|
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
|
|
|
AMPICILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$20.57
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301726
|
|
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
|
|
|
AMPICILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$20.57
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$18.51 |
| Rate for Payer: Aetna American Axle |
$13.37
|
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Medicare |
$10.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.37
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$16.46
|
| 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 |
$7.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.43
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$29.43
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Aetna American Axle |
$19.13
|
| Rate for Payer: Aetna American Axle |
$11.56
|
| Rate for Payer: Aetna American Axle |
$10.26
|
| Rate for Payer: Aetna American Axle |
$21.33
|
| Rate for Payer: Aetna Commercial |
$25.02
|
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Commercial |
$13.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.13
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Cofinity Commercial |
$11.05
|
| Rate for Payer: Cofinity Commercial |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$22.97
|
| Rate for Payer: Cofinity Commercial |
$20.60
|
| Rate for Payer: Cofinity Commercial |
$12.45
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$13.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$14.20
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$29.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.02
|
| Rate for Payer: PHP Commercial |
$25.02
|
| Rate for Payer: PHP Commercial |
$27.90
|
| Rate for Payer: PHP Commercial |
$13.41
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.26
|
| Rate for Payer: Priority Health SBD |
$20.68
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$11.20
|
| Rate for Payer: Priority Health SBD |
$18.54
|
| Rate for Payer: UMR Bronson Commercial |
$12.95
|
| Rate for Payer: UMR Bronson Commercial |
$14.44
|
| Rate for Payer: UMR Bronson Commercial |
$7.82
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.07
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$32.82
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$29.54 |
| Rate for Payer: Aetna American Axle |
$21.33
|
| Rate for Payer: Aetna American Axle |
$19.13
|
| Rate for Payer: Aetna American Axle |
$10.26
|
| Rate for Payer: Aetna American Axle |
$11.56
|
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Commercial |
$13.41
|
| Rate for Payer: Aetna Commercial |
$25.02
|
| Rate for Payer: Aetna Medicare |
$14.72
|
| Rate for Payer: Aetna Medicare |
$8.89
|
| Rate for Payer: Aetna Medicare |
$7.89
|
| Rate for Payer: Aetna Medicare |
$16.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.56
|
| Rate for Payer: BCBS Complete |
$11.77
|
| Rate for Payer: BCBS Complete |
$6.31
|
| Rate for Payer: BCBS Complete |
$13.13
|
| Rate for Payer: BCBS Complete |
$7.11
|
| 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 |
$14.22
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Cofinity Commercial |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$11.05
|
| Rate for Payer: Cofinity Commercial |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$12.45
|
| Rate for Payer: Cofinity Commercial |
$20.60
|
| Rate for Payer: Cofinity Commercial |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$22.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Healthscope Commercial |
$14.20
|
| Rate for Payer: Healthscope Commercial |
$29.54
|
| Rate for Payer: Healthscope Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.41
|
| Rate for Payer: PHP Commercial |
$27.90
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: PHP Commercial |
$13.41
|
| Rate for Payer: PHP Commercial |
$25.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.13
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$18.54
|
| Rate for Payer: Priority Health SBD |
$11.20
|
| Rate for Payer: Priority Health SBD |
$20.68
|
| Rate for Payer: UMR Bronson Commercial |
$5.84
|
| Rate for Payer: UMR Bronson Commercial |
$10.89
|
| Rate for Payer: UMR Bronson Commercial |
$12.14
|
| Rate for Payer: UMR Bronson Commercial |
$6.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.62
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$17.78
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna American Axle |
$11.56
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Medicare |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.56
|
| Rate for Payer: BCBS Complete |
$7.11
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$12.45
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.11
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: Priority Health SBD |
$11.20
|
| Rate for Payer: UMR Bronson Commercial |
$6.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.34
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$17.78
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna American Axle |
$11.56
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.56
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$12.45
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.11
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: Priority Health SBD |
$11.20
|
| Rate for Payer: UMR Bronson Commercial |
$7.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.34
|
|
|
AMPICILLIN 500 MG/5 ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna American Axle |
$6.80
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
|
AMPICILLIN 500 MG/5 ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna American Axle |
$6.80
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
|
AMPICILLIN 500 MG IM
|
Facility
|
OP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna American Axle |
$6.80
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
|
AMPICILLIN 500 MG IM
|
Facility
|
IP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna American Axle |
$6.80
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$16.87
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$15.18 |
| Rate for Payer: Aetna American Axle |
$10.97
|
| Rate for Payer: Aetna American Axle |
$7.72
|
| Rate for Payer: Aetna American Axle |
$6.80
|
| Rate for Payer: Aetna American Axle |
$12.14
|
| Rate for Payer: Aetna Commercial |
$14.34
|
| Rate for Payer: Aetna Commercial |
$15.88
|
| Rate for Payer: Aetna Commercial |
$10.09
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cash Price |
$14.94
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$16.06
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Cofinity Commercial |
$11.81
|
| Rate for Payer: Cofinity Commercial |
$10.21
|
| Rate for Payer: Cofinity Commercial |
$8.31
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.50
|
| Rate for Payer: Healthscope Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Healthscope Commercial |
$10.68
|
| Rate for Payer: Healthscope Commercial |
$16.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: PHP Commercial |
$14.34
|
| Rate for Payer: PHP Commercial |
$15.88
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$10.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$11.77
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: Priority Health SBD |
$7.48
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: UMR Bronson Commercial |
$7.42
|
| Rate for Payer: UMR Bronson Commercial |
$8.22
|
| Rate for Payer: UMR Bronson Commercial |
$5.22
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.65
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$18.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$16.81 |
| Rate for Payer: Aetna American Axle |
$12.14
|
| Rate for Payer: Aetna American Axle |
$10.97
|
| Rate for Payer: Aetna American Axle |
$6.80
|
| Rate for Payer: Aetna American Axle |
$7.72
|
| Rate for Payer: Aetna Commercial |
$15.88
|
| Rate for Payer: Aetna Commercial |
$10.09
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Commercial |
$14.34
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Aetna Medicare |
$9.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.72
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: BCBS Complete |
$7.47
|
| Rate for Payer: BCBS Complete |
$4.75
|
| 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 |
$9.50
|
| Rate for Payer: Cash Price |
$14.94
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$14.94
|
| Rate for Payer: Cofinity Commercial |
$16.06
|
| Rate for Payer: Cofinity Commercial |
$8.31
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Commercial |
$10.21
|
| Rate for Payer: Cofinity Commercial |
$11.81
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Healthscope Commercial |
$16.81
|
| Rate for Payer: Healthscope Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$10.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$15.88
|
| Rate for Payer: PHP Commercial |
$10.09
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$14.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: Priority Health SBD |
$7.48
|
| Rate for Payer: Priority Health SBD |
$11.77
|
| Rate for Payer: UMR Bronson Commercial |
$3.87
|
| Rate for Payer: UMR Bronson Commercial |
$6.24
|
| Rate for Payer: UMR Bronson Commercial |
$6.91
|
| Rate for Payer: UMR Bronson Commercial |
$4.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.01
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION (BMH OSC)
|
Facility
|
OP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
169409
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna American Axle |
$6.80
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION (BMH OSC)
|
Facility
|
IP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
169409
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna American Axle |
$6.80
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
|
AMPICILLIN IV 0.0004 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Aetna American Axle |
$0.41
|
| Rate for Payer: Aetna Commercial |
$0.54
|
| Rate for Payer: Aetna Medicare |
$0.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.41
|
| Rate for Payer: BCBS Complete |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cofinity Commercial |
$0.44
|
| Rate for Payer: Cofinity Commercial |
$0.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.50
|
| Rate for Payer: Healthscope Commercial |
$0.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.54
|
| Rate for Payer: PHP Commercial |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.41
|
| Rate for Payer: Priority Health SBD |
$0.40
|
| Rate for Payer: UMR Bronson Commercial |
$0.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.47
|
|
|
AMPICILLIN IV 0.0004 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$0.63
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna American Axle |
$0.41
|
| Rate for Payer: Aetna Commercial |
$0.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.41
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cofinity Commercial |
$0.44
|
| Rate for Payer: Cofinity Commercial |
$0.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.50
|
| Rate for Payer: Healthscope Commercial |
$0.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.54
|
| Rate for Payer: PHP Commercial |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.41
|
| Rate for Payer: Priority Health SBD |
$0.40
|
| Rate for Payer: UMR Bronson Commercial |
$0.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.47
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$26.93
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$24.24 |
| Rate for Payer: Aetna American Axle |
$17.50
|
| Rate for Payer: Aetna American Axle |
$18.89
|
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna American Axle |
$14.62
|
| Rate for Payer: Aetna American Axle |
$18.00
|
| Rate for Payer: Aetna American Axle |
$11.59
|
| Rate for Payer: Aetna American Axle |
$12.81
|
| Rate for Payer: Aetna American Axle |
$14.84
|
| Rate for Payer: Aetna American Axle |
$18.41
|
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Commercial |
$19.12
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$16.75
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: Aetna Medicare |
$11.25
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna Medicare |
$8.92
|
| Rate for Payer: Aetna Medicare |
$11.42
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: Aetna Medicare |
$14.53
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Aetna Medicare |
$14.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: BCBS Complete |
$10.77
|
| Rate for Payer: BCBS Complete |
$9.00
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: BCBS Complete |
$9.13
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS Complete |
$11.33
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: BCBS Complete |
$7.13
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$18.85
|
| Rate for Payer: Cofinity Commercial |
$19.63
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$15.98
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$19.35
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Cofinity Commercial |
$15.75
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$18.22
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$20.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: PHP Commercial |
$19.12
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: PHP Commercial |
$19.41
|
| Rate for Payer: PHP Commercial |
$24.07
|
| Rate for Payer: PHP Commercial |
$16.75
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.59
|
| Rate for Payer: Priority Health SBD |
$14.38
|
| Rate for Payer: Priority Health SBD |
$14.18
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: Priority Health SBD |
$12.75
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: Priority Health SBD |
$17.84
|
| Rate for Payer: UMR Bronson Commercial |
$10.48
|
| Rate for Payer: UMR Bronson Commercial |
$10.25
|
| Rate for Payer: UMR Bronson Commercial |
$7.49
|
| Rate for Payer: UMR Bronson Commercial |
$6.60
|
| Rate for Payer: UMR Bronson Commercial |
$9.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.32
|
| Rate for Payer: UMR Bronson Commercial |
$10.75
|
| Rate for Payer: UMR Bronson Commercial |
$7.29
|
| Rate for Payer: UMR Bronson Commercial |
$8.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.12
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$22.50
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna American Axle |
$14.62
|
| Rate for Payer: Aetna American Axle |
$18.89
|
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna American Axle |
$18.41
|
| Rate for Payer: Aetna American Axle |
$14.84
|
| Rate for Payer: Aetna American Axle |
$18.00
|
| Rate for Payer: Aetna American Axle |
$17.50
|
| Rate for Payer: Aetna American Axle |
$11.59
|
| Rate for Payer: Aetna American Axle |
$12.81
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Commercial |
$16.75
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna Commercial |
$19.12
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.84
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$19.35
|
| Rate for Payer: Cofinity Commercial |
$15.75
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$15.98
|
| Rate for Payer: Cofinity Commercial |
$19.63
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Commercial |
$18.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.00
|
| Rate for Payer: Healthscope Commercial |
$18.22
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$20.55
|
| Rate for Payer: Healthscope Commercial |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$17.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$19.41
|
| Rate for Payer: PHP Commercial |
$24.07
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: PHP Commercial |
$19.12
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$16.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: Priority Health SBD |
$14.38
|
| Rate for Payer: Priority Health SBD |
$14.18
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$12.75
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$17.84
|
| Rate for Payer: UMR Bronson Commercial |
$11.85
|
| Rate for Payer: UMR Bronson Commercial |
$12.46
|
| Rate for Payer: UMR Bronson Commercial |
$12.79
|
| Rate for Payer: UMR Bronson Commercial |
$8.67
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: UMR Bronson Commercial |
$7.85
|
| Rate for Payer: UMR Bronson Commercial |
$12.19
|
| Rate for Payer: UMR Bronson Commercial |
$9.90
|
| Rate for Payer: UMR Bronson Commercial |
$10.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$91.05
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.06 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna American Axle |
$59.18
|
| Rate for Payer: Aetna American Axle |
$57.42
|
| Rate for Payer: Aetna American Axle |
$86.95
|
| Rate for Payer: Aetna American Axle |
$64.56
|
| Rate for Payer: Aetna Commercial |
$77.39
|
| Rate for Payer: Aetna Commercial |
$84.43
|
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Commercial |
$113.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.18
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cash Price |
$107.02
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cofinity Commercial |
$115.04
|
| Rate for Payer: Cofinity Commercial |
$85.42
|
| Rate for Payer: Cofinity Commercial |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$63.74
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Cofinity Commercial |
$75.97
|
| Rate for Payer: Cofinity Commercial |
$78.30
|
| Rate for Payer: Cofinity Commercial |
$93.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.67
|
| Rate for Payer: Healthscope Commercial |
$81.94
|
| Rate for Payer: Healthscope Commercial |
$120.39
|
| Rate for Payer: Healthscope Commercial |
$79.51
|
| Rate for Payer: Healthscope Commercial |
$89.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.39
|
| Rate for Payer: PHP Commercial |
$77.39
|
| Rate for Payer: PHP Commercial |
$84.43
|
| Rate for Payer: PHP Commercial |
$113.70
|
| Rate for Payer: PHP Commercial |
$75.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.95
|
| Rate for Payer: Priority Health SBD |
$62.58
|
| Rate for Payer: Priority Health SBD |
$84.28
|
| Rate for Payer: Priority Health SBD |
$55.65
|
| Rate for Payer: Priority Health SBD |
$57.36
|
| Rate for Payer: UMR Bronson Commercial |
$40.06
|
| Rate for Payer: UMR Bronson Commercial |
$43.71
|
| Rate for Payer: UMR Bronson Commercial |
$38.87
|
| Rate for Payer: UMR Bronson Commercial |
$58.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.29
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$99.33
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$89.40 |
| Rate for Payer: Aetna American Axle |
$64.56
|
| Rate for Payer: Aetna American Axle |
$59.18
|
| Rate for Payer: Aetna American Axle |
$86.95
|
| Rate for Payer: Aetna American Axle |
$57.42
|
| Rate for Payer: Aetna Commercial |
$84.43
|
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Commercial |
$113.70
|
| Rate for Payer: Aetna Commercial |
$77.39
|
| Rate for Payer: Aetna Medicare |
$45.52
|
| Rate for Payer: Aetna Medicare |
$44.17
|
| Rate for Payer: Aetna Medicare |
$66.88
|
| Rate for Payer: Aetna Medicare |
$49.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.42
|
| Rate for Payer: BCBS Complete |
$36.42
|
| Rate for Payer: BCBS Complete |
$53.51
|
| Rate for Payer: BCBS Complete |
$39.73
|
| Rate for Payer: BCBS Complete |
$35.34
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cash Price |
$107.02
|
| Rate for Payer: Cash Price |
$107.02
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cofinity Commercial |
$85.42
|
| Rate for Payer: Cofinity Commercial |
$75.97
|
| Rate for Payer: Cofinity Commercial |
$115.04
|
| Rate for Payer: Cofinity Commercial |
$93.64
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Cofinity Commercial |
$63.74
|
| Rate for Payer: Cofinity Commercial |
$78.30
|
| Rate for Payer: Cofinity Commercial |
$69.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.02
|
| Rate for Payer: Healthscope Commercial |
$120.39
|
| Rate for Payer: Healthscope Commercial |
$89.40
|
| Rate for Payer: Healthscope Commercial |
$81.94
|
| Rate for Payer: Healthscope Commercial |
$79.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.70
|
| Rate for Payer: PHP Commercial |
$84.43
|
| Rate for Payer: PHP Commercial |
$75.09
|
| Rate for Payer: PHP Commercial |
$113.70
|
| Rate for Payer: PHP Commercial |
$77.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.18
|
| Rate for Payer: Priority Health SBD |
$84.28
|
| Rate for Payer: Priority Health SBD |
$57.36
|
| Rate for Payer: Priority Health SBD |
$55.65
|
| Rate for Payer: Priority Health SBD |
$62.58
|
| Rate for Payer: UMR Bronson Commercial |
$49.49
|
| Rate for Payer: UMR Bronson Commercial |
$33.69
|
| Rate for Payer: UMR Bronson Commercial |
$36.75
|
| Rate for Payer: UMR Bronson Commercial |
$32.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.50
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION (BMH OSC)
|
Facility
|
OP
|
$19.71
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
169411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$17.74 |
| Rate for Payer: Aetna American Axle |
$12.81
|
| Rate for Payer: Aetna Commercial |
$16.75
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.81
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Healthscope Commercial |
$17.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.75
|
| Rate for Payer: PHP Commercial |
$16.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$7.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.78
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION (BMH OSC)
|
Facility
|
IP
|
$19.71
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
169411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$17.74 |
| Rate for Payer: Aetna American Axle |
$12.81
|
| Rate for Payer: Aetna Commercial |
$16.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.81
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Healthscope Commercial |
$17.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.75
|
| Rate for Payer: PHP Commercial |
$16.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$8.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.78
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$29.06
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$26.15 |
| Rate for Payer: Aetna American Axle |
$18.89
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Medicare |
$14.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.89
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: UMR Bronson Commercial |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$29.06
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$26.15 |
| Rate for Payer: Aetna American Axle |
$18.89
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.89
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: UMR Bronson Commercial |
$12.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
|
