|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$201.40
|
|
|
Service Code
|
NDC 68180044101
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.52 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna Medicare |
$100.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: BCBS Complete |
$80.56
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$74.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$201.40
|
|
|
Service Code
|
NDC 68180044101
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$88.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,032.30
|
|
|
Service Code
|
NDC 62135048142
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$454.21 |
| Max. Negotiated Rate |
$929.07 |
| Rate for Payer: Aetna American Axle |
$671.00
|
| Rate for Payer: Aetna Commercial |
$877.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.00
|
| Rate for Payer: Cash Price |
$825.84
|
| Rate for Payer: Cofinity Commercial |
$722.61
|
| Rate for Payer: Cofinity Commercial |
$887.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$722.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.84
|
| Rate for Payer: Healthscope Commercial |
$929.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$722.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$774.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.46
|
| Rate for Payer: PHP Commercial |
$877.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$671.00
|
| Rate for Payer: Priority Health SBD |
$650.35
|
| Rate for Payer: UMR Bronson Commercial |
$454.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$774.23
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$203.30
|
|
|
Service Code
|
NDC 00093417773
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.22 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna American Axle |
$132.15
|
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna Medicare |
$101.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: BCBS Complete |
$81.32
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Commercial |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.15
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UMR Bronson Commercial |
$75.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.47
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$916.50
|
|
|
Service Code
|
NDC 68180044102
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.11 |
| Max. Negotiated Rate |
$824.85 |
| Rate for Payer: Aetna American Axle |
$595.73
|
| Rate for Payer: Aetna Commercial |
$779.02
|
| Rate for Payer: Aetna Medicare |
$458.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.73
|
| Rate for Payer: BCBS Complete |
$366.60
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cofinity Commercial |
$641.55
|
| Rate for Payer: Cofinity Commercial |
$788.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$641.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.20
|
| Rate for Payer: Healthscope Commercial |
$824.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$641.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$687.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$779.02
|
| Rate for Payer: PHP Commercial |
$779.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.73
|
| Rate for Payer: Priority Health SBD |
$577.39
|
| Rate for Payer: UMR Bronson Commercial |
$339.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.38
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$916.50
|
|
|
Service Code
|
NDC 68180044102
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$403.26 |
| Max. Negotiated Rate |
$824.85 |
| Rate for Payer: Aetna American Axle |
$595.73
|
| Rate for Payer: Aetna Commercial |
$779.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.73
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cofinity Commercial |
$641.55
|
| Rate for Payer: Cofinity Commercial |
$788.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$641.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.20
|
| Rate for Payer: Healthscope Commercial |
$824.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$641.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$687.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$779.02
|
| Rate for Payer: PHP Commercial |
$779.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.73
|
| Rate for Payer: Priority Health SBD |
$577.39
|
| Rate for Payer: UMR Bronson Commercial |
$403.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.38
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$203.30
|
|
|
Service Code
|
NDC 00093417773
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.45 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna American Axle |
$132.15
|
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Commercial |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.15
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UMR Bronson Commercial |
$89.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.47
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$498.20
|
|
|
Service Code
|
NDC 67877054568
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.21 |
| Max. Negotiated Rate |
$448.38 |
| Rate for Payer: Aetna American Axle |
$323.83
|
| Rate for Payer: Aetna Commercial |
$423.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.83
|
| Rate for Payer: Cash Price |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$348.74
|
| Rate for Payer: Cofinity Commercial |
$428.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.56
|
| Rate for Payer: Healthscope Commercial |
$448.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.47
|
| Rate for Payer: PHP Commercial |
$423.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.83
|
| Rate for Payer: Priority Health SBD |
$313.87
|
| Rate for Payer: UMR Bronson Commercial |
$219.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.65
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$498.20
|
|
|
Service Code
|
NDC 67877054568
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.33 |
| Max. Negotiated Rate |
$448.38 |
| Rate for Payer: Aetna American Axle |
$323.83
|
| Rate for Payer: Aetna Commercial |
$423.47
|
| Rate for Payer: Aetna Medicare |
$249.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.83
|
| Rate for Payer: BCBS Complete |
$199.28
|
| Rate for Payer: Cash Price |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$348.74
|
| Rate for Payer: Cofinity Commercial |
$428.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.56
|
| Rate for Payer: Healthscope Commercial |
$448.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.47
|
| Rate for Payer: PHP Commercial |
$423.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.83
|
| Rate for Payer: Priority Health SBD |
$313.87
|
| Rate for Payer: UMR Bronson Commercial |
$184.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.65
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,032.30
|
|
|
Service Code
|
NDC 62135048142
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$381.95 |
| Max. Negotiated Rate |
$929.07 |
| Rate for Payer: Aetna American Axle |
$671.00
|
| Rate for Payer: Aetna Commercial |
$877.46
|
| Rate for Payer: Aetna Medicare |
$516.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.00
|
| Rate for Payer: BCBS Complete |
$412.92
|
| Rate for Payer: Cash Price |
$825.84
|
| Rate for Payer: Cofinity Commercial |
$722.61
|
| Rate for Payer: Cofinity Commercial |
$887.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$722.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.84
|
| Rate for Payer: Healthscope Commercial |
$929.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$722.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$774.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.46
|
| Rate for Payer: PHP Commercial |
$877.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$671.00
|
| Rate for Payer: Priority Health SBD |
$650.35
|
| Rate for Payer: UMR Bronson Commercial |
$381.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$774.23
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$136.80
|
|
|
Service Code
|
NDC 50268015115
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$123.12 |
| Rate for Payer: Aetna American Axle |
$88.92
|
| Rate for Payer: Aetna Commercial |
$116.28
|
| Rate for Payer: Aetna Medicare |
$68.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.92
|
| Rate for Payer: BCBS Complete |
$54.72
|
| Rate for Payer: Cash Price |
$109.44
|
| Rate for Payer: Cofinity Commercial |
$117.65
|
| Rate for Payer: Cofinity Commercial |
$95.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.44
|
| Rate for Payer: Healthscope Commercial |
$123.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.28
|
| Rate for Payer: PHP Commercial |
$116.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.92
|
| Rate for Payer: Priority Health SBD |
$86.18
|
| Rate for Payer: UMR Bronson Commercial |
$50.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.60
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 50268015111
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna American Axle |
$1.78
|
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 00093314501
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.88
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UMR Bronson Commercial |
$127.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 67877022001
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.57
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$289.05
|
|
|
Service Code
|
NDC 00093314501
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna Medicare |
$144.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: BCBS Complete |
$115.62
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.88
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UMR Bronson Commercial |
$106.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 50268015111
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna American Axle |
$1.78
|
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$136.80
|
|
|
Service Code
|
NDC 50268015115
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$123.12 |
| Rate for Payer: Aetna American Axle |
$88.92
|
| Rate for Payer: Aetna Commercial |
$116.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.92
|
| Rate for Payer: Cash Price |
$109.44
|
| Rate for Payer: Cofinity Commercial |
$117.65
|
| Rate for Payer: Cofinity Commercial |
$95.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.44
|
| Rate for Payer: Healthscope Commercial |
$123.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.28
|
| Rate for Payer: PHP Commercial |
$116.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.92
|
| Rate for Payer: Priority Health SBD |
$86.18
|
| Rate for Payer: UMR Bronson Commercial |
$60.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.60
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 67877022001
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.57
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$113.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 00093314701
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UMR Bronson Commercial |
$84.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 00904733735
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna American Axle |
$1.51
|
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Medicare |
$1.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.51
|
| Rate for Payer: BCBS Complete |
$0.93
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.51
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UMR Bronson Commercial |
$0.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 00904733735
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna American Axle |
$1.51
|
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.51
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.51
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$116.38
|
|
|
Service Code
|
NDC 00904733706
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.06 |
| Max. Negotiated Rate |
$104.74 |
| Rate for Payer: Aetna American Axle |
$75.65
|
| Rate for Payer: Aetna Commercial |
$98.92
|
| Rate for Payer: Aetna Medicare |
$58.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.65
|
| Rate for Payer: BCBS Complete |
$46.55
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: Cofinity Commercial |
$100.09
|
| Rate for Payer: Cofinity Commercial |
$81.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.10
|
| Rate for Payer: Healthscope Commercial |
$104.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.92
|
| Rate for Payer: PHP Commercial |
$98.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.65
|
| Rate for Payer: Priority Health SBD |
$73.32
|
| Rate for Payer: UMR Bronson Commercial |
$43.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.28
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$116.38
|
|
|
Service Code
|
NDC 00904733706
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.21 |
| Max. Negotiated Rate |
$104.74 |
| Rate for Payer: Aetna American Axle |
$75.65
|
| Rate for Payer: Aetna Commercial |
$98.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.65
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: Cofinity Commercial |
$100.09
|
| Rate for Payer: Cofinity Commercial |
$81.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.10
|
| Rate for Payer: Healthscope Commercial |
$104.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.92
|
| Rate for Payer: PHP Commercial |
$98.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.65
|
| Rate for Payer: Priority Health SBD |
$73.32
|
| Rate for Payer: UMR Bronson Commercial |
$51.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.28
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$324.30
|
|
|
Service Code
|
NDC 67877021901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.99 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna American Axle |
$210.79
|
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Medicare |
$162.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.79
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$227.01
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: PHP Commercial |
$275.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.79
|
| Rate for Payer: Priority Health SBD |
$204.31
|
| Rate for Payer: UMR Bronson Commercial |
$119.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.22
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$254.60
|
|
|
Service Code
|
NDC 68180012201
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.02 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.41
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.49
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: UMR Bronson Commercial |
$112.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
|
