|
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
|
|
|
CEFAZOLIN IV SYRINGE
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
400102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna American Axle |
$15.49
|
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.26
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.96
|
| Rate for Payer: Priority Health SBD |
$15.01
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UMR Bronson Commercial |
$10.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.26
|
|
|
CEFAZOLIN IV SYRINGE
|
Facility
|
OP
|
$23.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
400102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna American Axle |
$15.49
|
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna Medicare |
$11.92
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS Complete |
$9.53
|
| 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: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.96
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: Priority Health SBD |
$15.01
|
| Rate for Payer: UMR Bronson Commercial |
$8.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.87
|
|
|
CEFAZOLIN IV SYRINGE 1 G PMX
|
Facility
|
IP
|
$3.02
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.96
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.26
|
|
|
CEFAZOLIN IV SYRINGE 1 G PMX
|
Facility
|
OP
|
$3.02
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.96
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.26
|
|
|
CEFAZOLIN IV SYRINGE 2 G PMX
|
Facility
|
OP
|
$6.04
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna American Axle |
$3.93
|
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: Aetna Medicare |
$3.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.93
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.83
|
| Rate for Payer: Healthscope Commercial |
$5.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.13
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: Priority Health SBD |
$3.81
|
| Rate for Payer: UMR Bronson Commercial |
$2.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.53
|
|
|
CEFAZOLIN IV SYRINGE 2 G PMX
|
Facility
|
IP
|
$6.04
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna American Axle |
$3.93
|
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.93
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.83
|
| Rate for Payer: Healthscope Commercial |
$5.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.13
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: Priority Health SBD |
$3.81
|
| Rate for Payer: UMR Bronson Commercial |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.53
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$169.06
|
|
|
Service Code
|
NDC 00093413664
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna American Axle |
$109.89
|
| Rate for Payer: Aetna Commercial |
$143.70
|
| Rate for Payer: Aetna Medicare |
$84.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.89
|
| Rate for Payer: BCBS Complete |
$67.62
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Cofinity Commercial |
$118.34
|
| Rate for Payer: Cofinity Commercial |
$145.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.25
|
| Rate for Payer: Healthscope Commercial |
$152.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.70
|
| Rate for Payer: PHP Commercial |
$143.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.89
|
| Rate for Payer: Priority Health SBD |
$106.51
|
| Rate for Payer: UMR Bronson Commercial |
$62.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.80
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$169.06
|
|
|
Service Code
|
NDC 00093413664
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna American Axle |
$109.89
|
| Rate for Payer: Aetna Commercial |
$143.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.89
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Cofinity Commercial |
$118.34
|
| Rate for Payer: Cofinity Commercial |
$145.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.25
|
| Rate for Payer: Healthscope Commercial |
$152.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.70
|
| Rate for Payer: PHP Commercial |
$143.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.89
|
| Rate for Payer: Priority Health SBD |
$106.51
|
| Rate for Payer: UMR Bronson Commercial |
$74.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.80
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$192.10
|
|
|
Service Code
|
NDC 68180071160
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.52 |
| Max. Negotiated Rate |
$172.89 |
| Rate for Payer: Aetna American Axle |
$124.86
|
| Rate for Payer: Aetna Commercial |
$163.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.86
|
| Rate for Payer: Cash Price |
$153.68
|
| Rate for Payer: Cofinity Commercial |
$134.47
|
| Rate for Payer: Cofinity Commercial |
$165.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.68
|
| Rate for Payer: Healthscope Commercial |
$172.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.28
|
| Rate for Payer: PHP Commercial |
$163.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.86
|
| Rate for Payer: Priority Health SBD |
$121.02
|
| Rate for Payer: UMR Bronson Commercial |
$84.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.08
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$163.01
|
|
|
Service Code
|
NDC 65862017760
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$146.71 |
| Rate for Payer: Aetna American Axle |
$105.96
|
| Rate for Payer: Aetna Commercial |
$138.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.96
|
| Rate for Payer: Cash Price |
$130.41
|
| Rate for Payer: Cofinity Commercial |
$114.11
|
| Rate for Payer: Cofinity Commercial |
$140.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.41
|
| Rate for Payer: Healthscope Commercial |
$146.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.56
|
| Rate for Payer: PHP Commercial |
$138.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.96
|
| Rate for Payer: Priority Health SBD |
$102.70
|
| Rate for Payer: UMR Bronson Commercial |
$71.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.26
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
OP
|
$192.10
|
|
|
Service Code
|
NDC 68180071160
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.08 |
| Max. Negotiated Rate |
$172.89 |
| Rate for Payer: Aetna American Axle |
$124.86
|
| Rate for Payer: Aetna Commercial |
$163.28
|
| Rate for Payer: Aetna Medicare |
$96.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.86
|
| Rate for Payer: BCBS Complete |
$76.84
|
| Rate for Payer: Cash Price |
$153.68
|
| Rate for Payer: Cofinity Commercial |
$134.47
|
| Rate for Payer: Cofinity Commercial |
$165.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.68
|
| Rate for Payer: Healthscope Commercial |
$172.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.28
|
| Rate for Payer: PHP Commercial |
$163.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.86
|
| Rate for Payer: Priority Health SBD |
$121.02
|
| Rate for Payer: UMR Bronson Commercial |
$71.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.08
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$223.20
|
|
|
Service Code
|
NDC 57237009960
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.21 |
| Max. Negotiated Rate |
$200.88 |
| Rate for Payer: Cofinity Medicare Advantage |
$156.24
|
| Rate for Payer: Aetna American Axle |
$145.08
|
| Rate for Payer: Aetna Commercial |
$189.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.08
|
| Rate for Payer: Cash Price |
$178.56
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$191.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.56
|
| Rate for Payer: Healthscope Commercial |
$200.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.72
|
| Rate for Payer: PHP Commercial |
$189.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.08
|
| Rate for Payer: Priority Health SBD |
$140.62
|
| Rate for Payer: UMR Bronson Commercial |
$98.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.40
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
OP
|
$163.01
|
|
|
Service Code
|
NDC 65862017760
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.31 |
| Max. Negotiated Rate |
$146.71 |
| Rate for Payer: Aetna American Axle |
$105.96
|
| Rate for Payer: Aetna Commercial |
$138.56
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.96
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: Cash Price |
$130.41
|
| Rate for Payer: Cofinity Commercial |
$114.11
|
| Rate for Payer: Cofinity Commercial |
$140.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.41
|
| Rate for Payer: Healthscope Commercial |
$146.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.56
|
| Rate for Payer: PHP Commercial |
$138.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.96
|
| Rate for Payer: Priority Health SBD |
$102.70
|
| Rate for Payer: UMR Bronson Commercial |
$60.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.26
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
OP
|
$223.20
|
|
|
Service Code
|
NDC 57237009960
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.58 |
| Max. Negotiated Rate |
$200.88 |
| Rate for Payer: Aetna American Axle |
$145.08
|
| Rate for Payer: Aetna Commercial |
$189.72
|
| Rate for Payer: Aetna Medicare |
$111.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.08
|
| Rate for Payer: BCBS Complete |
$89.28
|
| Rate for Payer: Cash Price |
$178.56
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$191.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.56
|
| Rate for Payer: Healthscope Commercial |
$200.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.72
|
| Rate for Payer: PHP Commercial |
$189.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.08
|
| Rate for Payer: Priority Health SBD |
$140.62
|
| Rate for Payer: UMR Bronson Commercial |
$82.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.40
|
|
|
CEFEPIME 100 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
188964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna American Axle |
$832.00
|
| Rate for Payer: Aetna American Axle |
$26.00
|
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna Commercial |
$1,088.00
|
| Rate for Payer: Aetna Medicare |
$640.00
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$832.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Complete |
$512.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$1,100.80
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$896.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$896.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,024.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$1,152.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$896.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$960.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,088.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.00
|
| Rate for Payer: PHP Commercial |
$1,088.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health SBD |
$25.20
|
| Rate for Payer: Priority Health SBD |
$806.40
|
| Rate for Payer: UMR Bronson Commercial |
$473.60
|
| Rate for Payer: UMR Bronson Commercial |
$14.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$960.00
|
|
|
CEFEPIME 100 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
188964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$563.20 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna American Axle |
$832.00
|
| Rate for Payer: Aetna American Axle |
$26.00
|
| Rate for Payer: Aetna Commercial |
$1,088.00
|
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$832.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$1,100.80
|
| Rate for Payer: Cofinity Commercial |
$896.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$896.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,024.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$1,152.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$896.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$960.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,088.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: PHP Commercial |
$1,088.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health SBD |
$806.40
|
| Rate for Payer: Priority Health SBD |
$25.20
|
| Rate for Payer: UMR Bronson Commercial |
$563.20
|
| Rate for Payer: UMR Bronson Commercial |
$17.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$960.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
CEFEPIME 1 GRAM CUSTOM SOLUTION FOR DESENSITIZATION
|
Facility
|
IP
|
$29.64
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna American Axle |
$19.27
|
| Rate for Payer: Aetna Commercial |
$25.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.27
|
| Rate for Payer: Cash Price |
$23.71
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.71
|
| Rate for Payer: Healthscope Commercial |
$26.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.19
|
| Rate for Payer: PHP Commercial |
$25.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.27
|
| Rate for Payer: Priority Health SBD |
$18.67
|
| Rate for Payer: UMR Bronson Commercial |
$13.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.23
|
|
|
CEFEPIME 1 GRAM CUSTOM SOLUTION FOR DESENSITIZATION
|
Facility
|
OP
|
$29.64
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna American Axle |
$19.27
|
| Rate for Payer: Aetna Commercial |
$25.19
|
| Rate for Payer: Aetna Medicare |
$14.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.27
|
| Rate for Payer: BCBS Complete |
$11.86
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$23.71
|
| Rate for Payer: Cash Price |
$23.71
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.71
|
| Rate for Payer: Healthscope Commercial |
$26.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.19
|
| Rate for Payer: PHP Commercial |
$25.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.27
|
| Rate for Payer: Priority Health SBD |
$18.67
|
| Rate for Payer: UMR Bronson Commercial |
$10.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.23
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR IM INJECTION CUSTOM
|
Facility
|
IP
|
$19.96
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
300392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: UMR Bronson Commercial |
$8.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR IM INJECTION CUSTOM
|
Facility
|
OP
|
$19.96
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
300392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: UMR Bronson Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$21.07
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$18.96 |
| Rate for Payer: Aetna American Axle |
$13.70
|
| Rate for Payer: Aetna American Axle |
$11.06
|
| Rate for Payer: Aetna American Axle |
$11.05
|
| Rate for Payer: Aetna American Axle |
$11.75
|
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna American Axle |
$13.20
|
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Aetna Commercial |
$17.26
|
| Rate for Payer: Aetna Commercial |
$14.47
|
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Commercial |
$17.91
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Medicare |
$10.54
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: Aetna Medicare |
$8.51
|
| Rate for Payer: Aetna Medicare |
$10.16
|
| Rate for Payer: Aetna Medicare |
$9.04
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.20
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS Complete |
$6.81
|
| Rate for Payer: BCBS Complete |
$8.43
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$12.66
|
| Rate for Payer: Cofinity Commercial |
$14.75
|
| Rate for Payer: Cofinity Commercial |
$11.91
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$17.47
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.86
|
| Rate for Payer: Healthscope Commercial |
$18.28
|
| Rate for Payer: Healthscope Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$16.27
|
| Rate for Payer: Healthscope Commercial |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$14.47
|
| Rate for Payer: PHP Commercial |
$14.45
|
| Rate for Payer: PHP Commercial |
$17.26
|
| Rate for Payer: PHP Commercial |
$17.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.06
|
| Rate for Payer: Priority Health SBD |
$12.80
|
| Rate for Payer: Priority Health SBD |
$10.72
|
| Rate for Payer: Priority Health SBD |
$11.39
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: Priority Health SBD |
$10.71
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: UMR Bronson Commercial |
$7.51
|
| Rate for Payer: UMR Bronson Commercial |
$7.80
|
| Rate for Payer: UMR Bronson Commercial |
$6.69
|
| Rate for Payer: UMR Bronson Commercial |
$6.29
|
| Rate for Payer: UMR Bronson Commercial |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$20.31
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$18.28 |
| Rate for Payer: Aetna American Axle |
$13.20
|
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna American Axle |
$11.75
|
| Rate for Payer: Aetna American Axle |
$13.70
|
| Rate for Payer: Aetna Commercial |
$17.26
|
| Rate for Payer: Aetna Commercial |
$17.91
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.20
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$12.66
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$14.75
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Commercial |
$17.47
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$18.28
|
| Rate for Payer: Healthscope Commercial |
$16.27
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$18.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.26
|
| Rate for Payer: PHP Commercial |
$17.26
|
| Rate for Payer: PHP Commercial |
$17.91
|
| Rate for Payer: PHP Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: Priority Health SBD |
$11.39
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: Priority Health SBD |
$12.80
|
| Rate for Payer: UMR Bronson Commercial |
$8.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.27
|
| Rate for Payer: UMR Bronson Commercial |
$8.78
|
| Rate for Payer: UMR Bronson Commercial |
$7.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.23
|
|
|
CEFEPIME 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$19.96
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: UMR Bronson Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
|
|
CEFEPIME 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$19.96
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: UMR Bronson Commercial |
$8.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
|
