|
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
|
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
|
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 |
$17.38
|
| 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 |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.38
|
|
|
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
|
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 |
$17.38
|
| 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
|
|
|
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
|
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 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
|
|
|
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
|
|
|
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
|
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 |
$187.18
|
| 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
|
|
|
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
|
$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 |
$111.96
|
| 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
|
$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
|
|
|
CEFTAROLINE FOSAMIL 0.06 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 09900000955
|
| Hospital Charge Code |
180576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna American Axle |
$0.03
|
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.03
|
| Rate for Payer: Priority Health SBD |
$0.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.04
|
|
|
CEFTAROLINE FOSAMIL 0.06 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 09900000955
|
| Hospital Charge Code |
180576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna American Axle |
$0.03
|
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.03
|
| Rate for Payer: Priority Health SBD |
$0.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.04
|
|
|
CEFTAROLINE FOSAMIL 0.6 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 09900000956
|
| Hospital Charge Code |
180577
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna American Axle |
$0.03
|
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.03
|
| Rate for Payer: Priority Health SBD |
$0.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.04
|
|
|
CEFTAROLINE FOSAMIL 0.6 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 09900000956
|
| Hospital Charge Code |
180577
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna American Axle |
$0.03
|
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.03
|
| Rate for Payer: Priority Health SBD |
$0.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.04
|
|
|
CEFTAROLINE FOSAMIL 600 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 09900000958
|
| Hospital Charge Code |
180579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna American Axle |
$2.34
|
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.34
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.70
|
|
|
CEFTAROLINE FOSAMIL 600 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 09900000958
|
| Hospital Charge Code |
180579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna American Axle |
$2.34
|
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.34
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.70
|
|
|
CEFTAROLINE FOSAMIL 600 MG CUSTOM INTRAVENOUS SOLUTION FOR DESENSITIZATION
|
Facility
|
OP
|
$513.76
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
180582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$462.38 |
| Rate for Payer: Aetna American Axle |
$333.94
|
| Rate for Payer: Aetna Commercial |
$436.70
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$10.59
|
| Rate for Payer: BCN Commercial |
$10.59
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$411.01
|
| Rate for Payer: Cash Price |
$411.01
|
| Rate for Payer: Cofinity Commercial |
$441.83
|
| Rate for Payer: Cofinity Commercial |
$359.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$462.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.32
|
| Rate for Payer: Mclaren Medicaid |
$2.12
|
| Rate for Payer: Mclaren Medicare |
$3.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.70
|
| Rate for Payer: Nomi Health Commercial |
$11.85
|
| Rate for Payer: PACE Medicare |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$436.70
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.32
|
| Rate for Payer: Priority Health Medicare |
$3.95
|
| Rate for Payer: Priority Health Narrow Network |
$9.06
|
| Rate for Payer: Priority Health SBD |
$323.67
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.95
|
| Rate for Payer: UHC Exchange |
$7.55
|
| Rate for Payer: UHC Medicare Advantage |
$3.95
|
| Rate for Payer: UHCCP Medicaid |
$2.12
|
| Rate for Payer: UMR Bronson Commercial |
$190.09
|
| Rate for Payer: VA VA |
$3.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.32
|
|
|
CEFTAROLINE FOSAMIL 600 MG CUSTOM INTRAVENOUS SOLUTION FOR DESENSITIZATION
|
Facility
|
IP
|
$513.76
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
180582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.05 |
| Max. Negotiated Rate |
$462.38 |
| Rate for Payer: Aetna American Axle |
$333.94
|
| Rate for Payer: Aetna Commercial |
$436.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.94
|
| Rate for Payer: Cash Price |
$411.01
|
| Rate for Payer: Cofinity Commercial |
$359.63
|
| Rate for Payer: Cofinity Commercial |
$441.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.01
|
| Rate for Payer: Healthscope Commercial |
$462.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.70
|
| Rate for Payer: PHP Commercial |
$436.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.94
|
| Rate for Payer: Priority Health SBD |
$323.67
|
| Rate for Payer: UMR Bronson Commercial |
$226.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.32
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$671.51
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$295.46 |
| Max. Negotiated Rate |
$604.36 |
| Rate for Payer: Aetna American Axle |
$436.48
|
| Rate for Payer: Aetna Commercial |
$570.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.48
|
| Rate for Payer: Cash Price |
$537.21
|
| Rate for Payer: Cofinity Commercial |
$470.06
|
| Rate for Payer: Cofinity Commercial |
$577.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$470.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$604.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.78
|
| Rate for Payer: PHP Commercial |
$570.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.48
|
| Rate for Payer: Priority Health SBD |
$423.05
|
| Rate for Payer: UMR Bronson Commercial |
$295.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.63
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$671.51
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$604.36 |
| Rate for Payer: Aetna American Axle |
$436.48
|
| Rate for Payer: Aetna Commercial |
$570.78
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$10.59
|
| Rate for Payer: BCN Commercial |
$10.59
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$537.21
|
| Rate for Payer: Cash Price |
$537.21
|
| Rate for Payer: Cofinity Commercial |
$577.50
|
| Rate for Payer: Cofinity Commercial |
$470.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$470.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$604.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.63
|
| Rate for Payer: Mclaren Medicaid |
$2.12
|
| Rate for Payer: Mclaren Medicare |
$3.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.78
|
| Rate for Payer: Nomi Health Commercial |
$11.85
|
| Rate for Payer: PACE Medicare |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$570.78
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.32
|
| Rate for Payer: Priority Health Medicare |
$3.95
|
| Rate for Payer: Priority Health Narrow Network |
$9.06
|
| Rate for Payer: Priority Health SBD |
$423.05
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.95
|
| Rate for Payer: UHC Exchange |
$7.55
|
| Rate for Payer: UHC Medicare Advantage |
$3.95
|
| Rate for Payer: UHCCP Medicaid |
$2.12
|
| Rate for Payer: UMR Bronson Commercial |
$248.46
|
| Rate for Payer: VA VA |
$3.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.63
|
|
