|
CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$34.57
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Aetna American Axle |
$22.47
|
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna American Axle |
$18.90
|
| Rate for Payer: Aetna Commercial |
$24.71
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.47
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cash Price |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Cofinity Commercial |
$20.35
|
| Rate for Payer: Cofinity Commercial |
$34.77
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.38
|
| Rate for Payer: PHP Commercial |
$24.71
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.20
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$21.78
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: UMR Bronson Commercial |
$12.79
|
| Rate for Payer: UMR Bronson Commercial |
$15.21
|
| Rate for Payer: UMR Bronson Commercial |
$21.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$22.12
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$19.91 |
| Rate for Payer: Aetna American Axle |
$14.38
|
| Rate for Payer: Aetna American Axle |
$12.62
|
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna Commercial |
$18.80
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.62
|
| Rate for Payer: BCBS Complete |
$8.85
|
| Rate for Payer: BCBS Complete |
$7.76
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$9.76
|
| Rate for Payer: Cofinity Commercial |
$19.02
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.70
|
| Rate for Payer: Healthscope Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.80
|
| Rate for Payer: PHP Commercial |
$18.80
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.48
|
| Rate for Payer: Priority Health SBD |
$12.23
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$13.94
|
| Rate for Payer: UMR Bronson Commercial |
$5.16
|
| Rate for Payer: UMR Bronson Commercial |
$8.18
|
| Rate for Payer: UMR Bronson Commercial |
$7.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.59
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$13.46
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$12.11 |
| Rate for Payer: Aetna American Axle |
$8.75
|
| Rate for Payer: Aetna American Axle |
$15.17
|
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna American Axle |
$14.38
|
| Rate for Payer: Aetna American Axle |
$12.62
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna Commercial |
$11.44
|
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Commercial |
$18.80
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.62
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Cofinity Commercial |
$11.58
|
| Rate for Payer: Cofinity Commercial |
$9.42
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$9.76
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Cofinity Commercial |
$19.02
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$21.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.44
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$19.84
|
| Rate for Payer: PHP Commercial |
$11.44
|
| Rate for Payer: PHP Commercial |
$18.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.76
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$12.23
|
| Rate for Payer: Priority Health SBD |
$14.70
|
| Rate for Payer: Priority Health SBD |
$13.94
|
| Rate for Payer: Priority Health SBD |
$8.48
|
| Rate for Payer: UMR Bronson Commercial |
$9.73
|
| Rate for Payer: UMR Bronson Commercial |
$10.27
|
| Rate for Payer: UMR Bronson Commercial |
$5.92
|
| Rate for Payer: UMR Bronson Commercial |
$6.14
|
| Rate for Payer: UMR Bronson Commercial |
$8.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
|
|
CEFAZOLIN 300 G SOLUTION FOR INJECTION
|
Facility
|
IP
|
$798.75
|
|
|
Service Code
|
NDC 66288-1300-1
|
| Hospital Charge Code |
31087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$351.45 |
| Max. Negotiated Rate |
$718.88 |
| Rate for Payer: Aetna American Axle |
$519.19
|
| Rate for Payer: Aetna Commercial |
$678.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.19
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cofinity Commercial |
$559.12
|
| Rate for Payer: Cofinity Commercial |
$686.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.00
|
| Rate for Payer: Healthscope Commercial |
$718.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$559.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$678.94
|
| Rate for Payer: PHP Commercial |
$678.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.12
|
| Rate for Payer: Priority Health SBD |
$503.21
|
| Rate for Payer: UMR Bronson Commercial |
$351.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$599.06
|
|
|
CEFAZOLIN 3 GM IVPB 50 ML (IV PREMIX)
|
Facility
|
IP
|
$63.80
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.23
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: UMR Bronson Commercial |
$28.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
CEFAZOLIN 50 MG/0.5 ML IN NS FOR DISCOGRAM
|
Facility
|
IP
|
$7.81
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna American Axle |
$5.08
|
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.64
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.47
|
| Rate for Payer: Priority Health SBD |
$4.92
|
| Rate for Payer: UMR Bronson Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.86
|
|
|
CEFAZOLIN 50 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
IP
|
$191.84
|
|
|
Service Code
|
NDC 9900-0001-50
|
| Hospital Charge Code |
500641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Aetna American Axle |
$124.70
|
| Rate for Payer: Aetna Commercial |
$163.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.70
|
| Rate for Payer: Cash Price |
$153.47
|
| Rate for Payer: Cofinity Commercial |
$134.29
|
| Rate for Payer: Cofinity Commercial |
$164.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.47
|
| Rate for Payer: Healthscope Commercial |
$172.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.06
|
| Rate for Payer: PHP Commercial |
$163.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.29
|
| Rate for Payer: Priority Health SBD |
$120.86
|
| Rate for Payer: UMR Bronson Commercial |
$84.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.88
|
|
|
CEFAZOLIN IV SYRINGE
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
400102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna American Axle |
$15.49
|
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.26
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health SBD |
$15.01
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UMR Bronson Commercial |
$10.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.26
|
|
|
CEFAZOLIN IV SYRINGE 1 G PMX
|
Facility
|
IP
|
$3.02
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.57
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.26
|
|
|
CEFAZOLIN IV SYRINGE 2 G PMX
|
Facility
|
IP
|
$6.04
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna American Axle |
$3.93
|
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.93
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.83
|
| Rate for Payer: Healthscope Commercial |
$5.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.13
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.23
|
| Rate for Payer: Priority Health SBD |
$3.81
|
| Rate for Payer: UMR Bronson Commercial |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.53
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$367.65
|
|
|
Service Code
|
NDC 0781-6077-46
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.77 |
| Max. Negotiated Rate |
$330.88 |
| Rate for Payer: Aetna American Axle |
$238.97
|
| Rate for Payer: Aetna Commercial |
$312.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.97
|
| Rate for Payer: Cash Price |
$294.12
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Cofinity Commercial |
$316.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.12
|
| Rate for Payer: Healthscope Commercial |
$330.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.50
|
| Rate for Payer: PHP Commercial |
$312.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.36
|
| Rate for Payer: Priority Health SBD |
$231.62
|
| Rate for Payer: UMR Bronson Commercial |
$161.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.74
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$169.06
|
|
|
Service Code
|
NDC 0093-4136-64
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna American Axle |
$109.89
|
| Rate for Payer: Aetna Commercial |
$143.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.89
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Cofinity Commercial |
$118.34
|
| Rate for Payer: Cofinity Commercial |
$145.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.25
|
| Rate for Payer: Healthscope Commercial |
$152.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.70
|
| Rate for Payer: PHP Commercial |
$143.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.34
|
| Rate for Payer: Priority Health SBD |
$106.51
|
| Rate for Payer: UMR Bronson Commercial |
$74.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.80
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$192.10
|
|
|
Service Code
|
NDC 68180-711-60
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.52 |
| Max. Negotiated Rate |
$172.89 |
| Rate for Payer: Aetna American Axle |
$124.86
|
| Rate for Payer: Aetna Commercial |
$163.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.86
|
| Rate for Payer: Cash Price |
$153.68
|
| Rate for Payer: Cofinity Commercial |
$134.47
|
| Rate for Payer: Cofinity Commercial |
$165.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.68
|
| Rate for Payer: Healthscope Commercial |
$172.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.28
|
| Rate for Payer: PHP Commercial |
$163.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.47
|
| Rate for Payer: Priority Health SBD |
$121.02
|
| Rate for Payer: UMR Bronson Commercial |
$84.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.08
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$270.18
|
|
|
Service Code
|
NDC 65862-177-60
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.88 |
| Max. Negotiated Rate |
$243.16 |
| Rate for Payer: Aetna American Axle |
$175.62
|
| Rate for Payer: Aetna Commercial |
$229.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.62
|
| Rate for Payer: Cash Price |
$216.14
|
| Rate for Payer: Cofinity Commercial |
$189.13
|
| Rate for Payer: Cofinity Commercial |
$232.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.14
|
| Rate for Payer: Healthscope Commercial |
$243.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.65
|
| Rate for Payer: PHP Commercial |
$229.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.13
|
| Rate for Payer: Priority Health SBD |
$170.21
|
| Rate for Payer: UMR Bronson Commercial |
$118.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.64
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$221.19
|
|
|
Service Code
|
NDC 0781-2176-60
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.32 |
| Max. Negotiated Rate |
$199.07 |
| Rate for Payer: Aetna American Axle |
$143.77
|
| Rate for Payer: Aetna Commercial |
$188.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.77
|
| Rate for Payer: Cash Price |
$176.95
|
| Rate for Payer: Cofinity Commercial |
$154.83
|
| Rate for Payer: Cofinity Commercial |
$190.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.95
|
| Rate for Payer: Healthscope Commercial |
$199.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.01
|
| Rate for Payer: PHP Commercial |
$188.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.83
|
| Rate for Payer: Priority Health SBD |
$139.35
|
| Rate for Payer: UMR Bronson Commercial |
$97.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.89
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$223.20
|
|
|
Service Code
|
NDC 57237-099-60
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.21 |
| Max. Negotiated Rate |
$200.88 |
| Rate for Payer: Aetna American Axle |
$145.08
|
| Rate for Payer: Aetna Commercial |
$189.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.08
|
| Rate for Payer: Cash Price |
$178.56
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$191.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.56
|
| Rate for Payer: Healthscope Commercial |
$200.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.72
|
| Rate for Payer: PHP Commercial |
$189.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.24
|
| Rate for Payer: Priority Health SBD |
$140.62
|
| Rate for Payer: UMR Bronson Commercial |
$98.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.40
|
|
|
CEFEPIME 100 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
188964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$563.20 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna American Axle |
$832.00
|
| Rate for Payer: Aetna American Axle |
$26.00
|
| Rate for Payer: Aetna Commercial |
$1,088.00
|
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$832.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$896.00
|
| Rate for Payer: Cofinity Commercial |
$1,100.80
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,024.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$1,152.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$896.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$960.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,088.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: PHP Commercial |
$1,088.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$896.00
|
| Rate for Payer: Priority Health SBD |
$806.40
|
| Rate for Payer: Priority Health SBD |
$25.20
|
| Rate for Payer: UMR Bronson Commercial |
$563.20
|
| Rate for Payer: UMR Bronson Commercial |
$17.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$960.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
CEFEPIME 1 GRAM CUSTOM SOLUTION FOR DESENSITIZATION
|
Facility
|
IP
|
$29.64
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna American Axle |
$19.27
|
| Rate for Payer: Aetna Commercial |
$25.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.27
|
| Rate for Payer: Cash Price |
$23.71
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.71
|
| Rate for Payer: Healthscope Commercial |
$26.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.19
|
| Rate for Payer: PHP Commercial |
$25.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health SBD |
$18.67
|
| Rate for Payer: UMR Bronson Commercial |
$13.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.23
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR IM INJECTION CUSTOM
|
Facility
|
IP
|
$19.96
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
300392
|
|
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 Commercial |
$17.17
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| 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 Multiplan/Beech St/PHCS |
$16.97
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.97
|
| 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
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna American Axle |
$11.05
|
| Rate for Payer: Aetna American Axle |
$13.70
|
| Rate for Payer: Aetna American Axle |
$11.06
|
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Commercial |
$14.47
|
| Rate for Payer: Aetna Commercial |
$17.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.06
|
| Rate for Payer: BCBS Complete |
$8.43
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS Complete |
$6.81
|
| Rate for Payer: BCBS Trust/PPO |
$4.06
|
| Rate for Payer: BCBS Trust/PPO |
$4.06
|
| Rate for Payer: BCBS Trust/PPO |
$4.06
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$11.91
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$14.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Healthscope Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.47
|
| Rate for Payer: PHP Commercial |
$14.47
|
| Rate for Payer: PHP Commercial |
$14.45
|
| Rate for Payer: PHP Commercial |
$17.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.75
|
| Rate for Payer: Priority Health SBD |
$10.72
|
| Rate for Payer: Priority Health SBD |
$10.71
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: UMR Bronson Commercial |
$6.29
|
| Rate for Payer: UMR Bronson Commercial |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.75
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$18.08
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna American Axle |
$11.75
|
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna American Axle |
$13.20
|
| Rate for Payer: Aetna American Axle |
$13.70
|
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Commercial |
$17.26
|
| Rate for Payer: Aetna Commercial |
$17.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.20
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$17.47
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$14.75
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$12.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.86
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$16.27
|
| Rate for Payer: Healthscope Commercial |
$18.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.91
|
| Rate for Payer: PHP Commercial |
$17.91
|
| Rate for Payer: PHP Commercial |
$17.26
|
| Rate for Payer: PHP Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.66
|
| Rate for Payer: Priority Health SBD |
$12.80
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: Priority Health SBD |
$11.39
|
| Rate for Payer: UMR Bronson Commercial |
$8.94
|
| Rate for Payer: UMR Bronson Commercial |
$8.78
|
| Rate for Payer: UMR Bronson Commercial |
$7.96
|
| Rate for Payer: UMR Bronson Commercial |
$9.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.80
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$19.18
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$17.26 |
| Rate for Payer: Aetna American Axle |
$12.47
|
| Rate for Payer: Aetna American Axle |
$12.46
|
| Rate for Payer: Aetna American Axle |
$21.47
|
| Rate for Payer: Aetna American Axle |
$12.73
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.73
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$13.71
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.08
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.43
|
| Rate for Payer: Priority Health SBD |
$20.81
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: Priority Health SBD |
$12.34
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: UMR Bronson Commercial |
$8.44
|
| Rate for Payer: UMR Bronson Commercial |
$8.62
|
| Rate for Payer: UMR Bronson Commercial |
$8.43
|
| Rate for Payer: UMR Bronson Commercial |
$14.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$25.05
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$22.54 |
| Rate for Payer: Aetna American Axle |
$16.28
|
| Rate for Payer: Aetna American Axle |
$12.47
|
| Rate for Payer: Aetna American Axle |
$21.08
|
| Rate for Payer: Aetna Commercial |
$27.57
|
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Commercial |
$21.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.47
|
| Rate for Payer: BCBS Complete |
$12.97
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS Complete |
$10.02
|
| Rate for Payer: BCBS Trust/PPO |
$4.06
|
| Rate for Payer: BCBS Trust/PPO |
$4.06
|
| Rate for Payer: BCBS Trust/PPO |
$4.06
|
| Rate for Payer: Cash Price |
$20.04
|
| Rate for Payer: Cash Price |
$20.04
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$22.70
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.94
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$22.54
|
| Rate for Payer: Healthscope Commercial |
$29.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.57
|
| Rate for Payer: PHP Commercial |
$27.57
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: PHP Commercial |
$21.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.43
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: Priority Health SBD |
$20.43
|
| Rate for Payer: Priority Health SBD |
$15.78
|
| Rate for Payer: UMR Bronson Commercial |
$7.10
|
| Rate for Payer: UMR Bronson Commercial |
$9.27
|
| Rate for Payer: UMR Bronson Commercial |
$12.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.32
|
|
|
CEFEPIME IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$1.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna American Axle |
$1.14
|
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.22
|
| Rate for Payer: Priority Health SBD |
$1.10
|
| Rate for Payer: UMR Bronson Commercial |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.31
|
|
|
CEFEPIME IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$16.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$15.08 |
| Rate for Payer: Aetna American Axle |
$10.89
|
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.89
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Healthscope Commercial |
$15.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.24
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.72
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$7.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.56
|
|
