|
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
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 67877022001
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.52 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna American Axle |
$203.16
|
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| 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: 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: UMR Bronson Commercial |
$137.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
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
|
$289.05
|
|
|
Service Code
|
NDC 00093314501
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna Medicare |
$144.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: BCBS Complete |
$115.62
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Advantage |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.88
|
| Rate for Payer: UHC Core |
$150.60
|
| Rate for Payer: UHC Exchange |
$113.60
|
| Rate for Payer: UMR Bronson Commercial |
$106.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$2.34
|
|
|
Service Code
|
NDC 00904733735
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Aetna American Axle |
$1.52
|
| Rate for Payer: Aetna Commercial |
$1.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.52
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cofinity Advantage |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$2.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.87
|
| Rate for Payer: Healthscope Commercial |
$2.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.99
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$262.20
|
|
|
Service Code
|
NDC 68180012201
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.37 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna American Axle |
$170.43
|
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
| Rate for Payer: UMR Bronson Commercial |
$115.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.65
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$129.20
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$116.28 |
| Rate for Payer: Aetna American Axle |
$83.98
|
| Rate for Payer: Aetna Commercial |
$109.82
|
| Rate for Payer: Aetna Medicare |
$64.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.98
|
| Rate for Payer: BCBS Complete |
$51.68
|
| Rate for Payer: Cash Price |
$103.36
|
| Rate for Payer: Cofinity Advantage |
$90.44
|
| Rate for Payer: Cofinity Commercial |
$111.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.36
|
| Rate for Payer: Healthscope Commercial |
$116.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.90
|
| Rate for Payer: PHP Commercial |
$109.82
|
| Rate for Payer: Priority Health SBD |
$81.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.98
|
| Rate for Payer: UHC Core |
$67.31
|
| Rate for Payer: UHC Exchange |
$50.78
|
| Rate for Payer: UMR Bronson Commercial |
$47.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.90
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$397.15
|
|
|
Service Code
|
NDC 65862001901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.95 |
| Max. Negotiated Rate |
$357.44 |
| Rate for Payer: Aetna American Axle |
$258.15
|
| Rate for Payer: Aetna Commercial |
$337.58
|
| Rate for Payer: Aetna Medicare |
$198.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.15
|
| Rate for Payer: BCBS Complete |
$158.86
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Advantage |
$278.00
|
| Rate for Payer: Cofinity Commercial |
$341.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$357.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.86
|
| Rate for Payer: PHP Commercial |
$337.58
|
| Rate for Payer: Priority Health SBD |
$250.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.15
|
| Rate for Payer: UHC Core |
$206.92
|
| Rate for Payer: UHC Exchange |
$156.08
|
| Rate for Payer: UMR Bronson Commercial |
$146.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.86
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 00093314701
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$96.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: BCBS Complete |
$77.14
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Advantage |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.64
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.35
|
| Rate for Payer: UHC Core |
$100.47
|
| Rate for Payer: UHC Exchange |
$75.79
|
| Rate for Payer: UMR Bronson Commercial |
$71.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 50268015211
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna American Axle |
$1.68
|
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.68
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Advantage |
$1.81
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: Priority Health SBD |
$1.63
|
| Rate for Payer: UMR Bronson Commercial |
$1.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$2.34
|
|
|
Service Code
|
NDC 00904733735
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Aetna American Axle |
$1.52
|
| Rate for Payer: Aetna Commercial |
$1.99
|
| Rate for Payer: Aetna Medicare |
$1.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.52
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cofinity Advantage |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$2.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.87
|
| Rate for Payer: Healthscope Commercial |
$2.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.99
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.52
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UMR Bronson Commercial |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$116.85
|
|
|
Service Code
|
NDC 00904733706
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$105.17 |
| Rate for Payer: Aetna American Axle |
$75.95
|
| Rate for Payer: Aetna Commercial |
$99.32
|
| Rate for Payer: Aetna Medicare |
$58.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.95
|
| Rate for Payer: BCBS Complete |
$46.74
|
| Rate for Payer: Cash Price |
$93.48
|
| Rate for Payer: Cofinity Advantage |
$81.80
|
| Rate for Payer: Cofinity Commercial |
$100.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.48
|
| Rate for Payer: Healthscope Commercial |
$105.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.64
|
| Rate for Payer: PHP Commercial |
$99.32
|
| Rate for Payer: Priority Health SBD |
$73.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.95
|
| Rate for Payer: UHC Core |
$60.88
|
| Rate for Payer: UHC Exchange |
$45.92
|
| Rate for Payer: UMR Bronson Commercial |
$43.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.64
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 00093314701
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Advantage |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.64
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UMR Bronson Commercial |
$84.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 67877021901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.86 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Advantage |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UMR Bronson Commercial |
$147.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 67877021901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$168.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Advantage |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.43
|
| Rate for Payer: UHC Core |
$175.08
|
| Rate for Payer: UHC Exchange |
$132.07
|
| Rate for Payer: UMR Bronson Commercial |
$124.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$116.85
|
|
|
Service Code
|
NDC 00904733706
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.41 |
| Max. Negotiated Rate |
$105.17 |
| Rate for Payer: Aetna American Axle |
$75.95
|
| Rate for Payer: Aetna Commercial |
$99.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.95
|
| Rate for Payer: Cash Price |
$93.48
|
| Rate for Payer: Cofinity Advantage |
$81.80
|
| Rate for Payer: Cofinity Commercial |
$100.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.48
|
| Rate for Payer: Healthscope Commercial |
$105.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.64
|
| Rate for Payer: PHP Commercial |
$99.32
|
| Rate for Payer: Priority Health SBD |
$73.62
|
| Rate for Payer: UMR Bronson Commercial |
$51.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.64
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$262.20
|
|
|
Service Code
|
NDC 68180012201
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna American Axle |
$170.43
|
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna Medicare |
$131.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: BCBS Complete |
$104.88
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.43
|
| Rate for Payer: UHC Core |
$136.61
|
| Rate for Payer: UHC Exchange |
$103.04
|
| Rate for Payer: UMR Bronson Commercial |
$97.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.65
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$129.20
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$116.28 |
| Rate for Payer: Aetna American Axle |
$83.98
|
| Rate for Payer: Aetna Commercial |
$109.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.98
|
| Rate for Payer: Cash Price |
$103.36
|
| Rate for Payer: Cofinity Advantage |
$90.44
|
| Rate for Payer: Cofinity Commercial |
$111.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.36
|
| Rate for Payer: Healthscope Commercial |
$116.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.90
|
| Rate for Payer: PHP Commercial |
$109.82
|
| Rate for Payer: Priority Health SBD |
$81.40
|
| Rate for Payer: UMR Bronson Commercial |
$56.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.90
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 50268015211
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna American Axle |
$1.68
|
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna Medicare |
$1.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.68
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Advantage |
$1.81
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: Priority Health SBD |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.68
|
| Rate for Payer: UHC Core |
$1.35
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UMR Bronson Commercial |
$0.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$397.15
|
|
|
Service Code
|
NDC 65862001901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$357.44 |
| Rate for Payer: Aetna American Axle |
$258.15
|
| Rate for Payer: Aetna Commercial |
$337.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.15
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Advantage |
$278.00
|
| Rate for Payer: Cofinity Commercial |
$341.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$357.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.86
|
| Rate for Payer: PHP Commercial |
$337.58
|
| Rate for Payer: Priority Health SBD |
$250.20
|
| Rate for Payer: UMR Bronson Commercial |
$174.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.86
|
|
|
CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 59320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$4,000.61
|
| Rate for Payer: BCN Commercial |
$4,000.61
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
IP
|
$6,158.53
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,709.75 |
| Max. Negotiated Rate |
$5,542.68 |
| Rate for Payer: Aetna American Axle |
$4,003.04
|
| Rate for Payer: Aetna Commercial |
$5,234.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,003.04
|
| Rate for Payer: Cash Price |
$4,926.82
|
| Rate for Payer: Cofinity Advantage |
$4,310.97
|
| Rate for Payer: Cofinity Commercial |
$5,296.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,926.82
|
| Rate for Payer: Healthscope Commercial |
$5,542.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,310.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,618.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,234.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,618.90
|
| Rate for Payer: PHP Commercial |
$5,234.75
|
| Rate for Payer: Priority Health SBD |
$3,879.87
|
| Rate for Payer: UMR Bronson Commercial |
$2,709.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,618.90
|
|
|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
OP
|
$6,158.53
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$5,542.68 |
| Rate for Payer: Aetna American Axle |
$4,003.04
|
| Rate for Payer: Aetna Commercial |
$5,234.75
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,003.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.74
|
| Rate for Payer: BCBS Complete |
$2.08
|
| Rate for Payer: BCBS MAPPO |
$3.79
|
| Rate for Payer: BCBS Trust/PPO |
$12.51
|
| Rate for Payer: BCN Commercial |
$12.51
|
| Rate for Payer: BCN Medicare Advantage |
$3.79
|
| Rate for Payer: Cash Price |
$4,926.82
|
| Rate for Payer: Cash Price |
$4,926.82
|
| Rate for Payer: Cofinity Advantage |
$4,310.97
|
| Rate for Payer: Cofinity Commercial |
$5,296.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,926.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.79
|
| Rate for Payer: Healthscope Commercial |
$5,542.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,310.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,618.90
|
| Rate for Payer: Mclaren Medicaid |
$3.79
|
| Rate for Payer: Mclaren Medicare |
$3.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.98
|
| Rate for Payer: Meridian Medicaid |
$3.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,234.75
|
| Rate for Payer: Nomi Health Commercial |
$11.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,618.90
|
| Rate for Payer: PACE Medicare |
$3.60
|
| Rate for Payer: PACE SWMI |
$3.79
|
| Rate for Payer: PHP Commercial |
$5,234.75
|
| Rate for Payer: PHP Medicare Advantage |
$3.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.34
|
| Rate for Payer: Priority Health Medicare |
$3.79
|
| Rate for Payer: Priority Health SBD |
$3,879.87
|
| Rate for Payer: Priority Health Tiered Network |
$9.87
|
| Rate for Payer: Railroad Medicare Medicare |
$3.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.39
|
| Rate for Payer: UHC Core |
$6.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.79
|
| Rate for Payer: UHC Exchange |
$6.39
|
| Rate for Payer: UHC Medicaid |
$1.98
|
| Rate for Payer: UHCCP Medicaid |
$1.98
|
| Rate for Payer: UMR Bronson Commercial |
$2,278.66
|
| Rate for Payer: VA VA |
$3.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,618.90
|
|
|
CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DISSECTION)
|
Facility
|
OP
|
$9,625.70
|
|
|
Service Code
|
CPT 38724
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,625.70 |
| Max. Negotiated Rate |
$9,625.70 |
| Rate for Payer: BCBS Trust/PPO |
$9,625.70
|
| Rate for Payer: BCN Commercial |
$9,625.70
|
|
