|
CEFEPIME 2 GM IVPB (IV PREMIX)
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna American Axle |
$14.46
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.96
|
| Rate for Payer: BCN Commercial |
$2.96
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: UMR Bronson Commercial |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
|
|
CEFEPIME 2 GM IVPB (IV PREMIX)
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna American Axle |
$14.46
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: UMR Bronson Commercial |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna American Axle |
$12.46
|
| Rate for Payer: Aetna American Axle |
$12.47
|
| Rate for Payer: Aetna American Axle |
$21.08
|
| Rate for Payer: Aetna American Axle |
$21.47
|
| Rate for Payer: Aetna American Axle |
$12.73
|
| Rate for Payer: Aetna American Axle |
$16.68
|
| Rate for Payer: Aetna American Axle |
$16.37
|
| Rate for Payer: Aetna Commercial |
$21.41
|
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Commercial |
$27.57
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Aetna Medicare |
$12.83
|
| Rate for Payer: Aetna Medicare |
$9.59
|
| Rate for Payer: Aetna Medicare |
$16.22
|
| Rate for Payer: Aetna Medicare |
$9.79
|
| Rate for Payer: Aetna Medicare |
$9.58
|
| Rate for Payer: Aetna Medicare |
$16.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.08
|
| Rate for Payer: BCBS Complete |
$10.26
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS Complete |
$13.21
|
| Rate for Payer: BCBS Complete |
$12.97
|
| Rate for Payer: BCBS Complete |
$10.08
|
| 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: 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: BCN Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Cofinity Commercial |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Commercial |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$13.71
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$22.70
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$17.63
|
| Rate for Payer: Cofinity Commercial |
$21.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$22.67
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Healthscope Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$29.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: PHP Commercial |
$21.41
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$21.81
|
| Rate for Payer: PHP Commercial |
$27.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.47
|
| Rate for Payer: Priority Health SBD |
$15.87
|
| Rate for Payer: Priority Health SBD |
$16.17
|
| Rate for Payer: Priority Health SBD |
$20.81
|
| Rate for Payer: Priority Health SBD |
$20.43
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: Priority Health SBD |
$12.34
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: UMR Bronson Commercial |
$9.49
|
| Rate for Payer: UMR Bronson Commercial |
$7.24
|
| Rate for Payer: UMR Bronson Commercial |
$7.09
|
| Rate for Payer: UMR Bronson Commercial |
$7.10
|
| Rate for Payer: UMR Bronson Commercial |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$12.00
|
| Rate for Payer: UMR Bronson Commercial |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.32
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$25.66
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$23.09 |
| Rate for Payer: Aetna American Axle |
$16.68
|
| Rate for Payer: Aetna American Axle |
$12.46
|
| Rate for Payer: Aetna American Axle |
$12.47
|
| Rate for Payer: Aetna American Axle |
$21.47
|
| Rate for Payer: Aetna American Axle |
$12.73
|
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.47
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Commercial |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$13.71
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$21.81
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.46
|
| Rate for Payer: Priority Health SBD |
$20.81
|
| Rate for Payer: Priority Health SBD |
$12.34
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: Priority Health SBD |
$16.17
|
| Rate for Payer: UMR Bronson Commercial |
$8.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.44
|
| Rate for Payer: UMR Bronson Commercial |
$11.29
|
| Rate for Payer: UMR Bronson Commercial |
$14.53
|
| Rate for Payer: UMR Bronson Commercial |
$8.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.24
|
|
|
CEFEPIME 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Aetna American Axle |
$21.47
|
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.47
|
| Rate for Payer: Priority Health SBD |
$20.81
|
| Rate for Payer: UMR Bronson Commercial |
$14.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
|
|
CEFEPIME 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Aetna American Axle |
$21.47
|
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Medicare |
$16.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: BCBS Complete |
$13.21
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.47
|
| Rate for Payer: Priority Health SBD |
$20.81
|
| Rate for Payer: UMR Bronson Commercial |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
|
|
CEFEPIME IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$1.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna American Axle |
$1.14
|
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.14
|
| Rate for Payer: Priority Health SBD |
$1.10
|
| Rate for Payer: UMR Bronson Commercial |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.31
|
|
|
CEFEPIME IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$1.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna American Axle |
$1.14
|
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: BCBS Complete |
$0.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.14
|
| Rate for Payer: Priority Health SBD |
$1.10
|
| Rate for Payer: UMR Bronson Commercial |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.31
|
|
|
CEFEPIME IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$16.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$15.08 |
| Rate for Payer: Aetna American Axle |
$10.89
|
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna Medicare |
$8.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.89
|
| Rate for Payer: BCBS Complete |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Healthscope Commercial |
$15.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.24
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.89
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$6.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.56
|
|
|
CEFEPIME IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$16.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$15.08 |
| Rate for Payer: Aetna American Axle |
$10.89
|
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.89
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Healthscope Commercial |
$15.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.24
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.89
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$7.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.56
|
|
|
CEFEPIME (MAXIPIME) 4 GRAM /540 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
IP
|
$45.66
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna American Axle |
$29.68
|
| Rate for Payer: Aetna Commercial |
$38.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.68
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.53
|
| Rate for Payer: Healthscope Commercial |
$41.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.81
|
| Rate for Payer: PHP Commercial |
$38.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.68
|
| Rate for Payer: Priority Health SBD |
$28.77
|
| Rate for Payer: UMR Bronson Commercial |
$20.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.24
|
|
|
CEFEPIME (MAXIPIME) 4 GRAM /540 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
OP
|
$45.66
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna American Axle |
$29.68
|
| Rate for Payer: Aetna Commercial |
$38.81
|
| Rate for Payer: Aetna Medicare |
$22.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.68
|
| Rate for Payer: BCBS Complete |
$18.26
|
| Rate for Payer: BCBS Trust/PPO |
$2.96
|
| Rate for Payer: BCN Commercial |
$2.96
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.53
|
| Rate for Payer: Healthscope Commercial |
$41.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.81
|
| Rate for Payer: PHP Commercial |
$38.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.68
|
| Rate for Payer: Priority Health SBD |
$28.77
|
| Rate for Payer: UMR Bronson Commercial |
$16.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.24
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$768.73
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
192885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$691.86 |
| Rate for Payer: Aetna American Axle |
$499.67
|
| Rate for Payer: Aetna Commercial |
$653.42
|
| Rate for Payer: Aetna Medicare |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.85
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: BCBS MAPPO |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.14
|
| Rate for Payer: BCN Commercial |
$6.14
|
| Rate for Payer: BCN Medicare Advantage |
$2.28
|
| Rate for Payer: Cash Price |
$614.98
|
| Rate for Payer: Cash Price |
$614.98
|
| Rate for Payer: Cofinity Commercial |
$661.11
|
| Rate for Payer: Cofinity Commercial |
$538.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$538.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$691.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$538.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$576.55
|
| Rate for Payer: Mclaren Medicaid |
$1.22
|
| Rate for Payer: Mclaren Medicare |
$2.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.39
|
| Rate for Payer: Meridian Medicaid |
$1.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$653.42
|
| Rate for Payer: Nomi Health Commercial |
$6.84
|
| Rate for Payer: PACE Medicare |
$2.17
|
| Rate for Payer: PACE SWMI |
$2.28
|
| Rate for Payer: PHP Commercial |
$653.42
|
| Rate for Payer: PHP Medicare Advantage |
$2.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.57
|
| Rate for Payer: Priority Health Medicare |
$2.28
|
| Rate for Payer: Priority Health Narrow Network |
$5.26
|
| Rate for Payer: Priority Health SBD |
$484.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.28
|
| Rate for Payer: UHC Exchange |
$4.36
|
| Rate for Payer: UHC Medicare Advantage |
$2.28
|
| Rate for Payer: UHCCP Medicaid |
$1.22
|
| Rate for Payer: UMR Bronson Commercial |
$284.43
|
| Rate for Payer: VA VA |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$576.55
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$768.73
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
192885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$691.86 |
| Rate for Payer: Aetna American Axle |
$499.67
|
| Rate for Payer: Aetna Commercial |
$653.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.67
|
| Rate for Payer: Cash Price |
$614.98
|
| Rate for Payer: Cofinity Commercial |
$538.11
|
| Rate for Payer: Cofinity Commercial |
$661.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$538.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.98
|
| Rate for Payer: Healthscope Commercial |
$691.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$538.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$576.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$653.42
|
| Rate for Payer: PHP Commercial |
$653.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.67
|
| Rate for Payer: Priority Health SBD |
$484.30
|
| Rate for Payer: UMR Bronson Commercial |
$338.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$576.55
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$119.86
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$107.87 |
| Rate for Payer: Aetna American Axle |
$77.91
|
| Rate for Payer: Aetna Commercial |
$101.88
|
| Rate for Payer: Aetna Medicare |
$59.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.91
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: BCBS Trust/PPO |
$12.15
|
| Rate for Payer: BCN Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$95.89
|
| 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 |
$89.90
|
| 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 |
$44.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.90
|
|
|
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 |
$89.90
|
| 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 |
$89.90
|
|
|
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: BCBS Trust/PPO |
$12.15
|
| Rate for Payer: BCN Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| 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 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 |
$20.42
|
| 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 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 |
$15.44
|
| Rate for Payer: Aetna American Axle |
$11.19
|
| Rate for Payer: Aetna American Axle |
$19.06
|
| 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 Commercial |
$24.56
|
| Rate for Payer: Aetna Medicare |
$11.88
|
| Rate for Payer: Aetna Medicare |
$14.44
|
| Rate for Payer: Aetna Medicare |
$9.64
|
| Rate for Payer: Aetna Medicare |
$8.60
|
| Rate for Payer: Aetna Medicare |
$14.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.78
|
| 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) |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.44
|
| Rate for Payer: BCBS Complete |
$7.71
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$11.56
|
| Rate for Payer: BCBS Complete |
$11.73
|
| Rate for Payer: BCBS Complete |
$9.50
|
| Rate for Payer: BCBS Trust/PPO |
$12.15
|
| Rate for Payer: BCBS Trust/PPO |
$12.15
|
| Rate for Payer: BCBS Trust/PPO |
$12.15
|
| Rate for Payer: BCBS Trust/PPO |
$12.15
|
| Rate for Payer: BCBS Trust/PPO |
$12.15
|
| Rate for Payer: BCN Commercial |
$12.15
|
| Rate for Payer: BCN Commercial |
$12.15
|
| Rate for Payer: BCN Commercial |
$12.15
|
| Rate for Payer: BCN Commercial |
$12.15
|
| Rate for Payer: BCN Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cash Price |
$23.11
|
| Rate for Payer: Cash Price |
$23.11
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Cofinity Commercial |
$24.85
|
| Rate for Payer: Cofinity Commercial |
$20.22
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| 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 |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.11
|
| Rate for Payer: Healthscope Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$26.40
|
| 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 |
$20.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| 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 |
$24.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$24.93
|
| Rate for Payer: PHP Commercial |
$24.56
|
| Rate for Payer: PHP Commercial |
$16.38
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$20.19
|
| 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 |
$15.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.53
|
| Rate for Payer: Priority Health SBD |
$12.14
|
| Rate for Payer: Priority Health SBD |
$18.48
|
| Rate for Payer: Priority Health SBD |
$18.20
|
| Rate for Payer: Priority Health SBD |
$10.84
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: UMR Bronson Commercial |
$6.37
|
| Rate for Payer: UMR Bronson Commercial |
$8.79
|
| Rate for Payer: UMR Bronson Commercial |
$7.13
|
| Rate for Payer: UMR Bronson Commercial |
$10.69
|
| Rate for Payer: UMR Bronson Commercial |
$10.85
|
| 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 |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
|
|
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 |
$20.42
|
| 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 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 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 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 |
$20.92
|
| 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
|
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 |
$17.38
|
| 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 |
$17.38
|
|
