|
CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,044.23
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
29568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna American Axle |
$678.75
|
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: Aetna Medicare |
$522.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.75
|
| Rate for Payer: BCBS Complete |
$417.69
|
| Rate for Payer: BCBS Trust/PPO |
$17.02
|
| Rate for Payer: BCN Commercial |
$17.02
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Commercial |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$730.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$730.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.75
|
| Rate for Payer: Priority Health SBD |
$657.86
|
| Rate for Payer: UMR Bronson Commercial |
$386.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.17
|
|
|
CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,044.23
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
29568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$459.46 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna American Axle |
$678.75
|
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.75
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Commercial |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$730.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$730.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.75
|
| Rate for Payer: Priority Health SBD |
$657.86
|
| Rate for Payer: UMR Bronson Commercial |
$459.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.17
|
|
|
CASTOR OIL
|
Facility
|
IP
|
$12.66
|
|
|
Service Code
|
NDC 00395051592
|
| Hospital Charge Code |
15209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$11.39 |
| Rate for Payer: Aetna American Axle |
$8.23
|
| Rate for Payer: Aetna Commercial |
$10.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.23
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cofinity Commercial |
$10.89
|
| Rate for Payer: Cofinity Commercial |
$8.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.13
|
| Rate for Payer: Healthscope Commercial |
$11.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.76
|
| Rate for Payer: PHP Commercial |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.23
|
| Rate for Payer: Priority Health SBD |
$7.98
|
| Rate for Payer: UMR Bronson Commercial |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.50
|
|
|
CASTOR OIL
|
Facility
|
OP
|
$12.66
|
|
|
Service Code
|
NDC 00395051592
|
| Hospital Charge Code |
15209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$11.39 |
| Rate for Payer: Aetna American Axle |
$8.23
|
| Rate for Payer: Aetna Commercial |
$10.76
|
| Rate for Payer: Aetna Medicare |
$6.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.23
|
| Rate for Payer: BCBS Complete |
$5.06
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cofinity Commercial |
$10.89
|
| Rate for Payer: Cofinity Commercial |
$8.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.13
|
| Rate for Payer: Healthscope Commercial |
$11.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.76
|
| Rate for Payer: PHP Commercial |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.23
|
| Rate for Payer: Priority Health SBD |
$7.98
|
| Rate for Payer: UMR Bronson Commercial |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.50
|
|
|
CASTOR OIL
|
Facility
|
OP
|
$8.30
|
|
|
Service Code
|
NDC 09629513775
|
| Hospital Charge Code |
15209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Aetna American Axle |
$5.40
|
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Aetna Medicare |
$4.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.40
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cofinity Commercial |
$5.81
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.64
|
| Rate for Payer: Healthscope Commercial |
$7.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.06
|
| Rate for Payer: PHP Commercial |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.40
|
| Rate for Payer: Priority Health SBD |
$5.23
|
| Rate for Payer: UMR Bronson Commercial |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.22
|
|
|
CASTOR OIL
|
Facility
|
IP
|
$8.30
|
|
|
Service Code
|
NDC 09629513775
|
| Hospital Charge Code |
15209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Aetna American Axle |
$5.40
|
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.40
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cofinity Commercial |
$5.81
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.64
|
| Rate for Payer: Healthscope Commercial |
$7.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.06
|
| Rate for Payer: PHP Commercial |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.40
|
| Rate for Payer: Priority Health SBD |
$5.23
|
| Rate for Payer: UMR Bronson Commercial |
$3.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.22
|
|
|
CATHETER, BALLOON DILATATION, NON-VASCULAR
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
CPT C1726
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
|
|
CATHETERIZATION AND INTRODUCTION OF SALINE OR CONTRAST MATERIAL FOR SALINE INFUSION SONOHYSTEROGRAPHY (SIS) OR HYSTEROSALPINGOGRAPHY
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 58340
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$354.90
|
| Rate for Payer: BCN Commercial |
$354.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.91
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$55.37
|
|
|
CEFAZOLIN 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$301.75
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
31086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$271.58 |
| Rate for Payer: Aetna American Axle |
$196.14
|
| Rate for Payer: Aetna Commercial |
$256.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.14
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cofinity Commercial |
$211.22
|
| Rate for Payer: Cofinity Commercial |
$259.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.40
|
| Rate for Payer: Healthscope Commercial |
$271.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.49
|
| Rate for Payer: PHP Commercial |
$256.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.14
|
| Rate for Payer: Priority Health SBD |
$190.10
|
| Rate for Payer: UMR Bronson Commercial |
$132.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.31
|
|
|
CEFAZOLIN 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$301.75
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
31086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$271.58 |
| Rate for Payer: Aetna American Axle |
$196.14
|
| Rate for Payer: Aetna Commercial |
$256.49
|
| Rate for Payer: Aetna Medicare |
$150.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.14
|
| Rate for Payer: BCBS Complete |
$120.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cofinity Commercial |
$211.22
|
| Rate for Payer: Cofinity Commercial |
$259.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.40
|
| Rate for Payer: Healthscope Commercial |
$271.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.49
|
| Rate for Payer: PHP Commercial |
$256.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.14
|
| Rate for Payer: Priority Health SBD |
$190.10
|
| Rate for Payer: UMR Bronson Commercial |
$111.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.31
|
|
|
CEFAZOLIN 100 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
OP
|
$191.84
|
|
|
Service Code
|
NDC 09900000151
|
| Hospital Charge Code |
500642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Aetna American Axle |
$124.70
|
| Rate for Payer: Aetna Commercial |
$163.06
|
| Rate for Payer: Aetna Medicare |
$95.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.70
|
| Rate for Payer: BCBS Complete |
$76.74
|
| Rate for Payer: Cash Price |
$153.47
|
| Rate for Payer: Cofinity Commercial |
$134.29
|
| Rate for Payer: Cofinity Commercial |
$164.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.47
|
| Rate for Payer: Healthscope Commercial |
$172.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.06
|
| Rate for Payer: PHP Commercial |
$163.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.70
|
| Rate for Payer: Priority Health SBD |
$120.86
|
| Rate for Payer: UMR Bronson Commercial |
$70.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.88
|
|
|
CEFAZOLIN 100 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
IP
|
$191.84
|
|
|
Service Code
|
NDC 09900000151
|
| Hospital Charge Code |
500642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Aetna American Axle |
$124.70
|
| Rate for Payer: Aetna Commercial |
$163.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.70
|
| Rate for Payer: Cash Price |
$153.47
|
| Rate for Payer: Cofinity Commercial |
$134.29
|
| Rate for Payer: Cofinity Commercial |
$164.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.47
|
| Rate for Payer: Healthscope Commercial |
$172.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.06
|
| Rate for Payer: PHP Commercial |
$163.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.70
|
| Rate for Payer: Priority Health SBD |
$120.86
|
| Rate for Payer: UMR Bronson Commercial |
$84.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.88
|
|
|
CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$49.67
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$44.70 |
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna American Axle |
$22.47
|
| Rate for Payer: Aetna American Axle |
$18.90
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Commercial |
$24.71
|
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Medicare |
$17.28
|
| Rate for Payer: Aetna Medicare |
$14.54
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.47
|
| Rate for Payer: BCBS Complete |
$13.83
|
| Rate for Payer: BCBS Complete |
$19.87
|
| Rate for Payer: BCBS Complete |
$11.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$23.26
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cash Price |
$23.26
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Cofinity Commercial |
$20.35
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Cofinity Commercial |
$34.77
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$24.71
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.29
|
| Rate for Payer: Priority Health SBD |
$21.78
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: UMR Bronson Commercial |
$18.38
|
| Rate for Payer: UMR Bronson Commercial |
$10.76
|
| Rate for Payer: UMR Bronson Commercial |
$12.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
|
|
CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$29.07
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$26.16 |
| Rate for Payer: Aetna American Axle |
$18.90
|
| Rate for Payer: Aetna American Axle |
$22.47
|
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Commercial |
$24.71
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.47
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cash Price |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$34.77
|
| Rate for Payer: Cofinity Commercial |
$20.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: PHP Commercial |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$21.78
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: UMR Bronson Commercial |
$12.79
|
| Rate for Payer: UMR Bronson Commercial |
$21.85
|
| Rate for Payer: UMR Bronson Commercial |
$15.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.93
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna American Axle |
$14.38
|
| Rate for Payer: Aetna American Axle |
$12.62
|
| Rate for Payer: Aetna American Axle |
$9.02
|
| Rate for Payer: Aetna American Axle |
$15.17
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna Commercial |
$18.80
|
| Rate for Payer: Aetna Medicare |
$9.70
|
| Rate for Payer: Aetna Medicare |
$11.06
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Aetna Medicare |
$6.94
|
| Rate for Payer: Aetna Medicare |
$11.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.62
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Complete |
$5.55
|
| Rate for Payer: BCBS Complete |
$8.85
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS Complete |
$7.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$19.02
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Cofinity Commercial |
$9.76
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.70
|
| Rate for Payer: Healthscope Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$21.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.80
|
| Rate for Payer: PHP Commercial |
$19.84
|
| Rate for Payer: PHP Commercial |
$18.80
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$11.80
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$14.70
|
| Rate for Payer: Priority Health SBD |
$13.94
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Priority Health SBD |
$12.23
|
| Rate for Payer: UMR Bronson Commercial |
$5.14
|
| Rate for Payer: UMR Bronson Commercial |
$7.18
|
| Rate for Payer: UMR Bronson Commercial |
$5.16
|
| Rate for Payer: UMR Bronson Commercial |
$8.18
|
| Rate for Payer: UMR Bronson Commercial |
$8.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.41
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$22.12
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$19.91 |
| Rate for Payer: Aetna American Axle |
$14.38
|
| Rate for Payer: Aetna American Axle |
$9.02
|
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna American Axle |
$15.17
|
| Rate for Payer: Aetna American Axle |
$12.62
|
| Rate for Payer: Aetna Commercial |
$18.80
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$19.02
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$9.76
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$12.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.80
|
| Rate for Payer: PHP Commercial |
$11.80
|
| Rate for Payer: PHP Commercial |
$19.84
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$18.80
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health SBD |
$14.70
|
| Rate for Payer: Priority Health SBD |
$12.23
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Priority Health SBD |
$13.94
|
| Rate for Payer: UMR Bronson Commercial |
$6.11
|
| Rate for Payer: UMR Bronson Commercial |
$6.14
|
| Rate for Payer: UMR Bronson Commercial |
$9.73
|
| Rate for Payer: UMR Bronson Commercial |
$10.27
|
| Rate for Payer: UMR Bronson Commercial |
$8.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.59
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$9.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: UMR Bronson Commercial |
$5.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$9.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: UMR Bronson Commercial |
$6.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
|
|
CEFAZOLIN 300 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$798.75
|
|
|
Service Code
|
NDC 66288130001
|
| Hospital Charge Code |
31087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$351.45 |
| Max. Negotiated Rate |
$718.88 |
| Rate for Payer: Aetna American Axle |
$519.19
|
| Rate for Payer: Aetna Commercial |
$678.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.19
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cofinity Commercial |
$559.12
|
| Rate for Payer: Cofinity Commercial |
$686.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$559.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.00
|
| Rate for Payer: Healthscope Commercial |
$718.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$559.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$678.94
|
| Rate for Payer: PHP Commercial |
$678.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.19
|
| Rate for Payer: Priority Health SBD |
$503.21
|
| Rate for Payer: UMR Bronson Commercial |
$351.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$599.06
|
|
|
CEFAZOLIN 300 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$798.75
|
|
|
Service Code
|
NDC 66288130001
|
| Hospital Charge Code |
31087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$295.54 |
| Max. Negotiated Rate |
$718.88 |
| Rate for Payer: Aetna American Axle |
$519.19
|
| Rate for Payer: Aetna Commercial |
$678.94
|
| Rate for Payer: Aetna Medicare |
$399.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.19
|
| Rate for Payer: BCBS Complete |
$319.50
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cofinity Commercial |
$559.12
|
| Rate for Payer: Cofinity Commercial |
$686.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$559.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.00
|
| Rate for Payer: Healthscope Commercial |
$718.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$559.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$678.94
|
| Rate for Payer: PHP Commercial |
$678.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.19
|
| Rate for Payer: Priority Health SBD |
$503.21
|
| Rate for Payer: UMR Bronson Commercial |
$295.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$599.06
|
|
|
CEFAZOLIN 3 GM IVPB 50 ML (IV PREMIX)
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Medicare |
$31.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: UMR Bronson Commercial |
$23.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
CEFAZOLIN 3 GM IVPB 50 ML (IV PREMIX)
|
Facility
|
IP
|
$63.80
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: UMR Bronson Commercial |
$28.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
CEFAZOLIN 50 MG/0.5 ML IN NS FOR DISCOGRAM
|
Facility
|
OP
|
$7.81
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna American Axle |
$5.08
|
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: BCBS Complete |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.08
|
| Rate for Payer: Priority Health SBD |
$4.92
|
| Rate for Payer: UMR Bronson Commercial |
$2.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.86
|
|
|
CEFAZOLIN 50 MG/0.5 ML IN NS FOR DISCOGRAM
|
Facility
|
IP
|
$7.81
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna American Axle |
$5.08
|
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.08
|
| Rate for Payer: Priority Health SBD |
$4.92
|
| Rate for Payer: UMR Bronson Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.86
|
|
|
CEFAZOLIN 50 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
OP
|
$191.84
|
|
|
Service Code
|
NDC 09900000150
|
| Hospital Charge Code |
500641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Aetna American Axle |
$124.70
|
| Rate for Payer: Aetna Commercial |
$163.06
|
| Rate for Payer: Aetna Medicare |
$95.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.70
|
| Rate for Payer: BCBS Complete |
$76.74
|
| Rate for Payer: Cash Price |
$153.47
|
| Rate for Payer: Cofinity Commercial |
$134.29
|
| Rate for Payer: Cofinity Commercial |
$164.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.47
|
| Rate for Payer: Healthscope Commercial |
$172.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.06
|
| Rate for Payer: PHP Commercial |
$163.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.70
|
| Rate for Payer: Priority Health SBD |
$120.86
|
| Rate for Payer: UMR Bronson Commercial |
$70.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.88
|
|
