|
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 Advantage |
$541.52
|
| Rate for Payer: Cofinity Commercial |
$665.30
|
| 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: MI Amish Medical Board Commercial |
$618.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$657.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$580.20
|
| Rate for Payer: PHP Commercial |
$657.56
|
| Rate for Payer: Priority Health SBD |
$487.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.84
|
| Rate for Payer: UHC Core |
$403.05
|
| Rate for Payer: UHC Exchange |
$304.02
|
| 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 Advantage |
$541.52
|
| Rate for Payer: Cofinity Commercial |
$665.30
|
| 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: Opus (Opus Packaging Group) HMA |
$580.20
|
| Rate for Payer: PHP Commercial |
$657.56
|
| 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
|
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: 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 |
$140.35
|
| Rate for Payer: BCN Commercial |
$140.35
|
| Rate for Payer: Cash Price |
$124.99
|
| Rate for Payer: Cash Price |
$124.99
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$124.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.18
|
| Rate for Payer: PHP Commercial |
$132.80
|
| Rate for Payer: Priority Health SBD |
$98.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.43
|
| Rate for Payer: UHC Core |
$71.43
|
| Rate for Payer: UHC Exchange |
$71.43
|
| Rate for Payer: UMR Bronson Commercial |
$57.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.18
|
|
|
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 Advantage |
$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: Opus (Opus Packaging Group) HMA |
$117.18
|
| Rate for Payer: PHP Commercial |
$132.80
|
| 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 LIPOSOME 50 MG INTRAVENOUS SUSPENSION
|
Facility
|
IP
|
$351.42
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
21900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.62 |
| Max. Negotiated Rate |
$316.28 |
| Rate for Payer: Aetna American Axle |
$228.42
|
| Rate for Payer: Aetna American Axle |
$435.64
|
| Rate for Payer: Aetna American Axle |
$249.79
|
| Rate for Payer: Aetna Commercial |
$326.65
|
| Rate for Payer: Aetna Commercial |
$298.71
|
| Rate for Payer: Aetna Commercial |
$569.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.79
|
| Rate for Payer: Cash Price |
$307.43
|
| Rate for Payer: Cash Price |
$281.14
|
| Rate for Payer: Cash Price |
$536.17
|
| Rate for Payer: Cofinity Advantage |
$469.15
|
| Rate for Payer: Cofinity Advantage |
$245.99
|
| Rate for Payer: Cofinity Advantage |
$269.00
|
| Rate for Payer: Cofinity Commercial |
$576.38
|
| Rate for Payer: Cofinity Commercial |
$302.22
|
| Rate for Payer: Cofinity Commercial |
$330.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.17
|
| Rate for Payer: Healthscope Commercial |
$345.86
|
| Rate for Payer: Healthscope Commercial |
$603.19
|
| Rate for Payer: Healthscope Commercial |
$316.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$469.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$502.66
|
| Rate for Payer: PHP Commercial |
$326.65
|
| Rate for Payer: PHP Commercial |
$298.71
|
| Rate for Payer: PHP Commercial |
$569.68
|
| Rate for Payer: Priority Health SBD |
$221.39
|
| Rate for Payer: Priority Health SBD |
$242.10
|
| Rate for Payer: Priority Health SBD |
$422.23
|
| Rate for Payer: UMR Bronson Commercial |
$154.62
|
| Rate for Payer: UMR Bronson Commercial |
$294.89
|
| Rate for Payer: UMR Bronson Commercial |
$169.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.66
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$670.21
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
21900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$603.19 |
| Rate for Payer: Aetna American Axle |
$435.64
|
| Rate for Payer: Aetna American Axle |
$228.42
|
| Rate for Payer: Aetna American Axle |
$249.79
|
| Rate for Payer: Aetna Commercial |
$569.68
|
| Rate for Payer: Aetna Commercial |
$326.65
|
| Rate for Payer: Aetna Commercial |
$298.71
|
| Rate for Payer: Aetna Medicare |
$23.72
|
| Rate for Payer: Aetna Medicare |
$23.72
|
| Rate for Payer: Aetna Medicare |
$23.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.51
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS MAPPO |
$22.81
|
| Rate for Payer: BCBS MAPPO |
$22.81
|
| Rate for Payer: BCBS MAPPO |
$22.81
|
| Rate for Payer: BCBS Trust/PPO |
$67.18
|
| Rate for Payer: BCBS Trust/PPO |
$67.18
|
| Rate for Payer: BCBS Trust/PPO |
$67.18
|
| Rate for Payer: BCN Commercial |
$67.18
|
| Rate for Payer: BCN Commercial |
$67.18
|
| Rate for Payer: BCN Commercial |
$67.18
|
| Rate for Payer: BCN Medicare Advantage |
$22.81
|
| Rate for Payer: BCN Medicare Advantage |
$22.81
|
| Rate for Payer: BCN Medicare Advantage |
$22.81
|
| Rate for Payer: Cash Price |
$307.43
|
| Rate for Payer: Cash Price |
$536.17
|
| Rate for Payer: Cash Price |
$281.14
|
| Rate for Payer: Cash Price |
$536.17
|
| Rate for Payer: Cash Price |
$307.43
|
| Rate for Payer: Cash Price |
$281.14
|
| Rate for Payer: Cofinity Advantage |
$245.99
|
| Rate for Payer: Cofinity Advantage |
$269.00
|
| Rate for Payer: Cofinity Advantage |
$469.15
|
| Rate for Payer: Cofinity Commercial |
$330.49
|
| Rate for Payer: Cofinity Commercial |
$576.38
|
| Rate for Payer: Cofinity Commercial |
$302.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.81
|
| Rate for Payer: Healthscope Commercial |
$316.28
|
| Rate for Payer: Healthscope Commercial |
$345.86
|
| Rate for Payer: Healthscope Commercial |
$603.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$469.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.56
|
| Rate for Payer: Mclaren Medicaid |
$22.81
|
| Rate for Payer: Mclaren Medicaid |
$22.81
|
| Rate for Payer: Mclaren Medicaid |
$22.81
|
| Rate for Payer: Mclaren Medicare |
$22.81
|
| Rate for Payer: Mclaren Medicare |
$22.81
|
| Rate for Payer: Mclaren Medicare |
$22.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.95
|
| Rate for Payer: Meridian Medicaid |
$23.95
|
| Rate for Payer: Meridian Medicaid |
$23.95
|
| Rate for Payer: Meridian Medicaid |
$23.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.68
|
| Rate for Payer: Nomi Health Commercial |
$68.43
|
| Rate for Payer: Nomi Health Commercial |
$68.43
|
| Rate for Payer: Nomi Health Commercial |
$68.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$502.66
|
| Rate for Payer: PACE Medicare |
$21.67
|
| Rate for Payer: PACE Medicare |
$21.67
|
| Rate for Payer: PACE Medicare |
$21.67
|
| Rate for Payer: PACE SWMI |
$22.81
|
| Rate for Payer: PACE SWMI |
$22.81
|
| Rate for Payer: PACE SWMI |
$22.81
|
| Rate for Payer: PHP Commercial |
$569.68
|
| Rate for Payer: PHP Commercial |
$298.71
|
| Rate for Payer: PHP Commercial |
$326.65
|
| Rate for Payer: PHP Medicare Advantage |
$22.81
|
| Rate for Payer: PHP Medicare Advantage |
$22.81
|
| Rate for Payer: PHP Medicare Advantage |
$22.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$67.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$67.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$67.76
|
| Rate for Payer: Priority Health Medicare |
$22.81
|
| Rate for Payer: Priority Health Medicare |
$22.81
|
| Rate for Payer: Priority Health Medicare |
$22.81
|
| Rate for Payer: Priority Health SBD |
$422.23
|
| Rate for Payer: Priority Health SBD |
$242.10
|
| Rate for Payer: Priority Health SBD |
$221.39
|
| Rate for Payer: Priority Health Tiered Network |
$54.21
|
| Rate for Payer: Priority Health Tiered Network |
$54.21
|
| Rate for Payer: Priority Health Tiered Network |
$54.21
|
| Rate for Payer: Railroad Medicare Medicare |
$22.81
|
| Rate for Payer: Railroad Medicare Medicare |
$22.81
|
| Rate for Payer: Railroad Medicare Medicare |
$22.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.19
|
| Rate for Payer: UHC Core |
$34.19
|
| Rate for Payer: UHC Core |
$34.19
|
| Rate for Payer: UHC Core |
$34.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.81
|
| Rate for Payer: UHC Exchange |
$34.19
|
| Rate for Payer: UHC Exchange |
$34.19
|
| Rate for Payer: UHC Exchange |
$34.19
|
| Rate for Payer: UHC Medicaid |
$11.93
|
| Rate for Payer: UHC Medicaid |
$11.93
|
| Rate for Payer: UHC Medicaid |
$11.93
|
| Rate for Payer: UHCCP Medicaid |
$11.93
|
| Rate for Payer: UHCCP Medicaid |
$11.93
|
| Rate for Payer: UHCCP Medicaid |
$11.93
|
| Rate for Payer: UMR Bronson Commercial |
$142.19
|
| Rate for Payer: UMR Bronson Commercial |
$130.03
|
| Rate for Payer: UMR Bronson Commercial |
$247.98
|
| Rate for Payer: VA VA |
$22.81
|
| Rate for Payer: VA VA |
$22.81
|
| Rate for Payer: VA VA |
$22.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.22
|
|
|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$92.08
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$82.87 |
| Rate for Payer: Aetna American Axle |
$59.85
|
| Rate for Payer: Aetna Commercial |
$78.27
|
| Rate for Payer: Aetna Medicare |
$46.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.85
|
| Rate for Payer: BCBS Complete |
$36.83
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$73.66
|
| Rate for Payer: Cash Price |
$73.66
|
| Rate for Payer: Cofinity Advantage |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$79.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.66
|
| Rate for Payer: Healthscope Commercial |
$82.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.06
|
| Rate for Payer: PHP Commercial |
$78.27
|
| Rate for Payer: Priority Health SBD |
$58.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$34.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.06
|
|
|
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 |
$0.97 |
| 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 |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Advantage |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| 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: MI Amish Medical Board Commercial |
$18.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$8.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
|
|
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 Advantage |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| 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: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: PHP Commercial |
$20.02
|
| 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 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 |
$13.32
|
| Rate for Payer: Aetna American Axle |
$20.18
|
| Rate for Payer: Aetna American Axle |
$12.75
|
| Rate for Payer: Aetna American Axle |
$10.84
|
| Rate for Payer: Aetna Commercial |
$14.18
|
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna Commercial |
$16.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cofinity Advantage |
$11.68
|
| Rate for Payer: Cofinity Advantage |
$21.73
|
| Rate for Payer: Cofinity Advantage |
$13.73
|
| Rate for Payer: Cofinity Advantage |
$15.67
|
| Rate for Payer: Cofinity Advantage |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Commercial |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$16.87
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Healthscope Commercial |
$15.01
|
| Rate for Payer: Healthscope Commercial |
$17.66
|
| Rate for Payer: Healthscope Commercial |
$18.44
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.37
|
| 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 |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: PHP Commercial |
$14.18
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$16.68
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: Priority Health SBD |
$12.36
|
| Rate for Payer: Priority Health SBD |
$10.51
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: UMR Bronson Commercial |
$8.63
|
| Rate for Payer: UMR Bronson Commercial |
$13.66
|
| Rate for Payer: UMR Bronson Commercial |
$9.02
|
| Rate for Payer: UMR Bronson Commercial |
$7.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.71
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$16.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$15.01 |
| Rate for Payer: Aetna American Axle |
$10.84
|
| Rate for Payer: Aetna American Axle |
$14.55
|
| Rate for Payer: Aetna American Axle |
$13.32
|
| Rate for Payer: Aetna American Axle |
$12.75
|
| Rate for Payer: Aetna American Axle |
$20.18
|
| Rate for Payer: Aetna Commercial |
$14.18
|
| Rate for Payer: Aetna Commercial |
$16.68
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna Medicare |
$15.52
|
| Rate for Payer: Aetna Medicare |
$9.81
|
| Rate for Payer: Aetna Medicare |
$8.34
|
| Rate for Payer: Aetna Medicare |
$10.24
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: BCBS Complete |
$8.96
|
| Rate for Payer: BCBS Complete |
$6.67
|
| Rate for Payer: BCBS Complete |
$7.85
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS Complete |
$12.42
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cofinity Advantage |
$15.67
|
| Rate for Payer: Cofinity Advantage |
$13.73
|
| Rate for Payer: Cofinity Advantage |
$14.34
|
| Rate for Payer: Cofinity Advantage |
$21.73
|
| Rate for Payer: Cofinity Advantage |
$11.68
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$16.87
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| 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 |
$15.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$18.44
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$15.01
|
| Rate for Payer: Healthscope Commercial |
$17.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.28
|
| Rate for Payer: PHP Commercial |
$16.68
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$14.18
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: Priority Health SBD |
$10.51
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: Priority Health SBD |
$12.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$6.17
|
| Rate for Payer: UMR Bronson Commercial |
$8.28
|
| Rate for Payer: UMR Bronson Commercial |
$7.58
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$7.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.51
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION (BMH OSC)
|
Facility
|
OP
|
$20.49
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
169408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna American Axle |
$13.32
|
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna Medicare |
$10.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cofinity Advantage |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$18.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.37
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$7.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.37
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION (BMH OSC)
|
Facility
|
IP
|
$20.49
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
169408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna American Axle |
$13.32
|
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cofinity Advantage |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$18.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.37
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: UMR Bronson Commercial |
$9.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.37
|
|
|
AMPICILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$20.49
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna American Axle |
$13.32
|
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna Medicare |
$10.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cofinity Advantage |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$18.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.37
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$7.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.37
|
|
|
AMPICILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$20.49
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna American Axle |
$13.32
|
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cofinity Advantage |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$18.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.37
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: UMR Bronson Commercial |
$9.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.37
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$18.25
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$16.43 |
| Rate for Payer: Aetna American Axle |
$11.86
|
| Rate for Payer: Aetna American Axle |
$19.13
|
| Rate for Payer: Aetna American Axle |
$21.33
|
| Rate for Payer: Aetna American Axle |
$11.32
|
| Rate for Payer: Aetna American Axle |
$36.06
|
| Rate for Payer: Aetna American Axle |
$13.29
|
| Rate for Payer: Aetna Commercial |
$47.15
|
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Commercial |
$25.02
|
| Rate for Payer: Aetna Commercial |
$15.51
|
| Rate for Payer: Aetna Medicare |
$8.71
|
| Rate for Payer: Aetna Medicare |
$9.12
|
| Rate for Payer: Aetna Medicare |
$10.22
|
| Rate for Payer: Aetna Medicare |
$27.73
|
| Rate for Payer: Aetna Medicare |
$16.41
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.13
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Complete |
$7.30
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS Complete |
$11.77
|
| Rate for Payer: BCBS Complete |
$13.13
|
| Rate for Payer: BCBS Complete |
$22.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$44.38
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Cash Price |
$44.38
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cofinity Advantage |
$20.60
|
| Rate for Payer: Cofinity Advantage |
$14.31
|
| Rate for Payer: Cofinity Advantage |
$38.83
|
| Rate for Payer: Cofinity Advantage |
$12.19
|
| Rate for Payer: Cofinity Advantage |
$12.78
|
| Rate for Payer: Cofinity Advantage |
$22.97
|
| Rate for Payer: Cofinity Commercial |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$15.70
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.26
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$29.54
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$49.92
|
| Rate for Payer: Healthscope Commercial |
$16.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.33
|
| Rate for Payer: PHP Commercial |
$15.51
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: PHP Commercial |
$25.02
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: PHP Commercial |
$27.90
|
| Rate for Payer: PHP Commercial |
$47.15
|
| Rate for Payer: Priority Health SBD |
$18.54
|
| Rate for Payer: Priority Health SBD |
$10.97
|
| Rate for Payer: Priority Health SBD |
$11.50
|
| Rate for Payer: Priority Health SBD |
$34.95
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: Priority Health SBD |
$20.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$10.89
|
| Rate for Payer: UMR Bronson Commercial |
$12.14
|
| Rate for Payer: UMR Bronson Commercial |
$6.75
|
| Rate for Payer: UMR Bronson Commercial |
$6.45
|
| Rate for Payer: UMR Bronson Commercial |
$20.52
|
| Rate for Payer: UMR Bronson Commercial |
$7.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.69
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$32.82
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.44 |
| 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 |
$36.06
|
| Rate for Payer: Aetna American Axle |
$11.86
|
| Rate for Payer: Aetna American Axle |
$11.32
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Commercial |
$25.02
|
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Commercial |
$47.15
|
| Rate for Payer: Aetna Commercial |
$15.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.06
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Cash Price |
$44.38
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cofinity Advantage |
$12.19
|
| Rate for Payer: Cofinity Advantage |
$38.83
|
| Rate for Payer: Cofinity Advantage |
$12.78
|
| Rate for Payer: Cofinity Advantage |
$22.97
|
| Rate for Payer: Cofinity Advantage |
$20.60
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$15.70
|
| Rate for Payer: Cofinity Commercial |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$28.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.38
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.54
|
| Rate for Payer: Healthscope Commercial |
$49.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.81
|
| 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 |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.61
|
| Rate for Payer: PHP Commercial |
$25.02
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: PHP Commercial |
$27.90
|
| Rate for Payer: PHP Commercial |
$47.15
|
| Rate for Payer: PHP Commercial |
$15.51
|
| Rate for Payer: Priority Health SBD |
$20.68
|
| Rate for Payer: Priority Health SBD |
$34.95
|
| Rate for Payer: Priority Health SBD |
$11.50
|
| Rate for Payer: Priority Health SBD |
$10.97
|
| Rate for Payer: Priority Health SBD |
$18.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.03
|
| Rate for Payer: UMR Bronson Commercial |
$24.41
|
| Rate for Payer: UMR Bronson Commercial |
$12.95
|
| Rate for Payer: UMR Bronson Commercial |
$7.66
|
| Rate for Payer: UMR Bronson Commercial |
$14.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.69
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$17.42
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$15.68 |
| Rate for Payer: Aetna American Axle |
$11.32
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Medicare |
$8.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.32
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cofinity Advantage |
$12.19
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.06
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: Priority Health SBD |
$10.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$6.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.06
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$17.42
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$15.68 |
| Rate for Payer: Aetna American Axle |
$11.32
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.32
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cofinity Advantage |
$12.19
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.06
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: Priority Health SBD |
$10.97
|
| Rate for Payer: UMR Bronson Commercial |
$7.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.06
|
|
|
AMPICILLIN 500 MG/5 ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna American Axle |
$6.94
|
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cofinity Advantage |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$9.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.01
|
| Rate for Payer: PHP Commercial |
$9.08
|
| Rate for Payer: Priority Health SBD |
$6.73
|
| Rate for Payer: UMR Bronson Commercial |
$4.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.01
|
|
|
AMPICILLIN 500 MG/5 ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna American Axle |
$6.94
|
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: BCBS Complete |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cofinity Advantage |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$9.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.01
|
| Rate for Payer: PHP Commercial |
$9.08
|
| Rate for Payer: Priority Health SBD |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$3.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.01
|
|
|
AMPICILLIN 500 MG IM
|
Facility
|
IP
|
$10.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna American Axle |
$6.94
|
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cofinity Advantage |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$9.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.01
|
| Rate for Payer: PHP Commercial |
$9.08
|
| Rate for Payer: Priority Health SBD |
$6.73
|
| Rate for Payer: UMR Bronson Commercial |
$4.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.01
|
|
|
AMPICILLIN 500 MG IM
|
Facility
|
OP
|
$10.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna American Axle |
$6.94
|
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: BCBS Complete |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cofinity Advantage |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$9.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.01
|
| Rate for Payer: PHP Commercial |
$9.08
|
| Rate for Payer: Priority Health SBD |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$3.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.01
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$10.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna American Axle |
$6.94
|
| Rate for Payer: Aetna American Axle |
$10.97
|
| Rate for Payer: Aetna American Axle |
$10.35
|
| Rate for Payer: Aetna American Axle |
$8.68
|
| Rate for Payer: Aetna American Axle |
$12.14
|
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna Commercial |
$11.36
|
| Rate for Payer: Aetna Commercial |
$15.88
|
| Rate for Payer: Aetna Commercial |
$14.34
|
| Rate for Payer: Aetna Commercial |
$13.54
|
| Rate for Payer: Aetna Medicare |
$9.34
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.14
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS Complete |
$4.27
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS Complete |
$6.37
|
| Rate for Payer: BCBS Complete |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$14.94
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: Cash Price |
$14.94
|
| Rate for Payer: Cofinity Advantage |
$11.81
|
| Rate for Payer: Cofinity Advantage |
$9.35
|
| Rate for Payer: Cofinity Advantage |
$11.15
|
| Rate for Payer: Cofinity Advantage |
$13.08
|
| Rate for Payer: Cofinity Advantage |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Cofinity Commercial |
$11.49
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Cofinity Commercial |
$16.06
|
| 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 |
$10.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.34
|
| Rate for Payer: Healthscope Commercial |
$16.81
|
| Rate for Payer: Healthscope Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$9.61
|
| Rate for Payer: Healthscope Commercial |
$12.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.01
|
| Rate for Payer: PHP Commercial |
$11.36
|
| Rate for Payer: PHP Commercial |
$13.54
|
| Rate for Payer: PHP Commercial |
$15.88
|
| Rate for Payer: PHP Commercial |
$14.34
|
| Rate for Payer: PHP Commercial |
$9.08
|
| Rate for Payer: Priority Health SBD |
$10.04
|
| Rate for Payer: Priority Health SBD |
$6.73
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: Priority Health SBD |
$11.77
|
| Rate for Payer: Priority Health SBD |
$8.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$3.95
|
| Rate for Payer: UMR Bronson Commercial |
$6.24
|
| Rate for Payer: UMR Bronson Commercial |
$5.89
|
| Rate for Payer: UMR Bronson Commercial |
$6.91
|
| Rate for Payer: UMR Bronson Commercial |
$4.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.01
|
|
|
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 |
$10.35
|
| Rate for Payer: Aetna American Axle |
$12.14
|
| Rate for Payer: Aetna American Axle |
$8.68
|
| Rate for Payer: Aetna American Axle |
$6.94
|
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna Commercial |
$13.54
|
| Rate for Payer: Aetna Commercial |
$14.34
|
| Rate for Payer: Aetna Commercial |
$15.88
|
| Rate for Payer: Aetna Commercial |
$11.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.14
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: Cash Price |
$14.94
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cofinity Advantage |
$7.48
|
| Rate for Payer: Cofinity Advantage |
$13.08
|
| Rate for Payer: Cofinity Advantage |
$9.35
|
| Rate for Payer: Cofinity Advantage |
$11.81
|
| Rate for Payer: Cofinity Advantage |
$11.15
|
| Rate for Payer: Cofinity Commercial |
$16.06
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Cofinity Commercial |
$11.49
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.94
|
| Rate for Payer: Healthscope Commercial |
$9.61
|
| Rate for Payer: Healthscope Commercial |
$12.02
|
| Rate for Payer: Healthscope Commercial |
$14.34
|
| Rate for Payer: Healthscope Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$16.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.95
|
| 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 |
$9.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.65
|
| Rate for Payer: PHP Commercial |
$13.54
|
| Rate for Payer: PHP Commercial |
$9.08
|
| Rate for Payer: PHP Commercial |
$14.34
|
| Rate for Payer: PHP Commercial |
$15.88
|
| Rate for Payer: PHP Commercial |
$11.36
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: Priority Health SBD |
$11.77
|
| Rate for Payer: Priority Health SBD |
$8.42
|
| Rate for Payer: Priority Health SBD |
$6.73
|
| Rate for Payer: Priority Health SBD |
$10.04
|
| Rate for Payer: UMR Bronson Commercial |
$5.88
|
| Rate for Payer: UMR Bronson Commercial |
$8.22
|
| Rate for Payer: UMR Bronson Commercial |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$4.70
|
| Rate for Payer: UMR Bronson Commercial |
$7.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.02
|
|
