|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$119.86
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.74 |
| Max. Negotiated Rate |
$107.87 |
| Rate for Payer: Aetna American Axle |
$77.91
|
| Rate for Payer: Aetna Commercial |
$101.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.91
|
| Rate for Payer: Cash Price |
$95.89
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Cofinity Commercial |
$83.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.89
|
| Rate for Payer: Healthscope Commercial |
$107.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.88
|
| Rate for Payer: PHP Commercial |
$101.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.91
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$52.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$23.75
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
301721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$21.38 |
| Rate for Payer: Aetna American Axle |
$15.44
|
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.44
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: UMR Bronson Commercial |
$10.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$23.75
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
301721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$21.38 |
| Rate for Payer: Aetna American Axle |
$15.44
|
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna Medicare |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.44
|
| Rate for Payer: BCBS Complete |
$9.50
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.89
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna American Axle |
$18.78
|
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna American Axle |
$12.53
|
| Rate for Payer: Aetna American Axle |
$19.06
|
| Rate for Payer: Aetna American Axle |
$15.44
|
| Rate for Payer: Aetna Commercial |
$24.56
|
| Rate for Payer: Aetna Commercial |
$16.38
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.53
|
| Rate for Payer: Cash Price |
$23.11
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$24.85
|
| Rate for Payer: Cofinity Commercial |
$20.22
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Healthscope Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$26.40
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$24.93
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: PHP Commercial |
$24.56
|
| Rate for Payer: PHP Commercial |
$16.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health SBD |
$18.48
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: Priority Health SBD |
$12.14
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$18.20
|
| Rate for Payer: UMR Bronson Commercial |
$7.57
|
| Rate for Payer: UMR Bronson Commercial |
$8.48
|
| Rate for Payer: UMR Bronson Commercial |
$12.71
|
| Rate for Payer: UMR Bronson Commercial |
$12.91
|
| Rate for Payer: UMR Bronson Commercial |
$10.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.67
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.27
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Aetna American Axle |
$12.53
|
| Rate for Payer: Aetna American Axle |
$18.78
|
| Rate for Payer: Aetna American Axle |
$19.06
|
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna American Axle |
$15.44
|
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna Commercial |
$24.56
|
| Rate for Payer: Aetna Commercial |
$16.38
|
| Rate for Payer: Aetna Medicare |
$14.45
|
| Rate for Payer: Aetna Medicare |
$9.63
|
| Rate for Payer: Aetna Medicare |
$14.66
|
| Rate for Payer: Aetna Medicare |
$11.88
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.78
|
| Rate for Payer: BCBS Complete |
$11.73
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$11.56
|
| Rate for Payer: BCBS Complete |
$9.50
|
| Rate for Payer: BCBS Complete |
$7.71
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$23.11
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$24.85
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$20.22
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$26.40
|
| Rate for Payer: Healthscope Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$17.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: PHP Commercial |
$24.56
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$16.38
|
| Rate for Payer: PHP Commercial |
$24.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.53
|
| Rate for Payer: Priority Health SBD |
$12.14
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: Priority Health SBD |
$18.20
|
| Rate for Payer: Priority Health SBD |
$18.48
|
| Rate for Payer: UMR Bronson Commercial |
$10.85
|
| Rate for Payer: UMR Bronson Commercial |
$10.69
|
| Rate for Payer: UMR Bronson Commercial |
$7.13
|
| Rate for Payer: UMR Bronson Commercial |
$6.37
|
| Rate for Payer: UMR Bronson Commercial |
$8.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$29.39
|
|
|
Service Code
|
NDC 44567024625
|
| Hospital Charge Code |
301722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna American Axle |
$19.10
|
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UMR Bronson Commercial |
$12.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.04
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
NDC 44567024625
|
| Hospital Charge Code |
301722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna American Axle |
$19.10
|
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna Medicare |
$14.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UMR Bronson Commercial |
$10.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.04
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.74
|
|
|
Service Code
|
NDC 63323034225
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$51.97 |
| Rate for Payer: Aetna American Axle |
$37.53
|
| Rate for Payer: Aetna Commercial |
$49.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.53
|
| Rate for Payer: Cash Price |
$46.19
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Commercial |
$49.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.19
|
| Rate for Payer: Healthscope Commercial |
$51.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.08
|
| Rate for Payer: PHP Commercial |
$49.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.53
|
| Rate for Payer: Priority Health SBD |
$36.38
|
| Rate for Payer: UMR Bronson Commercial |
$25.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.30
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.18
|
|
|
Service Code
|
NDC 00143987701
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$20.86 |
| Rate for Payer: Aetna American Axle |
$15.07
|
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Aetna Medicare |
$11.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.07
|
| Rate for Payer: BCBS Complete |
$9.27
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Cofinity Commercial |
$19.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.54
|
| Rate for Payer: Healthscope Commercial |
$20.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.70
|
| Rate for Payer: PHP Commercial |
$19.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.07
|
| Rate for Payer: Priority Health SBD |
$14.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.39
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$41.83
|
|
|
Service Code
|
NDC 09900001044
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Aetna American Axle |
$27.19
|
| Rate for Payer: Aetna Commercial |
$35.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.19
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$29.28
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$37.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.56
|
| Rate for Payer: PHP Commercial |
$35.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.19
|
| Rate for Payer: Priority Health SBD |
$26.35
|
| Rate for Payer: UMR Bronson Commercial |
$18.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.37
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$41.83
|
|
|
Service Code
|
NDC 09900001044
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Aetna American Axle |
$27.19
|
| Rate for Payer: Aetna Commercial |
$35.56
|
| Rate for Payer: Aetna Medicare |
$20.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.19
|
| Rate for Payer: BCBS Complete |
$16.73
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$29.28
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$37.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.56
|
| Rate for Payer: PHP Commercial |
$35.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.19
|
| Rate for Payer: Priority Health SBD |
$26.35
|
| Rate for Payer: UMR Bronson Commercial |
$15.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.37
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.18
|
|
|
Service Code
|
NDC 00143987701
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$20.86 |
| Rate for Payer: Aetna American Axle |
$15.07
|
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.07
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Cofinity Commercial |
$19.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.54
|
| Rate for Payer: Healthscope Commercial |
$20.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.70
|
| Rate for Payer: PHP Commercial |
$19.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.07
|
| Rate for Payer: Priority Health SBD |
$14.60
|
| Rate for Payer: UMR Bronson Commercial |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.39
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.18
|
|
|
Service Code
|
NDC 00143987725
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$20.86 |
| Rate for Payer: Aetna American Axle |
$15.07
|
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.07
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Cofinity Commercial |
$19.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.54
|
| Rate for Payer: Healthscope Commercial |
$20.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.70
|
| Rate for Payer: PHP Commercial |
$19.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.07
|
| Rate for Payer: Priority Health SBD |
$14.60
|
| Rate for Payer: UMR Bronson Commercial |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.39
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.39
|
|
|
Service Code
|
NDC 44567024625
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna American Axle |
$19.10
|
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UMR Bronson Commercial |
$12.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.04
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
NDC 25021011020
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna American Axle |
$19.10
|
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna Medicare |
$14.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UMR Bronson Commercial |
$10.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.04
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.39
|
|
|
Service Code
|
NDC 25021011020
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna American Axle |
$19.10
|
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UMR Bronson Commercial |
$12.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.04
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.18
|
|
|
Service Code
|
NDC 00143987725
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$20.86 |
| Rate for Payer: Aetna American Axle |
$15.07
|
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Aetna Medicare |
$11.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.07
|
| Rate for Payer: BCBS Complete |
$9.27
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Cofinity Commercial |
$19.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.54
|
| Rate for Payer: Healthscope Commercial |
$20.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.70
|
| Rate for Payer: PHP Commercial |
$19.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.07
|
| Rate for Payer: Priority Health SBD |
$14.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.39
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
NDC 44567024625
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna American Axle |
$19.10
|
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna Medicare |
$14.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UMR Bronson Commercial |
$10.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.04
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.74
|
|
|
Service Code
|
NDC 63323034225
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$51.97 |
| Rate for Payer: Aetna American Axle |
$37.53
|
| Rate for Payer: Aetna Commercial |
$49.08
|
| Rate for Payer: Aetna Medicare |
$28.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.53
|
| Rate for Payer: BCBS Complete |
$23.10
|
| Rate for Payer: Cash Price |
$46.19
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Commercial |
$49.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.19
|
| Rate for Payer: Healthscope Commercial |
$51.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.08
|
| Rate for Payer: PHP Commercial |
$49.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.53
|
| Rate for Payer: Priority Health SBD |
$36.38
|
| Rate for Payer: UMR Bronson Commercial |
$21.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.30
|
|
|
CEFPODOXIME 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$524.64
|
|
|
Service Code
|
NDC 64980040310
|
| Hospital Charge Code |
9466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.84 |
| Max. Negotiated Rate |
$472.18 |
| Rate for Payer: Aetna American Axle |
$341.02
|
| Rate for Payer: Aetna Commercial |
$445.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.02
|
| Rate for Payer: Cash Price |
$419.71
|
| Rate for Payer: Cofinity Commercial |
$367.25
|
| Rate for Payer: Cofinity Commercial |
$451.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$367.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.71
|
| Rate for Payer: Healthscope Commercial |
$472.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.94
|
| Rate for Payer: PHP Commercial |
$445.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.02
|
| Rate for Payer: Priority Health SBD |
$330.52
|
| Rate for Payer: UMR Bronson Commercial |
$230.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.48
|
|
|
CEFPODOXIME 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$524.64
|
|
|
Service Code
|
NDC 64980040310
|
| Hospital Charge Code |
9466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.12 |
| Max. Negotiated Rate |
$472.18 |
| Rate for Payer: Aetna American Axle |
$341.02
|
| Rate for Payer: Aetna Commercial |
$445.94
|
| Rate for Payer: Aetna Medicare |
$262.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.02
|
| Rate for Payer: BCBS Complete |
$209.86
|
| Rate for Payer: Cash Price |
$419.71
|
| Rate for Payer: Cofinity Commercial |
$367.25
|
| Rate for Payer: Cofinity Commercial |
$451.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$367.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.71
|
| Rate for Payer: Healthscope Commercial |
$472.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.94
|
| Rate for Payer: PHP Commercial |
$445.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.02
|
| Rate for Payer: Priority Health SBD |
$330.52
|
| Rate for Payer: UMR Bronson Commercial |
$194.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.48
|
|
|
CEFPODOXIME 200 MG TABLET
|
Facility
|
IP
|
$374.37
|
|
|
Service Code
|
NDC 00781543920
|
| Hospital Charge Code |
9469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.72 |
| Max. Negotiated Rate |
$336.93 |
| Rate for Payer: Aetna American Axle |
$243.34
|
| Rate for Payer: Aetna Commercial |
$318.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.34
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cofinity Commercial |
$262.06
|
| Rate for Payer: Cofinity Commercial |
$321.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.50
|
| Rate for Payer: Healthscope Commercial |
$336.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.21
|
| Rate for Payer: PHP Commercial |
$318.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.34
|
| Rate for Payer: Priority Health SBD |
$235.85
|
| Rate for Payer: UMR Bronson Commercial |
$164.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.78
|
|
|
CEFPODOXIME 200 MG TABLET
|
Facility
|
OP
|
$223.93
|
|
|
Service Code
|
NDC 65862009620
|
| Hospital Charge Code |
9469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.85 |
| Max. Negotiated Rate |
$201.54 |
| Rate for Payer: Aetna American Axle |
$145.55
|
| Rate for Payer: Aetna Commercial |
$190.34
|
| Rate for Payer: Aetna Medicare |
$111.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.55
|
| Rate for Payer: BCBS Complete |
$89.57
|
| Rate for Payer: Cash Price |
$179.14
|
| Rate for Payer: Cofinity Commercial |
$156.75
|
| Rate for Payer: Cofinity Commercial |
$192.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.14
|
| Rate for Payer: Healthscope Commercial |
$201.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.34
|
| Rate for Payer: PHP Commercial |
$190.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.55
|
| Rate for Payer: Priority Health SBD |
$141.08
|
| Rate for Payer: UMR Bronson Commercial |
$82.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.95
|
|
|
CEFPODOXIME 200 MG TABLET
|
Facility
|
IP
|
$223.93
|
|
|
Service Code
|
NDC 65862009620
|
| Hospital Charge Code |
9469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.53 |
| Max. Negotiated Rate |
$201.54 |
| Rate for Payer: Aetna American Axle |
$145.55
|
| Rate for Payer: Aetna Commercial |
$190.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.55
|
| Rate for Payer: Cash Price |
$179.14
|
| Rate for Payer: Cofinity Commercial |
$156.75
|
| Rate for Payer: Cofinity Commercial |
$192.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.14
|
| Rate for Payer: Healthscope Commercial |
$201.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.34
|
| Rate for Payer: PHP Commercial |
$190.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.55
|
| Rate for Payer: Priority Health SBD |
$141.08
|
| Rate for Payer: UMR Bronson Commercial |
$98.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.95
|
|
|
CEFPODOXIME 200 MG TABLET
|
Facility
|
OP
|
$374.37
|
|
|
Service Code
|
NDC 00781543920
|
| Hospital Charge Code |
9469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.52 |
| Max. Negotiated Rate |
$336.93 |
| Rate for Payer: Aetna American Axle |
$243.34
|
| Rate for Payer: Aetna Commercial |
$318.21
|
| Rate for Payer: Aetna Medicare |
$187.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.34
|
| Rate for Payer: BCBS Complete |
$149.75
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cofinity Commercial |
$262.06
|
| Rate for Payer: Cofinity Commercial |
$321.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.50
|
| Rate for Payer: Healthscope Commercial |
$336.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.21
|
| Rate for Payer: PHP Commercial |
$318.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.34
|
| Rate for Payer: Priority Health SBD |
$235.85
|
| Rate for Payer: UMR Bronson Commercial |
$138.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.78
|
|
