|
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
|
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 CUSTOM INTRAVENOUS SOLUTION FOR DESENSITIZATION
|
Facility
|
OP
|
$513.76
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
180582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| 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 |
$4.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.29
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: BCBS MAPPO |
$4.23
|
| Rate for Payer: BCN Medicare Advantage |
$4.23
|
| 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 |
$4.23
|
| 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 |
$2.27
|
| Rate for Payer: Mclaren Medicare |
$4.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.44
|
| Rate for Payer: Meridian Medicaid |
$2.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.70
|
| Rate for Payer: PACE Medicare |
$4.02
|
| Rate for Payer: PACE SWMI |
$4.23
|
| Rate for Payer: PHP Commercial |
$436.70
|
| Rate for Payer: PHP Medicare Advantage |
$4.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.94
|
| Rate for Payer: Priority Health Medicare |
$4.23
|
| Rate for Payer: Priority Health SBD |
$323.67
|
| Rate for Payer: Railroad Medicare Medicare |
$4.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.23
|
| Rate for Payer: UHC Exchange |
$8.08
|
| Rate for Payer: UHC Medicare Advantage |
$4.23
|
| Rate for Payer: UHCCP Medicaid |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$190.09
|
| Rate for Payer: VA VA |
$4.23
|
| 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 |
$2.27 |
| 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 |
$4.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.29
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: BCBS MAPPO |
$4.23
|
| Rate for Payer: BCN Medicare Advantage |
$4.23
|
| 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 |
$4.23
|
| 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 |
$2.27
|
| Rate for Payer: Mclaren Medicare |
$4.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.44
|
| Rate for Payer: Meridian Medicaid |
$2.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.78
|
| Rate for Payer: PACE Medicare |
$4.02
|
| Rate for Payer: PACE SWMI |
$4.23
|
| Rate for Payer: PHP Commercial |
$570.78
|
| Rate for Payer: PHP Medicare Advantage |
$4.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.48
|
| Rate for Payer: Priority Health Medicare |
$4.23
|
| Rate for Payer: Priority Health SBD |
$423.05
|
| Rate for Payer: Railroad Medicare Medicare |
$4.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.23
|
| Rate for Payer: UHC Exchange |
$8.08
|
| Rate for Payer: UHC Medicare Advantage |
$4.23
|
| Rate for Payer: UHCCP Medicaid |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$248.46
|
| Rate for Payer: VA VA |
$4.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.63
|
|
|
CEFTAROLINE FOSAMIL 600 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$671.51
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
301724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| 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 |
$4.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.29
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: BCBS MAPPO |
$4.23
|
| Rate for Payer: BCN Medicare Advantage |
$4.23
|
| 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 |
$4.23
|
| 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 |
$2.27
|
| Rate for Payer: Mclaren Medicare |
$4.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.44
|
| Rate for Payer: Meridian Medicaid |
$2.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.78
|
| Rate for Payer: PACE Medicare |
$4.02
|
| Rate for Payer: PACE SWMI |
$4.23
|
| Rate for Payer: PHP Commercial |
$570.78
|
| Rate for Payer: PHP Medicare Advantage |
$4.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.48
|
| Rate for Payer: Priority Health Medicare |
$4.23
|
| Rate for Payer: Priority Health SBD |
$423.05
|
| Rate for Payer: Railroad Medicare Medicare |
$4.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.23
|
| Rate for Payer: UHC Exchange |
$8.08
|
| Rate for Payer: UHC Medicare Advantage |
$4.23
|
| Rate for Payer: UHCCP Medicaid |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$248.46
|
| Rate for Payer: VA VA |
$4.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.63
|
|
|
CEFTAROLINE FOSAMIL 600 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$671.51
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
301724
|
|
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 60 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 09900000954
|
| Hospital Charge Code |
168966
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna American Axle |
$0.23
|
| Rate for Payer: Aetna Commercial |
$0.30
|
| Rate for Payer: Aetna Medicare |
$0.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.14
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cofinity Commercial |
$0.25
|
| Rate for Payer: Cofinity Commercial |
$0.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.28
|
| Rate for Payer: Healthscope Commercial |
$0.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.30
|
| Rate for Payer: PHP Commercial |
$0.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.23
|
| Rate for Payer: Priority Health SBD |
$0.22
|
| Rate for Payer: UMR Bronson Commercial |
$0.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.26
|
|
|
CEFTAROLINE FOSAMIL 60 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 09900000954
|
| Hospital Charge Code |
168966
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna American Axle |
$0.23
|
| Rate for Payer: Aetna Commercial |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.23
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cofinity Commercial |
$0.25
|
| Rate for Payer: Cofinity Commercial |
$0.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.28
|
| Rate for Payer: Healthscope Commercial |
$0.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.30
|
| Rate for Payer: PHP Commercial |
$0.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.23
|
| Rate for Payer: Priority Health SBD |
$0.22
|
| Rate for Payer: UMR Bronson Commercial |
$0.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.26
|
|
|
CEFTAROLINE FOSAMIL 6 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 09900000957
|
| Hospital Charge Code |
180578
|
|
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 6 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 09900000957
|
| Hospital Charge Code |
180578
|
|
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
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,174.32
|
|
|
Service Code
|
HCPCS J0714
|
| Hospital Charge Code |
161545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.14 |
| Max. Negotiated Rate |
$1,056.89 |
| Rate for Payer: Aetna American Axle |
$763.31
|
| Rate for Payer: Aetna Commercial |
$998.17
|
| Rate for Payer: Aetna Medicare |
$108.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.91
|
| Rate for Payer: BCBS Complete |
$58.94
|
| Rate for Payer: BCBS MAPPO |
$104.73
|
| Rate for Payer: BCN Medicare Advantage |
$104.73
|
| Rate for Payer: Cash Price |
$939.46
|
| Rate for Payer: Cash Price |
$939.46
|
| Rate for Payer: Cofinity Commercial |
$822.02
|
| Rate for Payer: Cofinity Commercial |
$1,009.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$822.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.73
|
| Rate for Payer: Healthscope Commercial |
$1,056.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$822.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$880.74
|
| Rate for Payer: Mclaren Medicaid |
$56.14
|
| Rate for Payer: Mclaren Medicare |
$104.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.97
|
| Rate for Payer: Meridian Medicaid |
$58.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.17
|
| Rate for Payer: PACE Medicare |
$99.49
|
| Rate for Payer: PACE SWMI |
$104.73
|
| Rate for Payer: PHP Commercial |
$998.17
|
| Rate for Payer: PHP Medicare Advantage |
$104.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.31
|
| Rate for Payer: Priority Health Medicare |
$104.73
|
| Rate for Payer: Priority Health SBD |
$739.82
|
| Rate for Payer: Railroad Medicare Medicare |
$104.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.73
|
| Rate for Payer: UHC Exchange |
$200.15
|
| Rate for Payer: UHC Medicare Advantage |
$104.73
|
| Rate for Payer: UHCCP Medicaid |
$56.14
|
| Rate for Payer: UMR Bronson Commercial |
$434.50
|
| Rate for Payer: VA VA |
$104.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$880.74
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,174.32
|
|
|
Service Code
|
HCPCS J0714
|
| Hospital Charge Code |
161545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$516.70 |
| Max. Negotiated Rate |
$1,056.89 |
| Rate for Payer: Aetna American Axle |
$763.31
|
| Rate for Payer: Aetna Commercial |
$998.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.31
|
| Rate for Payer: Cash Price |
$939.46
|
| Rate for Payer: Cofinity Commercial |
$1,009.92
|
| Rate for Payer: Cofinity Commercial |
$822.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$822.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.46
|
| Rate for Payer: Healthscope Commercial |
$1,056.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$822.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$880.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.17
|
| Rate for Payer: PHP Commercial |
$998.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.31
|
| Rate for Payer: Priority Health SBD |
$739.82
|
| Rate for Payer: UMR Bronson Commercial |
$516.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$880.74
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$1,174.32
|
|
|
Service Code
|
HCPCS J0714
|
| Hospital Charge Code |
301756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.14 |
| Max. Negotiated Rate |
$1,056.89 |
| Rate for Payer: Aetna American Axle |
$763.31
|
| Rate for Payer: Aetna Commercial |
$998.17
|
| Rate for Payer: Aetna Medicare |
$108.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.91
|
| Rate for Payer: BCBS Complete |
$58.94
|
| Rate for Payer: BCBS MAPPO |
$104.73
|
| Rate for Payer: BCN Medicare Advantage |
$104.73
|
| Rate for Payer: Cash Price |
$939.46
|
| Rate for Payer: Cash Price |
$939.46
|
| Rate for Payer: Cofinity Commercial |
$822.02
|
| Rate for Payer: Cofinity Commercial |
$1,009.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$822.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.73
|
| Rate for Payer: Healthscope Commercial |
$1,056.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$822.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$880.74
|
| Rate for Payer: Mclaren Medicaid |
$56.14
|
| Rate for Payer: Mclaren Medicare |
$104.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.97
|
| Rate for Payer: Meridian Medicaid |
$58.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.17
|
| Rate for Payer: PACE Medicare |
$99.49
|
| Rate for Payer: PACE SWMI |
$104.73
|
| Rate for Payer: PHP Commercial |
$998.17
|
| Rate for Payer: PHP Medicare Advantage |
$104.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.31
|
| Rate for Payer: Priority Health Medicare |
$104.73
|
| Rate for Payer: Priority Health SBD |
$739.82
|
| Rate for Payer: Railroad Medicare Medicare |
$104.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.73
|
| Rate for Payer: UHC Exchange |
$200.15
|
| Rate for Payer: UHC Medicare Advantage |
$104.73
|
| Rate for Payer: UHCCP Medicaid |
$56.14
|
| Rate for Payer: UMR Bronson Commercial |
$434.50
|
| Rate for Payer: VA VA |
$104.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$880.74
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$1,174.32
|
|
|
Service Code
|
HCPCS J0714
|
| Hospital Charge Code |
301756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$516.70 |
| Max. Negotiated Rate |
$1,056.89 |
| Rate for Payer: Aetna American Axle |
$763.31
|
| Rate for Payer: Aetna Commercial |
$998.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.31
|
| Rate for Payer: Cash Price |
$939.46
|
| Rate for Payer: Cofinity Commercial |
$1,009.92
|
| Rate for Payer: Cofinity Commercial |
$822.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$822.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.46
|
| Rate for Payer: Healthscope Commercial |
$1,056.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$822.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$880.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.17
|
| Rate for Payer: PHP Commercial |
$998.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.31
|
| Rate for Payer: Priority Health SBD |
$739.82
|
| Rate for Payer: UMR Bronson Commercial |
$516.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$880.74
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$523.77
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
173413
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.46 |
| Max. Negotiated Rate |
$471.39 |
| Rate for Payer: Aetna American Axle |
$340.45
|
| Rate for Payer: Aetna Commercial |
$445.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.45
|
| Rate for Payer: Cash Price |
$419.02
|
| Rate for Payer: Cofinity Commercial |
$366.64
|
| Rate for Payer: Cofinity Commercial |
$450.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$366.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.02
|
| Rate for Payer: Healthscope Commercial |
$471.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$392.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.20
|
| Rate for Payer: PHP Commercial |
$445.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.45
|
| Rate for Payer: Priority Health SBD |
$329.98
|
| Rate for Payer: UMR Bronson Commercial |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$392.83
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$523.77
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
173413
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$471.39 |
| Rate for Payer: Aetna American Axle |
$340.45
|
| Rate for Payer: Aetna Commercial |
$445.20
|
| Rate for Payer: Aetna Medicare |
$9.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.34
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS MAPPO |
$9.07
|
| Rate for Payer: BCN Medicare Advantage |
$9.07
|
| Rate for Payer: Cash Price |
$419.02
|
| Rate for Payer: Cash Price |
$419.02
|
| Rate for Payer: Cofinity Commercial |
$450.44
|
| Rate for Payer: Cofinity Commercial |
$366.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$366.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.07
|
| Rate for Payer: Healthscope Commercial |
$471.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$392.83
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$9.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.52
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.20
|
| Rate for Payer: PACE Medicare |
$8.62
|
| Rate for Payer: PACE SWMI |
$9.07
|
| Rate for Payer: PHP Commercial |
$445.20
|
| Rate for Payer: PHP Medicare Advantage |
$9.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.45
|
| Rate for Payer: Priority Health Medicare |
$9.07
|
| Rate for Payer: Priority Health SBD |
$329.98
|
| Rate for Payer: Railroad Medicare Medicare |
$9.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.07
|
| Rate for Payer: UHC Exchange |
$17.33
|
| Rate for Payer: UHC Medicare Advantage |
$9.07
|
| Rate for Payer: UHCCP Medicaid |
$4.86
|
| Rate for Payer: UMR Bronson Commercial |
$193.79
|
| Rate for Payer: VA VA |
$9.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$392.83
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$523.77
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
301725
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.46 |
| Max. Negotiated Rate |
$471.39 |
| Rate for Payer: Aetna American Axle |
$340.45
|
| Rate for Payer: Aetna Commercial |
$445.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.45
|
| Rate for Payer: Cash Price |
$419.02
|
| Rate for Payer: Cofinity Commercial |
$366.64
|
| Rate for Payer: Cofinity Commercial |
$450.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$366.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.02
|
| Rate for Payer: Healthscope Commercial |
$471.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$392.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.20
|
| Rate for Payer: PHP Commercial |
$445.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.45
|
| Rate for Payer: Priority Health SBD |
$329.98
|
| Rate for Payer: UMR Bronson Commercial |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$392.83
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$523.77
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
301725
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$471.39 |
| Rate for Payer: Aetna American Axle |
$340.45
|
| Rate for Payer: Aetna Commercial |
$445.20
|
| Rate for Payer: Aetna Medicare |
$9.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.34
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS MAPPO |
$9.07
|
| Rate for Payer: BCN Medicare Advantage |
$9.07
|
| Rate for Payer: Cash Price |
$419.02
|
| Rate for Payer: Cash Price |
$419.02
|
| Rate for Payer: Cofinity Commercial |
$450.44
|
| Rate for Payer: Cofinity Commercial |
$366.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$366.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.07
|
| Rate for Payer: Healthscope Commercial |
$471.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$392.83
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$9.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.52
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.20
|
| Rate for Payer: PACE Medicare |
$8.62
|
| Rate for Payer: PACE SWMI |
$9.07
|
| Rate for Payer: PHP Commercial |
$445.20
|
| Rate for Payer: PHP Medicare Advantage |
$9.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.45
|
| Rate for Payer: Priority Health Medicare |
$9.07
|
| Rate for Payer: Priority Health SBD |
$329.98
|
| Rate for Payer: Railroad Medicare Medicare |
$9.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.07
|
| Rate for Payer: UHC Exchange |
$17.33
|
| Rate for Payer: UHC Medicare Advantage |
$9.07
|
| Rate for Payer: UHCCP Medicaid |
$4.86
|
| Rate for Payer: UMR Bronson Commercial |
$193.79
|
| Rate for Payer: VA VA |
$9.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$392.83
|
|
|
CEFTRIAXONE 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
78580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$804.75 |
| Max. Negotiated Rate |
$1,957.50 |
| Rate for Payer: Aetna American Axle |
$1,413.75
|
| Rate for Payer: Aetna Commercial |
$1,848.75
|
| Rate for Payer: Aetna Medicare |
$1,087.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,413.75
|
| Rate for Payer: BCBS Complete |
$870.00
|
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Cofinity Commercial |
$1,522.50
|
| Rate for Payer: Cofinity Commercial |
$1,870.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,522.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.00
|
| Rate for Payer: Healthscope Commercial |
$1,957.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,522.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,631.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,848.75
|
| Rate for Payer: PHP Commercial |
$1,848.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,413.75
|
| Rate for Payer: Priority Health SBD |
$1,370.25
|
| Rate for Payer: UMR Bronson Commercial |
$804.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,631.25
|
|
