|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna American Axle |
$8.63
|
| Rate for Payer: Aetna American Axle |
$15.76
|
| Rate for Payer: Aetna American Axle |
$15.75
|
| Rate for Payer: Aetna American Axle |
$13.35
|
| Rate for Payer: Aetna American Axle |
$9.65
|
| Rate for Payer: Aetna American Axle |
$15.08
|
| Rate for Payer: Aetna American Axle |
$18.95
|
| Rate for Payer: Aetna Commercial |
$20.61
|
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: Aetna Commercial |
$24.79
|
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.76
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$19.38
|
| Rate for Payer: Cash Price |
$23.33
|
| Rate for Payer: Cofinity Commercial |
$20.86
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$10.39
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$20.84
|
| Rate for Payer: Cofinity Commercial |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$20.41
|
| Rate for Payer: Cofinity Commercial |
$25.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$26.24
|
| Rate for Payer: Healthscope Commercial |
$21.81
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Healthscope Commercial |
$21.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.61
|
| Rate for Payer: PHP Commercial |
$20.60
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$24.79
|
| Rate for Payer: PHP Commercial |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.75
|
| Rate for Payer: Priority Health SBD |
$12.94
|
| Rate for Payer: Priority Health SBD |
$9.35
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: Priority Health SBD |
$18.37
|
| Rate for Payer: Priority Health SBD |
$15.28
|
| Rate for Payer: Priority Health SBD |
$15.26
|
| Rate for Payer: Priority Health SBD |
$14.62
|
| Rate for Payer: UMR Bronson Commercial |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$12.83
|
| Rate for Payer: UMR Bronson Commercial |
$10.66
|
| Rate for Payer: UMR Bronson Commercial |
$10.67
|
| Rate for Payer: UMR Bronson Commercial |
$5.84
|
| Rate for Payer: UMR Bronson Commercial |
$9.04
|
| Rate for Payer: UMR Bronson Commercial |
$6.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$17.80
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$16.02 |
| Rate for Payer: Aetna American Axle |
$11.57
|
| Rate for Payer: Aetna American Axle |
$8.63
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Commercial |
$15.13
|
| Rate for Payer: Aetna Medicare |
$8.90
|
| Rate for Payer: Aetna Medicare |
$6.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.57
|
| Rate for Payer: BCBS Complete |
$7.12
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$12.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Healthscope Commercial |
$16.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$15.13
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.57
|
| Rate for Payer: Priority Health SBD |
$11.21
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: UMR Bronson Commercial |
$4.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.35
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$17.80
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$16.02 |
| Rate for Payer: Aetna American Axle |
$11.57
|
| Rate for Payer: Aetna Commercial |
$15.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.57
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Cofinity Commercial |
$12.46
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.24
|
| Rate for Payer: Healthscope Commercial |
$16.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.13
|
| Rate for Payer: PHP Commercial |
$15.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.57
|
| Rate for Payer: Priority Health SBD |
$11.21
|
| Rate for Payer: UMR Bronson Commercial |
$7.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.35
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$45.82
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$41.24 |
| Rate for Payer: Aetna American Axle |
$29.78
|
| Rate for Payer: Aetna American Axle |
$17.69
|
| Rate for Payer: Aetna American Axle |
$16.25
|
| Rate for Payer: Aetna American Axle |
$16.12
|
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna American Axle |
$13.90
|
| Rate for Payer: Aetna American Axle |
$10.82
|
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Commercial |
$23.13
|
| Rate for Payer: Aetna Commercial |
$38.95
|
| Rate for Payer: Aetna Medicare |
$12.40
|
| Rate for Payer: Aetna Medicare |
$8.32
|
| Rate for Payer: Aetna Medicare |
$13.60
|
| Rate for Payer: Aetna Medicare |
$10.70
|
| Rate for Payer: Aetna Medicare |
$22.91
|
| Rate for Payer: Aetna Medicare |
$12.50
|
| Rate for Payer: Aetna Medicare |
$8.24
|
| Rate for Payer: Aetna Medicare |
$12.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: BCBS Complete |
$18.33
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Complete |
$8.56
|
| Rate for Payer: BCBS Complete |
$10.88
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$21.77
|
| Rate for Payer: Cash Price |
$21.77
|
| Rate for Payer: Cash Price |
$36.66
|
| Rate for Payer: Cash Price |
$36.66
|
| Rate for Payer: Cofinity Commercial |
$17.36
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$32.07
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$14.97
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Cofinity Commercial |
$19.05
|
| Rate for Payer: Cofinity Commercial |
$39.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$19.25
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$24.49
|
| Rate for Payer: Healthscope Commercial |
$41.24
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.08
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$38.95
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: PHP Commercial |
$18.18
|
| Rate for Payer: PHP Commercial |
$23.13
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.69
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: Priority Health SBD |
$28.87
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: Priority Health SBD |
$13.48
|
| Rate for Payer: Priority Health SBD |
$17.14
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$10.07
|
| Rate for Payer: UMR Bronson Commercial |
$16.95
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: UMR Bronson Commercial |
$9.25
|
| Rate for Payer: UMR Bronson Commercial |
$9.18
|
| Rate for Payer: UMR Bronson Commercial |
$6.16
|
| Rate for Payer: UMR Bronson Commercial |
$6.09
|
| Rate for Payer: UMR Bronson Commercial |
$7.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$27.21
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$24.49 |
| Rate for Payer: Aetna American Axle |
$17.69
|
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna American Axle |
$16.25
|
| Rate for Payer: Aetna American Axle |
$13.90
|
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna American Axle |
$10.82
|
| Rate for Payer: Aetna American Axle |
$16.12
|
| Rate for Payer: Aetna American Axle |
$29.78
|
| Rate for Payer: Aetna Commercial |
$38.95
|
| Rate for Payer: Aetna Commercial |
$23.13
|
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$21.77
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$36.66
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Cofinity Commercial |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$17.36
|
| Rate for Payer: Cofinity Commercial |
$14.97
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$19.05
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Cofinity Commercial |
$32.07
|
| Rate for Payer: Cofinity Commercial |
$39.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.11
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$41.24
|
| Rate for Payer: Healthscope Commercial |
$24.49
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$19.25
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.18
|
| Rate for Payer: PHP Commercial |
$23.13
|
| Rate for Payer: PHP Commercial |
$18.18
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: PHP Commercial |
$38.95
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.90
|
| Rate for Payer: Priority Health SBD |
$13.48
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: Priority Health SBD |
$28.87
|
| Rate for Payer: Priority Health SBD |
$17.14
|
| Rate for Payer: UMR Bronson Commercial |
$9.41
|
| Rate for Payer: UMR Bronson Commercial |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: UMR Bronson Commercial |
$11.97
|
| Rate for Payer: UMR Bronson Commercial |
$7.33
|
| Rate for Payer: UMR Bronson Commercial |
$20.16
|
| Rate for Payer: UMR Bronson Commercial |
$11.00
|
| Rate for Payer: UMR Bronson Commercial |
$7.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$16.47
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: UMR Bronson Commercial |
$7.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$16.47
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Medicare |
$8.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: UMR Bronson Commercial |
$6.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna American Axle |
$5.59
|
| Rate for Payer: Aetna American Axle |
$5.04
|
| Rate for Payer: Aetna American Axle |
$2.73
|
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna Commercial |
$8.02
|
| Rate for Payer: Aetna Commercial |
$6.59
|
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Aetna Medicare |
$3.88
|
| Rate for Payer: Aetna Medicare |
$4.30
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: Aetna Medicare |
$4.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.04
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS Complete |
$3.44
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$6.61
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.88
|
| Rate for Payer: Healthscope Commercial |
$7.74
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$6.98
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.57
|
| Rate for Payer: PHP Commercial |
$8.02
|
| Rate for Payer: PHP Commercial |
$7.31
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$3.57
|
| Rate for Payer: PHP Commercial |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: Priority Health SBD |
$5.42
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: Priority Health SBD |
$4.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: UMR Bronson Commercial |
$2.87
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: UMR Bronson Commercial |
$3.18
|
| Rate for Payer: UMR Bronson Commercial |
$3.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.15
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$8.60
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Aetna American Axle |
$5.59
|
| Rate for Payer: Aetna American Axle |
$2.73
|
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna American Axle |
$5.04
|
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna Commercial |
$8.02
|
| Rate for Payer: Aetna Commercial |
$6.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$6.61
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Cofinity Commercial |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.20
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$7.74
|
| Rate for Payer: Healthscope Commercial |
$6.98
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.57
|
| Rate for Payer: PHP Commercial |
$3.57
|
| Rate for Payer: PHP Commercial |
$8.02
|
| Rate for Payer: PHP Commercial |
$6.59
|
| Rate for Payer: PHP Commercial |
$7.31
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.73
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: Priority Health SBD |
$4.88
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: Priority Health SBD |
$5.42
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$3.78
|
| Rate for Payer: UMR Bronson Commercial |
$4.15
|
| Rate for Payer: UMR Bronson Commercial |
$3.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.45
|
|
|
CEFTRIAXONE IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Aetna Medicare |
$0.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.21
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.19
|
|
|
CEFTRIAXONE IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.21
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$0.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.19
|
|
|
CEFTRIAXONE IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$3.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna American Axle |
$2.11
|
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health SBD |
$2.05
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.44
|
|
|
CEFTRIAXONE IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna American Axle |
$2.11
|
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health SBD |
$2.05
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.44
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
IP
|
$266.49
|
|
|
Service Code
|
NDC 65862069960
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.26 |
| Max. Negotiated Rate |
$239.84 |
| Rate for Payer: Aetna American Axle |
$173.22
|
| Rate for Payer: Aetna Commercial |
$226.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.22
|
| Rate for Payer: Cash Price |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$186.54
|
| Rate for Payer: Cofinity Commercial |
$229.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.19
|
| Rate for Payer: Healthscope Commercial |
$239.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.52
|
| Rate for Payer: PHP Commercial |
$226.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.22
|
| Rate for Payer: Priority Health SBD |
$167.89
|
| Rate for Payer: UMR Bronson Commercial |
$117.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.87
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
IP
|
$451.88
|
|
|
Service Code
|
NDC 68180030260
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.83 |
| Max. Negotiated Rate |
$406.69 |
| Rate for Payer: Aetna American Axle |
$293.72
|
| Rate for Payer: Aetna Commercial |
$384.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.72
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cofinity Commercial |
$316.32
|
| Rate for Payer: Cofinity Commercial |
$388.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$316.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.50
|
| Rate for Payer: Healthscope Commercial |
$406.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.10
|
| Rate for Payer: PHP Commercial |
$384.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.72
|
| Rate for Payer: Priority Health SBD |
$284.68
|
| Rate for Payer: UMR Bronson Commercial |
$198.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.91
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
OP
|
$266.49
|
|
|
Service Code
|
NDC 65862069960
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$239.84 |
| Rate for Payer: Aetna American Axle |
$173.22
|
| Rate for Payer: Aetna Commercial |
$226.52
|
| Rate for Payer: Aetna Medicare |
$133.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.22
|
| Rate for Payer: BCBS Complete |
$106.60
|
| Rate for Payer: Cash Price |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$186.54
|
| Rate for Payer: Cofinity Commercial |
$229.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.19
|
| Rate for Payer: Healthscope Commercial |
$239.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.52
|
| Rate for Payer: PHP Commercial |
$226.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.22
|
| Rate for Payer: Priority Health SBD |
$167.89
|
| Rate for Payer: UMR Bronson Commercial |
$98.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.87
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
OP
|
$451.88
|
|
|
Service Code
|
NDC 68180030260
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$406.69 |
| Rate for Payer: Aetna American Axle |
$293.72
|
| Rate for Payer: Aetna Commercial |
$384.10
|
| Rate for Payer: Aetna Medicare |
$225.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.72
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cofinity Commercial |
$316.32
|
| Rate for Payer: Cofinity Commercial |
$388.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$316.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.50
|
| Rate for Payer: Healthscope Commercial |
$406.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.10
|
| Rate for Payer: PHP Commercial |
$384.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.72
|
| Rate for Payer: Priority Health SBD |
$284.68
|
| Rate for Payer: UMR Bronson Commercial |
$167.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.91
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
OP
|
$241.06
|
|
|
Service Code
|
NDC 57237005860
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.19 |
| Max. Negotiated Rate |
$216.95 |
| Rate for Payer: Aetna American Axle |
$156.69
|
| Rate for Payer: Aetna Commercial |
$204.90
|
| Rate for Payer: Aetna Medicare |
$120.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.69
|
| Rate for Payer: BCBS Complete |
$96.42
|
| Rate for Payer: Cash Price |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$168.74
|
| Rate for Payer: Cofinity Commercial |
$207.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.85
|
| Rate for Payer: Healthscope Commercial |
$216.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.90
|
| Rate for Payer: PHP Commercial |
$204.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.69
|
| Rate for Payer: Priority Health SBD |
$151.87
|
| Rate for Payer: UMR Bronson Commercial |
$89.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.80
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
IP
|
$241.06
|
|
|
Service Code
|
NDC 57237005860
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.07 |
| Max. Negotiated Rate |
$216.95 |
| Rate for Payer: Aetna American Axle |
$156.69
|
| Rate for Payer: Aetna Commercial |
$204.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.69
|
| Rate for Payer: Cash Price |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$168.74
|
| Rate for Payer: Cofinity Commercial |
$207.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.85
|
| Rate for Payer: Healthscope Commercial |
$216.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.90
|
| Rate for Payer: PHP Commercial |
$204.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.69
|
| Rate for Payer: Priority Health SBD |
$151.87
|
| Rate for Payer: UMR Bronson Commercial |
$106.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.80
|
|
|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.05
|
| Rate for Payer: BCN Commercial |
$5.05
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 33342015611
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.82
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.82
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.82
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UMR Bronson Commercial |
$57.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.32
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 33342015611
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.24 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.82
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.82
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.82
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UMR Bronson Commercial |
$68.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.32
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 62332014131
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.54
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$192.46
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
