|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 68180039901
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| 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 |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$5,682.09
|
|
|
Service Code
|
NDC 00025152534
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,102.37 |
| Max. Negotiated Rate |
$5,113.88 |
| Rate for Payer: Aetna American Axle |
$3,693.36
|
| Rate for Payer: Aetna Commercial |
$4,829.78
|
| Rate for Payer: Aetna Medicare |
$2,841.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,693.36
|
| Rate for Payer: BCBS Complete |
$2,272.84
|
| Rate for Payer: Cash Price |
$4,545.67
|
| Rate for Payer: Cofinity Commercial |
$3,977.46
|
| Rate for Payer: Cofinity Commercial |
$4,886.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,977.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,545.67
|
| Rate for Payer: Healthscope Commercial |
$5,113.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,977.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,261.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,829.78
|
| Rate for Payer: PHP Commercial |
$4,829.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,693.36
|
| Rate for Payer: Priority Health SBD |
$3,579.72
|
| Rate for Payer: UMR Bronson Commercial |
$2,102.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,261.57
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 62332014231
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
CELLULOSE, OXIDIZED 2" X 14" PADS
|
Facility
|
IP
|
$250.27
|
|
|
Service Code
|
NDC 09900000602
|
| Hospital Charge Code |
169202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$225.24 |
| Rate for Payer: Aetna American Axle |
$162.68
|
| Rate for Payer: Aetna Commercial |
$212.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.68
|
| Rate for Payer: Cash Price |
$200.22
|
| Rate for Payer: Cofinity Commercial |
$175.19
|
| Rate for Payer: Cofinity Commercial |
$215.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.22
|
| Rate for Payer: Healthscope Commercial |
$225.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.73
|
| Rate for Payer: PHP Commercial |
$212.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.68
|
| Rate for Payer: Priority Health SBD |
$157.67
|
| Rate for Payer: UMR Bronson Commercial |
$110.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.70
|
|
|
CELLULOSE, OXIDIZED 2" X 14" PADS
|
Facility
|
OP
|
$250.27
|
|
|
Service Code
|
NDC 09900000602
|
| Hospital Charge Code |
169202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$225.24 |
| Rate for Payer: Aetna American Axle |
$162.68
|
| Rate for Payer: Aetna Commercial |
$212.73
|
| Rate for Payer: Aetna Medicare |
$125.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.68
|
| Rate for Payer: BCBS Complete |
$100.11
|
| Rate for Payer: Cash Price |
$200.22
|
| Rate for Payer: Cofinity Commercial |
$175.19
|
| Rate for Payer: Cofinity Commercial |
$215.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.22
|
| Rate for Payer: Healthscope Commercial |
$225.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.73
|
| Rate for Payer: PHP Commercial |
$212.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.68
|
| Rate for Payer: Priority Health SBD |
$157.67
|
| Rate for Payer: UMR Bronson Commercial |
$92.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.70
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
IP
|
$222.06
|
|
|
Service Code
|
NDC 63713091953
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.71 |
| Max. Negotiated Rate |
$199.85 |
| Rate for Payer: Aetna American Axle |
$144.34
|
| Rate for Payer: Aetna Commercial |
$188.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.34
|
| Rate for Payer: Cash Price |
$177.65
|
| Rate for Payer: Cofinity Commercial |
$155.44
|
| Rate for Payer: Cofinity Commercial |
$190.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.65
|
| Rate for Payer: Healthscope Commercial |
$199.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.75
|
| Rate for Payer: PHP Commercial |
$188.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.34
|
| Rate for Payer: Priority Health SBD |
$139.90
|
| Rate for Payer: UMR Bronson Commercial |
$97.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.54
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
IP
|
$159.91
|
|
|
Service Code
|
NDC 09900000603
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.36 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna American Axle |
$103.94
|
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.94
|
| Rate for Payer: Cash Price |
$127.93
|
| Rate for Payer: Cofinity Commercial |
$111.94
|
| Rate for Payer: Cofinity Commercial |
$137.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.93
|
| Rate for Payer: Healthscope Commercial |
$143.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.92
|
| Rate for Payer: PHP Commercial |
$135.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.94
|
| Rate for Payer: Priority Health SBD |
$100.74
|
| Rate for Payer: UMR Bronson Commercial |
$70.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.93
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
OP
|
$222.06
|
|
|
Service Code
|
NDC 63713091953
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$199.85 |
| Rate for Payer: Aetna American Axle |
$144.34
|
| Rate for Payer: Aetna Commercial |
$188.75
|
| Rate for Payer: Aetna Medicare |
$111.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.34
|
| Rate for Payer: BCBS Complete |
$88.82
|
| Rate for Payer: Cash Price |
$177.65
|
| Rate for Payer: Cofinity Commercial |
$155.44
|
| Rate for Payer: Cofinity Commercial |
$190.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.65
|
| Rate for Payer: Healthscope Commercial |
$199.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.75
|
| Rate for Payer: PHP Commercial |
$188.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.34
|
| Rate for Payer: Priority Health SBD |
$139.90
|
| Rate for Payer: UMR Bronson Commercial |
$82.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.54
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
OP
|
$159.91
|
|
|
Service Code
|
NDC 09900000603
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.17 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna American Axle |
$103.94
|
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Aetna Medicare |
$79.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.94
|
| Rate for Payer: BCBS Complete |
$63.96
|
| Rate for Payer: Cash Price |
$127.93
|
| Rate for Payer: Cofinity Commercial |
$111.94
|
| Rate for Payer: Cofinity Commercial |
$137.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.93
|
| Rate for Payer: Healthscope Commercial |
$143.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.92
|
| Rate for Payer: PHP Commercial |
$135.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.94
|
| Rate for Payer: Priority Health SBD |
$100.74
|
| Rate for Payer: UMR Bronson Commercial |
$59.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.93
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
OP
|
$279.50
|
|
|
Service Code
|
NDC 09900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.42 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna American Axle |
$181.68
|
| Rate for Payer: Aetna Commercial |
$237.58
|
| Rate for Payer: Aetna Medicare |
$139.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: BCBS Complete |
$111.80
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.58
|
| Rate for Payer: PHP Commercial |
$237.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.68
|
| Rate for Payer: Priority Health SBD |
$176.08
|
| Rate for Payer: UMR Bronson Commercial |
$103.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.62
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
IP
|
$279.50
|
|
|
Service Code
|
NDC 09900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$122.98 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna American Axle |
$181.68
|
| Rate for Payer: Aetna Commercial |
$237.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.58
|
| Rate for Payer: PHP Commercial |
$237.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.68
|
| Rate for Payer: Priority Health SBD |
$176.08
|
| Rate for Payer: UMR Bronson Commercial |
$122.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.62
|
|
|
CELLULOSE,OXIDIZED-COLLAGEN 4.34" X 4.34" 45 %-55 % BANDAGE
|
Facility
|
IP
|
$38.41
|
|
|
Service Code
|
NDC 09900000605
|
| Hospital Charge Code |
169205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Aetna American Axle |
$24.97
|
| Rate for Payer: Aetna Commercial |
$32.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.97
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Cofinity Commercial |
$26.89
|
| Rate for Payer: Cofinity Commercial |
$33.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.73
|
| Rate for Payer: Healthscope Commercial |
$34.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.65
|
| Rate for Payer: PHP Commercial |
$32.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.97
|
| Rate for Payer: Priority Health SBD |
$24.20
|
| Rate for Payer: UMR Bronson Commercial |
$16.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.81
|
|
|
CELLULOSE,OXIDIZED-COLLAGEN 4.34" X 4.34" 45 %-55 % BANDAGE
|
Facility
|
OP
|
$38.41
|
|
|
Service Code
|
NDC 09900000605
|
| Hospital Charge Code |
169205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Aetna American Axle |
$24.97
|
| Rate for Payer: Aetna Commercial |
$32.65
|
| Rate for Payer: Aetna Medicare |
$19.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.97
|
| Rate for Payer: BCBS Complete |
$15.36
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Cofinity Commercial |
$26.89
|
| Rate for Payer: Cofinity Commercial |
$33.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.73
|
| Rate for Payer: Healthscope Commercial |
$34.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.65
|
| Rate for Payer: PHP Commercial |
$32.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.97
|
| Rate for Payer: Priority Health SBD |
$24.20
|
| Rate for Payer: UMR Bronson Commercial |
$14.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.81
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47,624.34
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,954.71 |
| Max. Negotiated Rate |
$42,861.91 |
| Rate for Payer: Aetna American Axle |
$30,955.82
|
| Rate for Payer: Aetna Commercial |
$40,480.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,955.82
|
| Rate for Payer: Cash Price |
$38,099.47
|
| Rate for Payer: Cofinity Commercial |
$33,337.04
|
| Rate for Payer: Cofinity Commercial |
$40,956.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$33,337.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,099.47
|
| Rate for Payer: Healthscope Commercial |
$42,861.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,337.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,718.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,480.69
|
| Rate for Payer: PHP Commercial |
$40,480.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,955.82
|
| Rate for Payer: Priority Health SBD |
$30,003.33
|
| Rate for Payer: UMR Bronson Commercial |
$20,954.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,718.26
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47,624.34
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$42,861.91 |
| Rate for Payer: Aetna American Axle |
$30,955.82
|
| Rate for Payer: Aetna Commercial |
$40,480.69
|
| Rate for Payer: Aetna Medicare |
$29.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,955.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.26
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$28.21
|
| Rate for Payer: BCBS Trust/PPO |
$76.14
|
| Rate for Payer: BCN Commercial |
$76.14
|
| Rate for Payer: BCN Medicare Advantage |
$28.21
|
| Rate for Payer: Cash Price |
$38,099.47
|
| Rate for Payer: Cash Price |
$38,099.47
|
| Rate for Payer: Cofinity Commercial |
$40,956.93
|
| Rate for Payer: Cofinity Commercial |
$33,337.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$33,337.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,099.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$42,861.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,337.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,718.26
|
| Rate for Payer: Mclaren Medicaid |
$15.12
|
| Rate for Payer: Mclaren Medicare |
$28.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.62
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,480.69
|
| Rate for Payer: Nomi Health Commercial |
$84.63
|
| Rate for Payer: PACE Medicare |
$26.80
|
| Rate for Payer: PACE SWMI |
$28.21
|
| Rate for Payer: PHP Commercial |
$40,480.69
|
| Rate for Payer: PHP Medicare Advantage |
$28.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,955.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.27
|
| Rate for Payer: Priority Health Medicare |
$28.21
|
| Rate for Payer: Priority Health Narrow Network |
$65.02
|
| Rate for Payer: Priority Health SBD |
$30,003.33
|
| Rate for Payer: Railroad Medicare Medicare |
$28.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.21
|
| Rate for Payer: UHC Exchange |
$53.91
|
| Rate for Payer: UHC Medicare Advantage |
$28.21
|
| Rate for Payer: UHCCP Medicaid |
$15.12
|
| Rate for Payer: UMR Bronson Commercial |
$17,621.01
|
| Rate for Payer: VA VA |
$28.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,718.26
|
|
|
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
|
OP
|
$916.50
|
|
|
Service Code
|
NDC 68180044102
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.10 |
| Max. Negotiated Rate |
$824.85 |
| Rate for Payer: Aetna American Axle |
$595.72
|
| Rate for Payer: Aetna Commercial |
$779.02
|
| Rate for Payer: Aetna Medicare |
$458.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.72
|
| 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 |
$595.72
|
| Rate for Payer: Priority Health SBD |
$577.40
|
| Rate for Payer: UMR Bronson Commercial |
$339.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.38
|
|
|
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 |
$774.22
|
| 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 |
$774.22
|
|
|
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
|
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 |
$132.14
|
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.14
|
| 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 |
$152.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.80
|
| Rate for Payer: PHP Commercial |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.14
|
| 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 |
$152.48
|
|
|
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 |
$132.14
|
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Medicare |
$101.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.14
|
| 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 |
$152.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.80
|
| Rate for Payer: PHP Commercial |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.14
|
| 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 |
$152.48
|
|
|
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 |
$774.22
|
| 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 |
$774.22
|
|
|
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
|
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 |
$595.72
|
| Rate for Payer: Aetna Commercial |
$779.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.72
|
| 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 |
$595.72
|
| Rate for Payer: Priority Health SBD |
$577.40
|
| Rate for Payer: UMR Bronson Commercial |
$403.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.38
|
|
