|
CEFEPIME (MAXIPIME) 4 GRAM /540 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
IP
|
$45.66
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna American Axle |
$29.68
|
| Rate for Payer: Aetna Commercial |
$38.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.68
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.53
|
| Rate for Payer: Healthscope Commercial |
$41.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.81
|
| Rate for Payer: PHP Commercial |
$38.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.96
|
| Rate for Payer: Priority Health SBD |
$28.77
|
| Rate for Payer: UMR Bronson Commercial |
$20.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.24
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$725.21
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
192885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$319.09 |
| Max. Negotiated Rate |
$652.69 |
| Rate for Payer: Aetna American Axle |
$471.39
|
| Rate for Payer: Aetna Commercial |
$616.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.39
|
| Rate for Payer: Cash Price |
$580.17
|
| Rate for Payer: Cofinity Commercial |
$507.65
|
| Rate for Payer: Cofinity Commercial |
$623.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$580.17
|
| Rate for Payer: Healthscope Commercial |
$652.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$507.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$543.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$616.43
|
| Rate for Payer: PHP Commercial |
$616.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$507.65
|
| Rate for Payer: Priority Health SBD |
$456.88
|
| Rate for Payer: UMR Bronson Commercial |
$319.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$543.91
|
|
|
CEFOTAXIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$43.61
|
|
|
Service Code
|
HCPCS J0698
|
| Hospital Charge Code |
9452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$39.25 |
| Rate for Payer: Aetna American Axle |
$28.35
|
| Rate for Payer: Aetna Commercial |
$37.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.35
|
| Rate for Payer: Cash Price |
$34.89
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Cofinity Commercial |
$37.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.89
|
| Rate for Payer: Healthscope Commercial |
$39.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.07
|
| Rate for Payer: PHP Commercial |
$37.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.53
|
| Rate for Payer: Priority Health SBD |
$27.47
|
| Rate for Payer: UMR Bronson Commercial |
$19.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.71
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$119.86
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.74 |
| Max. Negotiated Rate |
$107.87 |
| Rate for Payer: Aetna American Axle |
$77.91
|
| Rate for Payer: Aetna Commercial |
$101.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.91
|
| Rate for Payer: Cash Price |
$95.89
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Cofinity Commercial |
$83.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.89
|
| Rate for Payer: Healthscope Commercial |
$107.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.88
|
| Rate for Payer: PHP Commercial |
$101.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.90
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$52.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.90
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna American Axle |
$13.42
|
| Rate for Payer: Aetna American Axle |
$13.49
|
| Rate for Payer: Aetna American Axle |
$15.44
|
| Rate for Payer: Aetna American Axle |
$18.78
|
| Rate for Payer: Aetna American Axle |
$19.06
|
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$24.56
|
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Cash Price |
$23.11
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Cofinity Commercial |
$24.85
|
| Rate for Payer: Cofinity Commercial |
$20.22
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.11
|
| Rate for Payer: Healthscope Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$26.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.55
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: PHP Commercial |
$24.93
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$24.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health SBD |
$13.08
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: Priority Health SBD |
$18.48
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: Priority Health SBD |
$18.20
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: UMR Bronson Commercial |
$10.45
|
| Rate for Payer: UMR Bronson Commercial |
$9.13
|
| Rate for Payer: UMR Bronson Commercial |
$12.71
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: UMR Bronson Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.00
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 44567-246-25
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$10.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.39
|
|
|
Service Code
|
NDC 25021-110-20
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna American Axle |
$19.10
|
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.57
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UMR Bronson Commercial |
$12.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.04
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$41.83
|
|
|
Service Code
|
NDC 9900-0010-44
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Aetna American Axle |
$27.19
|
| Rate for Payer: Aetna Commercial |
$35.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.19
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$29.28
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$37.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.56
|
| Rate for Payer: PHP Commercial |
$35.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.28
|
| Rate for Payer: Priority Health SBD |
$26.35
|
| Rate for Payer: UMR Bronson Commercial |
$18.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.37
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.59
|
|
|
Service Code
|
NDC 0143-9877-01
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Aetna American Axle |
$15.98
|
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.98
|
| Rate for Payer: Cash Price |
$19.67
|
| Rate for Payer: Cofinity Commercial |
$17.21
|
| Rate for Payer: Cofinity Commercial |
$21.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.67
|
| Rate for Payer: Healthscope Commercial |
$22.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.90
|
| Rate for Payer: PHP Commercial |
$20.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.21
|
| Rate for Payer: Priority Health SBD |
$15.49
|
| Rate for Payer: UMR Bronson Commercial |
$10.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.44
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.74
|
|
|
Service Code
|
NDC 63323-342-25
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$51.97 |
| Rate for Payer: Aetna American Axle |
$37.53
|
| Rate for Payer: Aetna Commercial |
$49.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.53
|
| Rate for Payer: Cash Price |
$46.19
|
| Rate for Payer: Cofinity Commercial |
$49.66
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.19
|
| Rate for Payer: Healthscope Commercial |
$51.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.08
|
| Rate for Payer: PHP Commercial |
$49.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.42
|
| Rate for Payer: Priority Health SBD |
$36.38
|
| Rate for Payer: UMR Bronson Commercial |
$25.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.30
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.59
|
|
|
Service Code
|
NDC 0143-9877-25
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Aetna American Axle |
$15.98
|
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.98
|
| Rate for Payer: Cash Price |
$19.67
|
| Rate for Payer: Cofinity Commercial |
$21.15
|
| Rate for Payer: Cofinity Commercial |
$17.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.67
|
| Rate for Payer: Healthscope Commercial |
$22.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.90
|
| Rate for Payer: PHP Commercial |
$20.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.21
|
| Rate for Payer: Priority Health SBD |
$15.49
|
| Rate for Payer: UMR Bronson Commercial |
$10.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.44
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
NDC 44567-246-85
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.99 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna American Axle |
$16.23
|
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.22
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.48
|
| Rate for Payer: Priority Health SBD |
$15.73
|
| Rate for Payer: UMR Bronson Commercial |
$10.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
NDC 25021-110-20
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna American Axle |
$19.10
|
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.57
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UMR Bronson Commercial |
$10.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.04
|
|
|
CEFPODOXIME 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
NDC 64980-403-10
|
| Hospital Charge Code |
9466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.04 |
| Max. Negotiated Rate |
$464.40 |
| Rate for Payer: Aetna American Axle |
$335.40
|
| Rate for Payer: Aetna Commercial |
$438.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.40
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$361.20
|
| Rate for Payer: Cofinity Commercial |
$443.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.80
|
| Rate for Payer: Healthscope Commercial |
$464.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$438.60
|
| Rate for Payer: PHP Commercial |
$438.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.20
|
| Rate for Payer: Priority Health SBD |
$325.08
|
| Rate for Payer: UMR Bronson Commercial |
$227.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.00
|
|
|
CEFPODOXIME 200 MG TABLET
|
Facility
|
IP
|
$465.61
|
|
|
Service Code
|
NDC 0781-5439-20
|
| Hospital Charge Code |
9469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.87 |
| Max. Negotiated Rate |
$419.05 |
| Rate for Payer: Aetna American Axle |
$302.65
|
| Rate for Payer: Aetna Commercial |
$395.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.65
|
| Rate for Payer: Cash Price |
$372.49
|
| Rate for Payer: Cofinity Commercial |
$325.93
|
| Rate for Payer: Cofinity Commercial |
$400.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.49
|
| Rate for Payer: Healthscope Commercial |
$419.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$395.77
|
| Rate for Payer: PHP Commercial |
$395.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.93
|
| Rate for Payer: Priority Health SBD |
$293.33
|
| Rate for Payer: UMR Bronson Commercial |
$204.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.21
|
|
|
CEFPODOXIME 200 MG TABLET
|
Facility
|
IP
|
$221.26
|
|
|
Service Code
|
NDC 65862-096-20
|
| Hospital Charge Code |
9469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.35 |
| Max. Negotiated Rate |
$199.13 |
| Rate for Payer: Aetna American Axle |
$143.82
|
| Rate for Payer: Aetna Commercial |
$188.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.82
|
| Rate for Payer: Cash Price |
$177.01
|
| Rate for Payer: Cofinity Commercial |
$154.88
|
| Rate for Payer: Cofinity Commercial |
$190.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.01
|
| Rate for Payer: Healthscope Commercial |
$199.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.07
|
| Rate for Payer: PHP Commercial |
$188.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.88
|
| Rate for Payer: Priority Health SBD |
$139.39
|
| Rate for Payer: UMR Bronson Commercial |
$97.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.94
|
|
|
CEFTAROLINE FOSAMIL 0.06 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 9900-0009-55
|
| Hospital Charge Code |
180576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna American Axle |
$0.03
|
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.04
|
| Rate for Payer: Priority Health SBD |
$0.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.04
|
|
|
CEFTAROLINE FOSAMIL 0.6 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 9900-0009-56
|
| Hospital Charge Code |
180577
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna American Axle |
$0.03
|
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.04
|
| Rate for Payer: Priority Health SBD |
$0.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.04
|
|
|
CEFTAROLINE FOSAMIL 600 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 9900-0009-58
|
| Hospital Charge Code |
180579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna American Axle |
$2.34
|
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.06
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.70
|
|
|
CEFTAROLINE FOSAMIL 600 MG CUSTOM INTRAVENOUS SOLUTION FOR DESENSITIZATION
|
Facility
|
IP
|
$513.76
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
180582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.05 |
| Max. Negotiated Rate |
$462.38 |
| Rate for Payer: Aetna American Axle |
$333.94
|
| Rate for Payer: Aetna Commercial |
$436.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.94
|
| Rate for Payer: Cash Price |
$411.01
|
| Rate for Payer: Cofinity Commercial |
$359.63
|
| Rate for Payer: Cofinity Commercial |
$441.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.01
|
| Rate for Payer: Healthscope Commercial |
$462.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$436.70
|
| Rate for Payer: PHP Commercial |
$436.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.63
|
| Rate for Payer: Priority Health SBD |
$323.67
|
| Rate for Payer: UMR Bronson Commercial |
$226.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.32
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$647.63
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$284.96 |
| Max. Negotiated Rate |
$582.87 |
| Rate for Payer: Aetna American Axle |
$420.96
|
| Rate for Payer: Aetna Commercial |
$550.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.96
|
| Rate for Payer: Cash Price |
$518.10
|
| Rate for Payer: Cofinity Commercial |
$453.34
|
| Rate for Payer: Cofinity Commercial |
$556.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.10
|
| Rate for Payer: Healthscope Commercial |
$582.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$453.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$485.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$550.49
|
| Rate for Payer: PHP Commercial |
$550.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.34
|
| Rate for Payer: Priority Health SBD |
$408.01
|
| Rate for Payer: UMR Bronson Commercial |
$284.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$485.72
|
|
|
CEFTAROLINE FOSAMIL 60 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 9900-0009-54
|
| Hospital Charge Code |
168966
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna American Axle |
$0.23
|
| Rate for Payer: Aetna Commercial |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.23
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cofinity Commercial |
$0.25
|
| Rate for Payer: Cofinity Commercial |
$0.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.28
|
| Rate for Payer: Healthscope Commercial |
$0.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.30
|
| Rate for Payer: PHP Commercial |
$0.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.25
|
| Rate for Payer: Priority Health SBD |
$0.22
|
| Rate for Payer: UMR Bronson Commercial |
$0.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.26
|
|
|
CEFTAROLINE FOSAMIL 6 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 9900-0009-57
|
| Hospital Charge Code |
180578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna American Axle |
$0.03
|
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.04
|
| Rate for Payer: Priority Health SBD |
$0.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.04
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,176.68
|
|
|
Service Code
|
HCPCS J0714
|
| Hospital Charge Code |
161545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$517.74 |
| Max. Negotiated Rate |
$1,059.01 |
| Rate for Payer: Aetna American Axle |
$764.84
|
| Rate for Payer: Aetna Commercial |
$1,000.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.84
|
| Rate for Payer: Cash Price |
$941.34
|
| Rate for Payer: Cofinity Commercial |
$1,011.94
|
| Rate for Payer: Cofinity Commercial |
$823.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$941.34
|
| Rate for Payer: Healthscope Commercial |
$1,059.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$823.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$882.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,000.18
|
| Rate for Payer: PHP Commercial |
$1,000.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.68
|
| Rate for Payer: Priority Health SBD |
$741.31
|
| Rate for Payer: UMR Bronson Commercial |
$517.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$882.51
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$411.89
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
173413
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.23 |
| Max. Negotiated Rate |
$370.70 |
| Rate for Payer: Aetna American Axle |
$267.73
|
| Rate for Payer: Aetna Commercial |
$350.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.73
|
| Rate for Payer: Cash Price |
$329.51
|
| Rate for Payer: Cofinity Commercial |
$288.32
|
| Rate for Payer: Cofinity Commercial |
$354.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.51
|
| Rate for Payer: Healthscope Commercial |
$370.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.11
|
| Rate for Payer: PHP Commercial |
$350.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.32
|
| Rate for Payer: Priority Health SBD |
$259.49
|
| Rate for Payer: UMR Bronson Commercial |
$181.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.92
|
|
