
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$381.95 |
| Max. Negotiated Rate |
$929.07 |
| Rate for Payer: Aetna American Axle |
$671.00
|
| Rate for Payer: Aetna Commercial |
$877.46
|
| Rate for Payer: Aetna Medicare |
$516.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.00
|
| Rate for Payer: BCBS Complete |
$412.92
|
| Rate for Payer: Cash Price |
$825.84
|
| Rate for Payer: Cofinity Advantage |
$722.61
|
| Rate for Payer: Cofinity Commercial |
$887.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.84
|
| Rate for Payer: Healthscope Commercial |
$929.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$722.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$774.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$825.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$774.23
|
| Rate for Payer: PHP Commercial |
$877.46
|
| Rate for Payer: Priority Health SBD |
$650.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.00
|
| Rate for Payer: UHC Core |
$537.83
|
| Rate for Payer: UHC Exchange |
$405.69
|
| Rate for Payer: UMR Bronson Commercial |
$381.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$774.23
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$203.30
|
|
|
Service Code
|
NDC 00093417773
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.22 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna American Axle |
$132.15
|
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna Medicare |
$101.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: BCBS Complete |
$81.32
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Advantage |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.47
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.15
|
| Rate for Payer: UHC Core |
$105.92
|
| Rate for Payer: UHC Exchange |
$79.90
|
| Rate for Payer: UMR Bronson Commercial |
$75.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.47
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$465.30
|
|
|
Service Code
|
NDC 68180044102
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.16 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna American Axle |
$302.44
|
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna Medicare |
$232.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: BCBS Complete |
$186.12
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Advantage |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.98
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health SBD |
$293.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.44
|
| Rate for Payer: UHC Core |
$242.42
|
| Rate for Payer: UHC Exchange |
$182.86
|
| Rate for Payer: UMR Bronson Commercial |
$172.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.98
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$312.55
|
|
|
Service Code
|
NDC 67877022001
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.64 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna American Axle |
$203.16
|
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna Medicare |
$156.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Advantage |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.41
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.16
|
| Rate for Payer: UHC Core |
$162.84
|
| Rate for Payer: UHC Exchange |
$122.83
|
| Rate for Payer: UMR Bronson Commercial |
$115.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$144.40
|
|
|
Service Code
|
NDC 50268015115
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$129.96 |
| Rate for Payer: Aetna American Axle |
$93.86
|
| Rate for Payer: Aetna Commercial |
$122.74
|
| Rate for Payer: Aetna Medicare |
$72.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.86
|
| Rate for Payer: BCBS Complete |
$57.76
|
| Rate for Payer: Cash Price |
$115.52
|
| Rate for Payer: Cofinity Advantage |
$101.08
|
| Rate for Payer: Cofinity Commercial |
$124.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.52
|
| Rate for Payer: Healthscope Commercial |
$129.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.30
|
| Rate for Payer: PHP Commercial |
$122.74
|
| Rate for Payer: Priority Health SBD |
$90.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.86
|
| Rate for Payer: UHC Core |
$75.23
|
| Rate for Payer: UHC Exchange |
$56.75
|
| Rate for Payer: UMR Bronson Commercial |
$53.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.30
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$144.40
|
|
|
Service Code
|
NDC 50268015115
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.54 |
| Max. Negotiated Rate |
$129.96 |
| Rate for Payer: Aetna American Axle |
$93.86
|
| Rate for Payer: Aetna Commercial |
$122.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.86
|
| Rate for Payer: Cash Price |
$115.52
|
| Rate for Payer: Cofinity Advantage |
$101.08
|
| Rate for Payer: Cofinity Commercial |
$124.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.52
|
| Rate for Payer: Healthscope Commercial |
$129.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.30
|
| Rate for Payer: PHP Commercial |
$122.74
|
| Rate for Payer: Priority Health SBD |
$90.97
|
| Rate for Payer: UMR Bronson Commercial |
$63.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.30
|
|
