|
AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$308.44
|
|
|
Service Code
|
NDC 00143985375
|
| Hospital Charge Code |
31177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.71 |
| Max. Negotiated Rate |
$277.60 |
| Rate for Payer: Aetna American Axle |
$200.49
|
| Rate for Payer: Aetna Commercial |
$262.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.49
|
| Rate for Payer: Cash Price |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$215.91
|
| Rate for Payer: Cofinity Commercial |
$265.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.75
|
| Rate for Payer: Healthscope Commercial |
$277.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.17
|
| Rate for Payer: PHP Commercial |
$262.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.49
|
| Rate for Payer: Priority Health SBD |
$194.32
|
| Rate for Payer: UMR Bronson Commercial |
$135.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.33
|
|
|
AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$266.14
|
|
|
Service Code
|
NDC 00781613957
|
| Hospital Charge Code |
31177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.10 |
| Max. Negotiated Rate |
$239.53 |
| Rate for Payer: Aetna American Axle |
$172.99
|
| Rate for Payer: Aetna Commercial |
$226.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.99
|
| Rate for Payer: Cash Price |
$212.91
|
| Rate for Payer: Cofinity Commercial |
$186.30
|
| Rate for Payer: Cofinity Commercial |
$228.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.91
|
| Rate for Payer: Healthscope Commercial |
$239.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.22
|
| Rate for Payer: PHP Commercial |
$226.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.99
|
| Rate for Payer: Priority Health SBD |
$167.67
|
| Rate for Payer: UMR Bronson Commercial |
$117.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.60
|
|
|
AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$266.14
|
|
|
Service Code
|
NDC 00781613957
|
| Hospital Charge Code |
31177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.47 |
| Max. Negotiated Rate |
$239.53 |
| Rate for Payer: Aetna American Axle |
$172.99
|
| Rate for Payer: Aetna Commercial |
$226.22
|
| Rate for Payer: Aetna Medicare |
$133.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.99
|
| Rate for Payer: BCBS Complete |
$106.46
|
| Rate for Payer: Cash Price |
$212.91
|
| Rate for Payer: Cofinity Commercial |
$186.30
|
| Rate for Payer: Cofinity Commercial |
$228.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.91
|
| Rate for Payer: Healthscope Commercial |
$239.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.22
|
| Rate for Payer: PHP Commercial |
$226.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.99
|
| Rate for Payer: Priority Health SBD |
$167.67
|
| Rate for Payer: UMR Bronson Commercial |
$98.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.60
|
|
|
AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$308.44
|
|
|
Service Code
|
NDC 00143985375
|
| Hospital Charge Code |
31177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.12 |
| Max. Negotiated Rate |
$277.60 |
| Rate for Payer: Aetna American Axle |
$200.49
|
| Rate for Payer: Aetna Commercial |
$262.17
|
| Rate for Payer: Aetna Medicare |
$154.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.49
|
| Rate for Payer: BCBS Complete |
$123.38
|
| Rate for Payer: Cash Price |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$215.91
|
| Rate for Payer: Cofinity Commercial |
$265.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.75
|
| Rate for Payer: Healthscope Commercial |
$277.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.17
|
| Rate for Payer: PHP Commercial |
$262.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.49
|
| Rate for Payer: Priority Health SBD |
$194.32
|
| Rate for Payer: UMR Bronson Commercial |
$114.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.33
|
|
|
AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$240.88
|
|
|
Service Code
|
NDC 65862053513
|
| Hospital Charge Code |
31177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.99 |
| Max. Negotiated Rate |
$216.79 |
| Rate for Payer: Aetna American Axle |
$156.57
|
| Rate for Payer: Aetna Commercial |
$204.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.57
|
| Rate for Payer: Cash Price |
$192.70
|
| Rate for Payer: Cofinity Commercial |
$168.62
|
| Rate for Payer: Cofinity Commercial |
$207.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.70
|
| Rate for Payer: Healthscope Commercial |
$216.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.75
|
| Rate for Payer: PHP Commercial |
$204.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.57
|
| Rate for Payer: Priority Health SBD |
$151.75
|
| Rate for Payer: UMR Bronson Commercial |
$105.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.66
|
|
|
AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$240.88
|
|
|
Service Code
|
NDC 65862053513
|
| Hospital Charge Code |
31177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.13 |
| Max. Negotiated Rate |
$216.79 |
| Rate for Payer: Aetna American Axle |
$156.57
|
| Rate for Payer: Aetna Commercial |
$204.75
|
| Rate for Payer: Aetna Medicare |
$120.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.57
|
| Rate for Payer: BCBS Complete |
$96.35
|
| Rate for Payer: Cash Price |
$192.70
|
| Rate for Payer: Cofinity Commercial |
$168.62
|
| Rate for Payer: Cofinity Commercial |
$207.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.70
|
| Rate for Payer: Healthscope Commercial |
$216.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.75
|
| Rate for Payer: PHP Commercial |
$204.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.57
|
| Rate for Payer: Priority Health SBD |
$151.75
|
| Rate for Payer: UMR Bronson Commercial |
$89.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.66
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$423.70
|
|
|
Service Code
|
NDC 65862050301
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.43 |
| Max. Negotiated Rate |
$381.33 |
| Rate for Payer: Aetna American Axle |
$275.40
|
| Rate for Payer: Aetna Commercial |
$360.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.40
|
| Rate for Payer: Cash Price |
$338.96
|
| Rate for Payer: Cofinity Commercial |
$296.59
|
| Rate for Payer: Cofinity Commercial |
$364.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.96
|
| Rate for Payer: Healthscope Commercial |
$381.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.14
|
| Rate for Payer: PHP Commercial |
$360.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.40
|
| Rate for Payer: Priority Health SBD |
$266.93
|
| Rate for Payer: UMR Bronson Commercial |
$186.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.78
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
NDC 42571016201
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.23 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$136.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: BCBS Complete |
$109.44
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UMR Bronson Commercial |
$101.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$509.28
|
|
|
Service Code
|
NDC 66685100101
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.43 |
| Max. Negotiated Rate |
$458.35 |
| Rate for Payer: Aetna American Axle |
$331.03
|
| Rate for Payer: Aetna Commercial |
$432.89
|
| Rate for Payer: Aetna Medicare |
$254.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.03
|
| Rate for Payer: BCBS Complete |
$203.71
|
| Rate for Payer: Cash Price |
$407.42
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Commercial |
$437.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$356.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.42
|
| Rate for Payer: Healthscope Commercial |
$458.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$356.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.89
|
| Rate for Payer: PHP Commercial |
$432.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.03
|
| Rate for Payer: Priority Health SBD |
$320.85
|
| Rate for Payer: UMR Bronson Commercial |
$188.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.96
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$273.60
|
|
|
Service Code
|
NDC 42571016201
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UMR Bronson Commercial |
$120.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$423.70
|
|
|
Service Code
|
NDC 65862050301
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.77 |
| Max. Negotiated Rate |
$381.33 |
| Rate for Payer: Aetna American Axle |
$275.40
|
| Rate for Payer: Aetna Commercial |
$360.14
|
| Rate for Payer: Aetna Medicare |
$211.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.40
|
| Rate for Payer: BCBS Complete |
$169.48
|
| Rate for Payer: Cash Price |
$338.96
|
| Rate for Payer: Cofinity Commercial |
$296.59
|
| Rate for Payer: Cofinity Commercial |
$364.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.96
|
| Rate for Payer: Healthscope Commercial |
$381.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.14
|
| Rate for Payer: PHP Commercial |
$360.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.40
|
| Rate for Payer: Priority Health SBD |
$266.93
|
| Rate for Payer: UMR Bronson Commercial |
$156.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.78
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$506.40
|
|
|
Service Code
|
NDC 00781185201
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.82 |
| Max. Negotiated Rate |
$455.76 |
| Rate for Payer: Aetna American Axle |
$329.16
|
| Rate for Payer: Aetna Commercial |
$430.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.16
|
| Rate for Payer: Cash Price |
$405.12
|
| Rate for Payer: Cofinity Commercial |
$354.48
|
| Rate for Payer: Cofinity Commercial |
$435.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$354.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.12
|
| Rate for Payer: Healthscope Commercial |
$455.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$354.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.44
|
| Rate for Payer: PHP Commercial |
$430.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.16
|
| Rate for Payer: Priority Health SBD |
$319.03
|
| Rate for Payer: UMR Bronson Commercial |
$222.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.80
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$509.28
|
|
|
Service Code
|
NDC 66685100101
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.08 |
| Max. Negotiated Rate |
$458.35 |
| Rate for Payer: Aetna American Axle |
$331.03
|
| Rate for Payer: Aetna Commercial |
$432.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.03
|
| Rate for Payer: Cash Price |
$407.42
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Commercial |
$437.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$356.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.42
|
| Rate for Payer: Healthscope Commercial |
$458.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$356.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.89
|
| Rate for Payer: PHP Commercial |
$432.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.03
|
| Rate for Payer: Priority Health SBD |
$320.85
|
| Rate for Payer: UMR Bronson Commercial |
$224.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.96
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$506.40
|
|
|
Service Code
|
NDC 00781185201
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.37 |
| Max. Negotiated Rate |
$455.76 |
| Rate for Payer: Aetna American Axle |
$329.16
|
| Rate for Payer: Aetna Commercial |
$430.44
|
| Rate for Payer: Aetna Medicare |
$253.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.16
|
| Rate for Payer: BCBS Complete |
$202.56
|
| Rate for Payer: Cash Price |
$405.12
|
| Rate for Payer: Cofinity Commercial |
$354.48
|
| Rate for Payer: Cofinity Commercial |
$435.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$354.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.12
|
| Rate for Payer: Healthscope Commercial |
$455.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$354.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.44
|
| Rate for Payer: PHP Commercial |
$430.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.16
|
| Rate for Payer: Priority Health SBD |
$319.03
|
| Rate for Payer: UMR Bronson Commercial |
$187.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.80
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR
|
Facility
|
OP
|
$773.60
|
|
|
Service Code
|
NDC 43598022040
|
| Hospital Charge Code |
33862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.23 |
| Max. Negotiated Rate |
$696.24 |
| Rate for Payer: Aetna American Axle |
$502.84
|
| Rate for Payer: Aetna Commercial |
$657.56
|
| Rate for Payer: Aetna Medicare |
$386.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.84
|
| Rate for Payer: BCBS Complete |
$309.44
|
| Rate for Payer: Cash Price |
$618.88
|
| Rate for Payer: Cofinity Commercial |
$541.52
|
| Rate for Payer: Cofinity Commercial |
$665.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$541.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.88
|
| Rate for Payer: Healthscope Commercial |
$696.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$541.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$580.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$657.56
|
| Rate for Payer: PHP Commercial |
$657.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.84
|
| Rate for Payer: Priority Health SBD |
$487.37
|
| Rate for Payer: UMR Bronson Commercial |
$286.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$580.20
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR
|
Facility
|
IP
|
$773.60
|
|
|
Service Code
|
NDC 43598022040
|
| Hospital Charge Code |
33862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$340.38 |
| Max. Negotiated Rate |
$696.24 |
| Rate for Payer: Aetna American Axle |
$502.84
|
| Rate for Payer: Aetna Commercial |
$657.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.84
|
| Rate for Payer: Cash Price |
$618.88
|
| Rate for Payer: Cofinity Commercial |
$541.52
|
| Rate for Payer: Cofinity Commercial |
$665.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$541.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.88
|
| Rate for Payer: Healthscope Commercial |
$696.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$541.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$580.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$657.56
|
| Rate for Payer: PHP Commercial |
$657.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.84
|
| Rate for Payer: Priority Health SBD |
$487.37
|
| Rate for Payer: UMR Bronson Commercial |
$340.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$580.20
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$156.24
|
|
|
Service Code
|
HCPCS J0285
|
| Hospital Charge Code |
464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$140.62 |
| Rate for Payer: Aetna American Axle |
$101.56
|
| Rate for Payer: Aetna Commercial |
$132.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.56
|
| Rate for Payer: Cash Price |
$124.99
|
| Rate for Payer: Cofinity Commercial |
$109.37
|
| Rate for Payer: Cofinity Commercial |
$134.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.99
|
| Rate for Payer: Healthscope Commercial |
$140.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.80
|
| Rate for Payer: PHP Commercial |
$132.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.56
|
| Rate for Payer: Priority Health SBD |
$98.43
|
| Rate for Payer: UMR Bronson Commercial |
$68.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.18
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$156.24
|
|
|
Service Code
|
HCPCS J0285
|
| Hospital Charge Code |
464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.81 |
| Max. Negotiated Rate |
$140.62 |
| Rate for Payer: Cofinity Medicare Advantage |
$109.37
|
| Rate for Payer: Aetna American Axle |
$101.56
|
| Rate for Payer: Aetna Commercial |
$132.80
|
| Rate for Payer: Aetna Medicare |
$78.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.56
|
| Rate for Payer: BCBS Complete |
$62.50
|
| Rate for Payer: BCBS Trust/PPO |
$134.99
|
| Rate for Payer: BCN Commercial |
$134.99
|
| Rate for Payer: Cash Price |
$124.99
|
| Rate for Payer: Cash Price |
$124.99
|
| Rate for Payer: Cofinity Commercial |
$109.37
|
| Rate for Payer: Cofinity Commercial |
$134.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.99
|
| Rate for Payer: Healthscope Commercial |
$140.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.80
|
| Rate for Payer: PHP Commercial |
$132.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.56
|
| Rate for Payer: Priority Health SBD |
$98.43
|
| Rate for Payer: UMR Bronson Commercial |
$57.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.18
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$304.24
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
21900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$273.82 |
| Rate for Payer: Cofinity Commercial |
$576.38
|
| Rate for Payer: Cofinity Commercial |
$261.65
|
| Rate for Payer: Cofinity Commercial |
$212.97
|
| Rate for Payer: Cofinity Commercial |
$293.43
|
| Rate for Payer: Cofinity Commercial |
$238.84
|
| Rate for Payer: Cofinity Commercial |
$469.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$469.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.97
|
| Rate for Payer: UHCCP Medicaid |
$12.85
|
| Rate for Payer: UHCCP Medicaid |
$12.85
|
| Rate for Payer: UHCCP Medicaid |
$12.85
|
| Rate for Payer: UMR Bronson Commercial |
$126.24
|
| Rate for Payer: UMR Bronson Commercial |
$112.57
|
| Rate for Payer: UMR Bronson Commercial |
$247.98
|
| Rate for Payer: VA VA |
$23.98
|
| Rate for Payer: VA VA |
$23.98
|
| Rate for Payer: VA VA |
$23.98
|
| Rate for Payer: Aetna American Axle |
$197.76
|
| Rate for Payer: Aetna American Axle |
$221.78
|
| Rate for Payer: Aetna American Axle |
$435.64
|
| Rate for Payer: Aetna Commercial |
$569.68
|
| Rate for Payer: Aetna Commercial |
$258.60
|
| Rate for Payer: Aetna Commercial |
$290.02
|
| Rate for Payer: Aetna Medicare |
$24.94
|
| Rate for Payer: Aetna Medicare |
$24.94
|
| Rate for Payer: Aetna Medicare |
$24.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.98
|
| Rate for Payer: BCBS Complete |
$13.50
|
| Rate for Payer: BCBS Complete |
$13.50
|
| Rate for Payer: BCBS Complete |
$13.50
|
| Rate for Payer: BCBS MAPPO |
$23.98
|
| Rate for Payer: BCBS MAPPO |
$23.98
|
| Rate for Payer: BCBS MAPPO |
$23.98
|
| Rate for Payer: BCBS Trust/PPO |
$62.88
|
| Rate for Payer: BCBS Trust/PPO |
$62.88
|
| Rate for Payer: BCBS Trust/PPO |
$62.88
|
| Rate for Payer: BCN Commercial |
$62.88
|
| Rate for Payer: BCN Commercial |
$62.88
|
| Rate for Payer: BCN Commercial |
$62.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.98
|
| Rate for Payer: BCN Medicare Advantage |
$23.98
|
| Rate for Payer: BCN Medicare Advantage |
$23.98
|
| Rate for Payer: Cash Price |
$536.17
|
| Rate for Payer: Cash Price |
$243.39
|
| Rate for Payer: Cash Price |
$243.39
|
| Rate for Payer: Cash Price |
$536.17
|
| Rate for Payer: Cash Price |
$272.96
|
| Rate for Payer: Cash Price |
$272.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.98
|
| Rate for Payer: Healthscope Commercial |
$273.82
|
| Rate for Payer: Healthscope Commercial |
$603.19
|
| Rate for Payer: Healthscope Commercial |
$307.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$469.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.18
|
| Rate for Payer: Mclaren Medicaid |
$12.85
|
| Rate for Payer: Mclaren Medicaid |
$12.85
|
| Rate for Payer: Mclaren Medicaid |
$12.85
|
| Rate for Payer: Mclaren Medicare |
$23.98
|
| Rate for Payer: Mclaren Medicare |
$23.98
|
| Rate for Payer: Mclaren Medicare |
$23.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.18
|
| Rate for Payer: Meridian Medicaid |
$13.50
|
| Rate for Payer: Meridian Medicaid |
$13.50
|
| Rate for Payer: Meridian Medicaid |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.02
|
| Rate for Payer: Nomi Health Commercial |
$71.94
|
| Rate for Payer: Nomi Health Commercial |
$71.94
|
| Rate for Payer: Nomi Health Commercial |
$71.94
|
| Rate for Payer: PACE Medicare |
$22.78
|
| Rate for Payer: PACE Medicare |
$22.78
|
| Rate for Payer: PACE Medicare |
$22.78
|
| Rate for Payer: PACE SWMI |
$23.98
|
| Rate for Payer: PACE SWMI |
$23.98
|
| Rate for Payer: PACE SWMI |
$23.98
|
| Rate for Payer: PHP Commercial |
$290.02
|
| Rate for Payer: PHP Commercial |
$258.60
|
| Rate for Payer: PHP Commercial |
$569.68
|
| Rate for Payer: PHP Medicare Advantage |
$23.98
|
| Rate for Payer: PHP Medicare Advantage |
$23.98
|
| Rate for Payer: PHP Medicare Advantage |
$23.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.13
|
| Rate for Payer: Priority Health Medicare |
$23.98
|
| Rate for Payer: Priority Health Medicare |
$23.98
|
| Rate for Payer: Priority Health Medicare |
$23.98
|
| Rate for Payer: Priority Health Narrow Network |
$53.70
|
| Rate for Payer: Priority Health Narrow Network |
$53.70
|
| Rate for Payer: Priority Health Narrow Network |
$53.70
|
| Rate for Payer: Priority Health SBD |
$191.67
|
| Rate for Payer: Priority Health SBD |
$214.96
|
| Rate for Payer: Priority Health SBD |
$422.23
|
| Rate for Payer: Railroad Medicare Medicare |
$23.98
|
| Rate for Payer: Railroad Medicare Medicare |
$23.98
|
| Rate for Payer: Railroad Medicare Medicare |
$23.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.98
|
| Rate for Payer: UHC Exchange |
$45.83
|
| Rate for Payer: UHC Exchange |
$45.83
|
| Rate for Payer: UHC Exchange |
$45.83
|
| Rate for Payer: UHC Medicare Advantage |
$23.98
|
| Rate for Payer: UHC Medicare Advantage |
$23.98
|
| Rate for Payer: UHC Medicare Advantage |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.90
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION
|
Facility
|
IP
|
$304.24
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
21900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.87 |
| Max. Negotiated Rate |
$273.82 |
| Rate for Payer: Aetna Commercial |
$569.68
|
| Rate for Payer: Aetna American Axle |
$197.76
|
| Rate for Payer: Aetna American Axle |
$221.78
|
| Rate for Payer: Aetna American Axle |
$435.64
|
| Rate for Payer: Aetna Commercial |
$290.02
|
| Rate for Payer: Aetna Commercial |
$258.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.78
|
| Rate for Payer: Cash Price |
$536.17
|
| Rate for Payer: Cash Price |
$272.96
|
| Rate for Payer: Cash Price |
$243.39
|
| Rate for Payer: Cofinity Commercial |
$261.65
|
| Rate for Payer: Cofinity Commercial |
$293.43
|
| Rate for Payer: Cofinity Commercial |
$238.84
|
| Rate for Payer: Cofinity Commercial |
$576.38
|
| Rate for Payer: Cofinity Commercial |
$469.15
|
| Rate for Payer: Cofinity Commercial |
$212.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$469.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.96
|
| Rate for Payer: Healthscope Commercial |
$307.08
|
| Rate for Payer: Healthscope Commercial |
$273.82
|
| Rate for Payer: Healthscope Commercial |
$603.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$469.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.02
|
| Rate for Payer: PHP Commercial |
$569.68
|
| Rate for Payer: PHP Commercial |
$290.02
|
| Rate for Payer: PHP Commercial |
$258.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.76
|
| Rate for Payer: Priority Health SBD |
$422.23
|
| Rate for Payer: Priority Health SBD |
$214.96
|
| Rate for Payer: Priority Health SBD |
$191.67
|
| Rate for Payer: UMR Bronson Commercial |
$133.87
|
| Rate for Payer: UMR Bronson Commercial |
$294.89
|
| Rate for Payer: UMR Bronson Commercial |
$150.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.90
|
|
|
AMPICILLIN 1 GRAM CUSTOM SOLUTION FOR INJECTION (CHARGE IN INCREMENTS)
|
Facility
|
IP
|
$23.55
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
|
|
AMPICILLIN 1 GRAM CUSTOM SOLUTION FOR INJECTION (CHARGE IN INCREMENTS)
|
Facility
|
OP
|
$23.55
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Medicare |
$11.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: UMR Bronson Commercial |
$8.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$22.39
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna American Axle |
$14.55
|
| Rate for Payer: Aetna American Axle |
$13.37
|
| Rate for Payer: Aetna American Axle |
$11.91
|
| Rate for Payer: Aetna American Axle |
$20.18
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Commercial |
$15.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cofinity Commercial |
$12.82
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Commercial |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$15.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$15.57
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.91
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: Priority Health SBD |
$11.54
|
| Rate for Payer: Priority Health SBD |
$12.96
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.85
|
| Rate for Payer: UMR Bronson Commercial |
$13.66
|
| Rate for Payer: UMR Bronson Commercial |
$9.05
|
| Rate for Payer: UMR Bronson Commercial |
$8.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.79
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$31.04
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$27.94 |
| Rate for Payer: Aetna American Axle |
$20.18
|
| Rate for Payer: Aetna American Axle |
$14.55
|
| Rate for Payer: Aetna American Axle |
$11.91
|
| Rate for Payer: Aetna American Axle |
$13.37
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Commercial |
$15.57
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: Aetna Medicare |
$10.28
|
| Rate for Payer: Aetna Medicare |
$9.16
|
| Rate for Payer: Aetna Medicare |
$15.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.37
|
| Rate for Payer: BCBS Complete |
$8.96
|
| Rate for Payer: BCBS Complete |
$7.33
|
| Rate for Payer: BCBS Complete |
$12.42
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Cofinity Commercial |
$12.82
|
| Rate for Payer: Cofinity Commercial |
$15.76
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$21.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.66
|
| Rate for Payer: Healthscope Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$18.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.57
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: PHP Commercial |
$15.57
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.55
|
| Rate for Payer: Priority Health SBD |
$11.54
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: Priority Health SBD |
$12.96
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: UMR Bronson Commercial |
$6.78
|
| Rate for Payer: UMR Bronson Commercial |
$8.28
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$7.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION (BMH OSC)
|
Facility
|
IP
|
$20.57
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
169408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$18.51 |
| Rate for Payer: Aetna American Axle |
$13.37
|
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.37
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$18.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.48
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.37
|
| Rate for Payer: Priority Health SBD |
$12.96
|
| Rate for Payer: UMR Bronson Commercial |
$9.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.43
|
|
