|
AMPICILLIN 500 MG SOLUTION FOR INJECTION (BMH OSC)
|
Facility
|
OP
|
$10.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
169409
|
|
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 (BMH OSC)
|
Facility
|
IP
|
$10.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
169409
|
|
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 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 Advantage |
$0.44
|
| Rate for Payer: Cofinity Commercial |
$0.54
|
| 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: Opus (Opus Packaging Group) HMA |
$0.47
|
| Rate for Payer: PHP Commercial |
$0.54
|
| 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 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 |
$1.91 |
| 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 |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cofinity Advantage |
$0.44
|
| Rate for Payer: Cofinity Commercial |
$0.54
|
| 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: MI Amish Medical Board Commercial |
$0.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.47
|
| Rate for Payer: PHP Commercial |
$0.54
|
| Rate for Payer: Priority Health SBD |
$0.40
|
| 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 |
$0.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.47
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$31.35
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$28.21 |
| Rate for Payer: Aetna American Axle |
$20.38
|
| Rate for Payer: Aetna American Axle |
$18.41
|
| Rate for Payer: Aetna American Axle |
$11.59
|
| Rate for Payer: Aetna American Axle |
$17.50
|
| Rate for Payer: Aetna American Axle |
$14.84
|
| Rate for Payer: Aetna American Axle |
$14.62
|
| Rate for Payer: Aetna American Axle |
$13.87
|
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna Commercial |
$19.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.38
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cofinity Advantage |
$14.17
|
| Rate for Payer: Cofinity Advantage |
$14.94
|
| Rate for Payer: Cofinity Advantage |
$15.75
|
| Rate for Payer: Cofinity Advantage |
$13.97
|
| Rate for Payer: Cofinity Advantage |
$21.95
|
| Rate for Payer: Cofinity Advantage |
$18.85
|
| Rate for Payer: Cofinity Advantage |
$15.98
|
| Rate for Payer: Cofinity Advantage |
$19.82
|
| Rate for Payer: Cofinity Advantage |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Commercial |
$19.35
|
| Rate for Payer: Cofinity Commercial |
$19.63
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.26
|
| Rate for Payer: Healthscope Commercial |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$18.22
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$20.55
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$19.21
|
| Rate for Payer: Healthscope Commercial |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$20.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| 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: Lakeland Regional Health Systems Commercial |
$21.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.20
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$18.14
|
| Rate for Payer: PHP Commercial |
$24.07
|
| Rate for Payer: PHP Commercial |
$19.12
|
| Rate for Payer: PHP Commercial |
$19.41
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$26.65
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: Priority Health SBD |
$14.38
|
| Rate for Payer: Priority Health SBD |
$14.18
|
| Rate for Payer: Priority Health SBD |
$19.75
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: Priority Health SBD |
$17.84
|
| Rate for Payer: Priority Health SBD |
$12.75
|
| Rate for Payer: Priority Health SBD |
$13.44
|
| Rate for Payer: UMR Bronson Commercial |
$7.85
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: UMR Bronson Commercial |
$10.05
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: UMR Bronson Commercial |
$11.85
|
| Rate for Payer: UMR Bronson Commercial |
$9.90
|
| Rate for Payer: UMR Bronson Commercial |
$13.79
|
| Rate for Payer: UMR Bronson Commercial |
$8.78
|
| Rate for Payer: UMR Bronson Commercial |
$12.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.51
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$20.24
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna American Axle |
$13.87
|
| Rate for Payer: Aetna American Axle |
$14.84
|
| Rate for Payer: Aetna American Axle |
$14.62
|
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna American Axle |
$11.59
|
| Rate for Payer: Aetna American Axle |
$20.38
|
| Rate for Payer: Aetna American Axle |
$18.41
|
| Rate for Payer: Aetna American Axle |
$17.50
|
| Rate for Payer: Aetna Commercial |
$19.12
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Aetna Medicare |
$8.91
|
| Rate for Payer: Aetna Medicare |
$15.68
|
| Rate for Payer: Aetna Medicare |
$11.25
|
| Rate for Payer: Aetna Medicare |
$10.67
|
| Rate for Payer: Aetna Medicare |
$14.16
|
| Rate for Payer: Aetna Medicare |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.87
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: BCBS Complete |
$9.13
|
| Rate for Payer: BCBS Complete |
$8.54
|
| Rate for Payer: BCBS Complete |
$10.77
|
| Rate for Payer: BCBS Complete |
$9.00
|
| Rate for Payer: BCBS Complete |
$12.54
|
| Rate for Payer: BCBS Complete |
$11.33
|
| Rate for Payer: BCBS Complete |
$7.13
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cofinity Advantage |
$13.97
|
| Rate for Payer: Cofinity Advantage |
$14.17
|
| Rate for Payer: Cofinity Advantage |
$12.48
|
| Rate for Payer: Cofinity Advantage |
$14.94
|
| Rate for Payer: Cofinity Advantage |
$15.75
|
| Rate for Payer: Cofinity Advantage |
$15.98
|
| Rate for Payer: Cofinity Advantage |
$18.85
|
| Rate for Payer: Cofinity Advantage |
$19.82
|
| Rate for Payer: Cofinity Advantage |
$21.95
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$19.35
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$19.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.19
|
| Rate for Payer: Healthscope Commercial |
$18.22
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$19.21
|
| Rate for Payer: Healthscope Commercial |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$20.55
|
| Rate for Payer: Healthscope Commercial |
$20.25
|
| 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 |
$14.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.51
|
| 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 |
$16.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.97
|
| 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 |
$16.97
|
| 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 |
$19.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.24
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: PHP Commercial |
$18.14
|
| Rate for Payer: PHP Commercial |
$19.12
|
| Rate for Payer: PHP Commercial |
$26.65
|
| Rate for Payer: PHP Commercial |
$19.41
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$24.07
|
| Rate for Payer: Priority Health SBD |
$14.18
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: Priority Health SBD |
$12.75
|
| Rate for Payer: Priority Health SBD |
$14.38
|
| Rate for Payer: Priority Health SBD |
$19.75
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: Priority Health SBD |
$13.44
|
| Rate for Payer: Priority Health SBD |
$17.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UMR Bronson Commercial |
$8.45
|
| Rate for Payer: UMR Bronson Commercial |
$7.49
|
| Rate for Payer: UMR Bronson Commercial |
$8.32
|
| Rate for Payer: UMR Bronson Commercial |
$9.96
|
| Rate for Payer: UMR Bronson Commercial |
$10.48
|
| Rate for Payer: UMR Bronson Commercial |
$11.60
|
| Rate for Payer: UMR Bronson Commercial |
$6.60
|
| Rate for Payer: UMR Bronson Commercial |
$7.39
|
| Rate for Payer: UMR Bronson Commercial |
$7.90
|
| 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 |
$16.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION (BMH OSC)
|
Facility
|
OP
|
$19.96
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
169411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Advantage |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.97
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION (BMH OSC)
|
Facility
|
IP
|
$19.96
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
169411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Advantage |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.97
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: UMR Bronson Commercial |
$8.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$31.35
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$28.21 |
| Rate for Payer: Aetna American Axle |
$20.38
|
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.38
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cofinity Advantage |
$21.95
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.08
|
| Rate for Payer: Healthscope Commercial |
$28.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: PHP Commercial |
$26.65
|
| Rate for Payer: Priority Health SBD |
$19.75
|
| Rate for Payer: UMR Bronson Commercial |
$13.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.51
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$31.35
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$28.21 |
| Rate for Payer: Aetna American Axle |
$20.38
|
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna Medicare |
$15.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.38
|
| Rate for Payer: BCBS Complete |
$12.54
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cofinity Advantage |
$21.95
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.08
|
| Rate for Payer: Healthscope Commercial |
$28.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: PHP Commercial |
$26.65
|
| Rate for Payer: Priority Health SBD |
$19.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UMR Bronson Commercial |
$11.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.51
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM/100 ML NS (IV PREMIX)
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
180341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UMR Bronson Commercial |
$41.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM/100 ML NS (IV PREMIX)
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
180341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UMR Bronson Commercial |
$34.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$32.09
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$28.88 |
| Rate for Payer: Aetna American Axle |
$20.86
|
| Rate for Payer: Aetna American Axle |
$23.66
|
| Rate for Payer: Aetna American Axle |
$23.83
|
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna American Axle |
$17.52
|
| Rate for Payer: Aetna American Axle |
$16.36
|
| Rate for Payer: Aetna American Axle |
$38.53
|
| Rate for Payer: Aetna American Axle |
$23.63
|
| Rate for Payer: Aetna Commercial |
$50.38
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$30.94
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.66
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cofinity Advantage |
$41.49
|
| Rate for Payer: Cofinity Advantage |
$17.62
|
| Rate for Payer: Cofinity Advantage |
$22.46
|
| Rate for Payer: Cofinity Advantage |
$18.87
|
| Rate for Payer: Cofinity Advantage |
$16.38
|
| Rate for Payer: Cofinity Advantage |
$25.48
|
| Rate for Payer: Cofinity Advantage |
$25.66
|
| Rate for Payer: Cofinity Advantage |
$25.45
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$50.97
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Cofinity Commercial |
$31.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$28.88
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$53.34
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$32.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.45
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$50.38
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$30.94
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: Priority Health SBD |
$22.93
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: Priority Health SBD |
$37.34
|
| Rate for Payer: Priority Health SBD |
$15.86
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$16.98
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health SBD |
$22.91
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: UMR Bronson Commercial |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.86
|
| Rate for Payer: UMR Bronson Commercial |
$26.08
|
| Rate for Payer: UMR Bronson Commercial |
$16.13
|
| Rate for Payer: UMR Bronson Commercial |
$14.12
|
| Rate for Payer: UMR Bronson Commercial |
$11.07
|
| Rate for Payer: UMR Bronson Commercial |
$16.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.50
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$36.66
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$32.99 |
| Rate for Payer: Aetna American Axle |
$23.83
|
| Rate for Payer: Aetna American Axle |
$23.66
|
| Rate for Payer: Aetna American Axle |
$17.52
|
| Rate for Payer: Aetna American Axle |
$20.86
|
| Rate for Payer: Aetna American Axle |
$23.63
|
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna American Axle |
$16.36
|
| Rate for Payer: Aetna American Axle |
$38.53
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Commercial |
$30.94
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Commercial |
$50.38
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: Aetna Medicare |
$18.33
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna Medicare |
$16.05
|
| Rate for Payer: Aetna Medicare |
$29.64
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.63
|
| Rate for Payer: BCBS Complete |
$23.71
|
| Rate for Payer: BCBS Complete |
$14.56
|
| Rate for Payer: BCBS Complete |
$12.84
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS Complete |
$14.54
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cofinity Advantage |
$25.48
|
| Rate for Payer: Cofinity Advantage |
$41.49
|
| Rate for Payer: Cofinity Advantage |
$18.87
|
| Rate for Payer: Cofinity Advantage |
$25.45
|
| Rate for Payer: Cofinity Advantage |
$25.66
|
| Rate for Payer: Cofinity Advantage |
$22.46
|
| Rate for Payer: Cofinity Advantage |
$16.38
|
| Rate for Payer: Cofinity Advantage |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$50.97
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$53.34
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$28.88
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Healthscope Commercial |
$32.76
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.22
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$30.94
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$50.38
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: Priority Health SBD |
$15.86
|
| Rate for Payer: Priority Health SBD |
$37.34
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$22.93
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: Priority Health SBD |
$16.98
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health SBD |
$22.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UMR Bronson Commercial |
$13.56
|
| Rate for Payer: UMR Bronson Commercial |
$21.93
|
| Rate for Payer: UMR Bronson Commercial |
$13.45
|
| Rate for Payer: UMR Bronson Commercial |
$9.98
|
| Rate for Payer: UMR Bronson Commercial |
$13.47
|
| Rate for Payer: UMR Bronson Commercial |
$8.66
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: UMR Bronson Commercial |
$11.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.50
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$23.40
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cofinity Advantage |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$23.40
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cofinity Advantage |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UMR Bronson Commercial |
$8.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
IP
|
$19.96
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Advantage |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.97
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: UMR Bronson Commercial |
$8.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
OP
|
$19.96
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Advantage |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.97
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH DIRECT CLOSURE
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 26951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,187.10
|
| Rate for Payer: BCN Commercial |
$3,187.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH LOCAL ADVANCEMENT FLAPS (V-Y, HOOD)
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 26952
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,293.43
|
| Rate for Payer: BCN Commercial |
$2,293.43
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
AMPUTATION, FOOT; TRANSMETATARSAL
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,751.29
|
| Rate for Payer: BCN Commercial |
$2,751.29
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC
|
Facility
|
IP
|
$52,165.14
|
|
|
Service Code
|
MSDRG 240
|
| Min. Negotiated Rate |
$23,209.29 |
| Max. Negotiated Rate |
$52,165.14 |
| Rate for Payer: Aetna Medicare |
$25,408.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,538.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,538.54
|
| Rate for Payer: BCBS MAPPO |
$24,430.83
|
| Rate for Payer: BCBS Trust/PPO |
$52,165.14
|
| Rate for Payer: BCN Commercial |
$52,165.14
|
| Rate for Payer: BCN Medicare Advantage |
$24,430.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,430.83
|
| Rate for Payer: Mclaren Medicare |
$24,430.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,652.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,095.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$26,873.91
|
| Rate for Payer: Nomi Health Commercial |
$36,771.45
|
| Rate for Payer: PACE Medicare |
$23,209.29
|
| Rate for Payer: PACE SWMI |
$24,430.83
|
| Rate for Payer: PHP Medicare Advantage |
$24,430.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$45,956.16
|
| Rate for Payer: Priority Health Medicare |
$24,430.83
|
| Rate for Payer: Priority Health Tiered Network |
$36,764.92
|
| Rate for Payer: Railroad Medicare Medicare |
$24,430.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46,463.15
|
| Rate for Payer: UHC Core |
$38,872.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,430.83
|
| Rate for Payer: UHC Exchange |
$31,746.02
|
| Rate for Payer: VA VA |
$24,430.83
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC
|
Facility
|
IP
|
$80,223.71
|
|
|
Service Code
|
MSDRG 239
|
| Min. Negotiated Rate |
$39,664.05 |
| Max. Negotiated Rate |
$80,223.71 |
| Rate for Payer: Aetna Medicare |
$43,421.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52,189.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52,189.54
|
| Rate for Payer: BCBS MAPPO |
$41,751.63
|
| Rate for Payer: BCBS Trust/PPO |
$70,411.82
|
| Rate for Payer: BCN Commercial |
$70,411.82
|
| Rate for Payer: BCN Medicare Advantage |
$41,751.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,751.63
|
| Rate for Payer: Mclaren Medicare |
$41,751.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43,839.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48,014.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$45,926.79
|
| Rate for Payer: Nomi Health Commercial |
$63,489.93
|
| Rate for Payer: PACE Medicare |
$39,664.05
|
| Rate for Payer: PACE SWMI |
$41,751.63
|
| Rate for Payer: PHP Medicare Advantage |
$41,751.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$79,348.34
|
| Rate for Payer: Priority Health Medicare |
$41,751.63
|
| Rate for Payer: Priority Health Tiered Network |
$63,478.66
|
| Rate for Payer: Railroad Medicare Medicare |
$41,751.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80,223.71
|
| Rate for Payer: UHC Core |
$67,117.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41,751.63
|
| Rate for Payer: UHC Exchange |
$54,812.97
|
| Rate for Payer: VA VA |
$41,751.63
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC
|
Facility
|
IP
|
$24,115.70
|
|
|
Service Code
|
MSDRG 241
|
| Min. Negotiated Rate |
$11,561.77 |
| Max. Negotiated Rate |
$24,115.70 |
| Rate for Payer: Aetna Medicare |
$12,657.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,212.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,212.85
|
| Rate for Payer: BCBS MAPPO |
$12,170.28
|
| Rate for Payer: BCBS Trust/PPO |
$24,115.70
|
| Rate for Payer: BCN Commercial |
$24,115.70
|
| Rate for Payer: BCN Medicare Advantage |
$12,170.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,170.28
|
| Rate for Payer: Mclaren Medicare |
$12,170.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,778.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,995.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,387.31
|
| Rate for Payer: Nomi Health Commercial |
$17,858.76
|
| Rate for Payer: PACE Medicare |
$11,561.77
|
| Rate for Payer: PACE SWMI |
$12,170.28
|
| Rate for Payer: PHP Medicare Advantage |
$12,170.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,319.49
|
| Rate for Payer: Priority Health Medicare |
$12,170.28
|
| Rate for Payer: Priority Health Tiered Network |
$17,855.59
|
| Rate for Payer: Railroad Medicare Medicare |
$12,170.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,565.72
|
| Rate for Payer: UHC Core |
$18,879.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,170.28
|
| Rate for Payer: UHC Exchange |
$15,418.06
|
| Rate for Payer: VA VA |
$12,170.28
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$42,159.25
|
|
|
Service Code
|
MSDRG 475
|
| Min. Negotiated Rate |
$18,642.73 |
| Max. Negotiated Rate |
$42,159.25 |
| Rate for Payer: Aetna Medicare |
$20,408.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,529.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,529.91
|
| Rate for Payer: BCBS MAPPO |
$19,623.93
|
| Rate for Payer: BCBS Trust/PPO |
$42,159.25
|
| Rate for Payer: BCN Commercial |
$42,159.25
|
| Rate for Payer: BCN Medicare Advantage |
$19,623.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,623.93
|
| Rate for Payer: Mclaren Medicare |
$19,623.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,605.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,567.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,586.32
|
| Rate for Payer: Nomi Health Commercial |
$29,356.53
|
| Rate for Payer: PACE Medicare |
$18,642.73
|
| Rate for Payer: PACE SWMI |
$19,623.93
|
| Rate for Payer: PHP Medicare Advantage |
$19,623.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36,689.15
|
| Rate for Payer: Priority Health Medicare |
$19,623.93
|
| Rate for Payer: Priority Health Tiered Network |
$29,351.32
|
| Rate for Payer: Railroad Medicare Medicare |
$19,623.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,093.91
|
| Rate for Payer: UHC Core |
$31,033.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,623.93
|
| Rate for Payer: UHC Exchange |
$25,344.47
|
| Rate for Payer: VA VA |
$19,623.93
|
|
