|
CEFTRIAXONE 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
78580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$957.00 |
| Max. Negotiated Rate |
$1,957.50 |
| Rate for Payer: Aetna American Axle |
$1,413.75
|
| Rate for Payer: Aetna Commercial |
$1,848.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,413.75
|
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Cofinity Commercial |
$1,522.50
|
| Rate for Payer: Cofinity Commercial |
$1,870.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.00
|
| Rate for Payer: Healthscope Commercial |
$1,957.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,522.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,631.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,848.75
|
| Rate for Payer: PHP Commercial |
$1,848.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.50
|
| Rate for Payer: Priority Health SBD |
$1,370.25
|
| Rate for Payer: UMR Bronson Commercial |
$957.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,631.25
|
|
|
CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$188.77
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$169.89 |
| Rate for Payer: Aetna American Axle |
$122.70
|
| Rate for Payer: Aetna American Axle |
$26.88
|
| Rate for Payer: Aetna American Axle |
$33.82
|
| Rate for Payer: Aetna American Axle |
$34.92
|
| Rate for Payer: Aetna American Axle |
$51.12
|
| Rate for Payer: Aetna Commercial |
$160.45
|
| Rate for Payer: Aetna Commercial |
$35.15
|
| Rate for Payer: Aetna Commercial |
$66.84
|
| Rate for Payer: Aetna Commercial |
$44.23
|
| Rate for Payer: Aetna Commercial |
$45.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.70
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cash Price |
$62.91
|
| Rate for Payer: Cash Price |
$42.98
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$151.02
|
| Rate for Payer: Cofinity Commercial |
$162.34
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$35.56
|
| Rate for Payer: Cofinity Commercial |
$36.42
|
| Rate for Payer: Cofinity Commercial |
$44.75
|
| Rate for Payer: Cofinity Commercial |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$46.20
|
| Rate for Payer: Cofinity Commercial |
$55.05
|
| Rate for Payer: Cofinity Commercial |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$132.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.83
|
| Rate for Payer: Healthscope Commercial |
$169.89
|
| Rate for Payer: Healthscope Commercial |
$48.35
|
| Rate for Payer: Healthscope Commercial |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$70.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.15
|
| Rate for Payer: PHP Commercial |
$160.45
|
| Rate for Payer: PHP Commercial |
$35.15
|
| Rate for Payer: PHP Commercial |
$45.66
|
| Rate for Payer: PHP Commercial |
$66.84
|
| Rate for Payer: PHP Commercial |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.05
|
| Rate for Payer: Priority Health SBD |
$49.54
|
| Rate for Payer: Priority Health SBD |
$32.78
|
| Rate for Payer: Priority Health SBD |
$33.84
|
| Rate for Payer: Priority Health SBD |
$26.05
|
| Rate for Payer: Priority Health SBD |
$118.93
|
| Rate for Payer: UMR Bronson Commercial |
$34.60
|
| Rate for Payer: UMR Bronson Commercial |
$83.06
|
| Rate for Payer: UMR Bronson Commercial |
$22.89
|
| Rate for Payer: UMR Bronson Commercial |
$18.19
|
| Rate for Payer: UMR Bronson Commercial |
$23.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.98
|
|
|
CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$78.64
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$70.78 |
| Rate for Payer: Aetna American Axle |
$51.12
|
| Rate for Payer: Aetna Commercial |
$66.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.12
|
| Rate for Payer: BCBS Complete |
$31.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: Cash Price |
$62.91
|
| Rate for Payer: Cash Price |
$62.91
|
| Rate for Payer: Cofinity Commercial |
$55.05
|
| Rate for Payer: Cofinity Commercial |
$67.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.91
|
| Rate for Payer: Healthscope Commercial |
$70.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.84
|
| Rate for Payer: PHP Commercial |
$66.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.05
|
| Rate for Payer: Priority Health SBD |
$49.54
|
| Rate for Payer: UMR Bronson Commercial |
$29.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.98
|
|
|
CEFTRIAXONE 1 GM IV SYRINGE
|
Facility
|
IP
|
$17.98
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
500542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.28
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.59
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$7.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
150848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna American Axle |
$8.63
|
| Rate for Payer: Aetna American Axle |
$9.65
|
| Rate for Payer: Aetna American Axle |
$15.08
|
| Rate for Payer: Aetna American Axle |
$15.76
|
| Rate for Payer: Aetna Commercial |
$20.61
|
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.08
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$20.86
|
| Rate for Payer: Cofinity Commercial |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$10.39
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$16.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.40
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$21.82
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.61
|
| Rate for Payer: PHP Commercial |
$20.61
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.39
|
| Rate for Payer: Priority Health SBD |
$9.35
|
| Rate for Payer: Priority Health SBD |
$14.62
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: Priority Health SBD |
$15.28
|
| Rate for Payer: UMR Bronson Commercial |
$5.84
|
| Rate for Payer: UMR Bronson Commercial |
$6.53
|
| Rate for Payer: UMR Bronson Commercial |
$10.67
|
| Rate for Payer: UMR Bronson Commercial |
$10.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.13
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION
|
Facility
|
OP
|
$29.16
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
150848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$26.24 |
| Rate for Payer: Aetna American Axle |
$18.95
|
| Rate for Payer: Aetna American Axle |
$8.63
|
| Rate for Payer: Aetna Commercial |
$24.79
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.95
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS Complete |
$11.66
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: Cash Price |
$23.33
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$23.33
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$25.08
|
| Rate for Payer: Cofinity Commercial |
$20.41
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$26.24
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.79
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.41
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: Priority Health SBD |
$18.37
|
| Rate for Payer: UMR Bronson Commercial |
$10.79
|
| Rate for Payer: UMR Bronson Commercial |
$4.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.87
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM SOLUTION FOR DESENSITIZATION
|
Facility
|
IP
|
$17.98
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.28
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.59
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$7.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna American Axle |
$8.63
|
| Rate for Payer: Aetna American Axle |
$9.65
|
| Rate for Payer: Aetna American Axle |
$15.08
|
| Rate for Payer: Aetna American Axle |
$13.35
|
| Rate for Payer: Aetna American Axle |
$18.95
|
| Rate for Payer: Aetna American Axle |
$15.75
|
| Rate for Payer: Aetna American Axle |
$15.76
|
| Rate for Payer: Aetna Commercial |
$20.61
|
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$24.79
|
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.35
|
| Rate for Payer: Cash Price |
$23.33
|
| Rate for Payer: Cash Price |
$19.38
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cofinity Commercial |
$25.08
|
| Rate for Payer: Cofinity Commercial |
$20.84
|
| Rate for Payer: Cofinity Commercial |
$20.86
|
| Rate for Payer: Cofinity Commercial |
$10.39
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$20.41
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Cofinity Commercial |
$16.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.40
|
| Rate for Payer: Healthscope Commercial |
$21.82
|
| Rate for Payer: Healthscope Commercial |
$21.81
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Healthscope Commercial |
$26.24
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.61
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$20.61
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$20.60
|
| Rate for Payer: PHP Commercial |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.98
|
| Rate for Payer: Priority Health SBD |
$15.28
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: Priority Health SBD |
$9.35
|
| Rate for Payer: Priority Health SBD |
$12.94
|
| Rate for Payer: Priority Health SBD |
$14.62
|
| Rate for Payer: Priority Health SBD |
$15.26
|
| Rate for Payer: Priority Health SBD |
$18.37
|
| Rate for Payer: UMR Bronson Commercial |
$10.66
|
| Rate for Payer: UMR Bronson Commercial |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$9.04
|
| Rate for Payer: UMR Bronson Commercial |
$6.53
|
| Rate for Payer: UMR Bronson Commercial |
$5.84
|
| Rate for Payer: UMR Bronson Commercial |
$12.83
|
| Rate for Payer: UMR Bronson Commercial |
$10.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.87
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$24.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$21.82 |
| Rate for Payer: Aetna American Axle |
$15.76
|
| Rate for Payer: Aetna American Axle |
$15.08
|
| Rate for Payer: Aetna American Axle |
$11.57
|
| Rate for Payer: Aetna American Axle |
$8.63
|
| Rate for Payer: Aetna American Axle |
$18.95
|
| Rate for Payer: Aetna Commercial |
$20.61
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Commercial |
$15.13
|
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: Aetna Commercial |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.76
|
| Rate for Payer: BCBS Complete |
$9.28
|
| Rate for Payer: BCBS Complete |
$11.66
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS Complete |
$7.12
|
| Rate for Payer: BCBS Complete |
$9.70
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: Cash Price |
$23.33
|
| Rate for Payer: Cash Price |
$23.33
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: Cofinity Commercial |
$25.08
|
| Rate for Payer: Cofinity Commercial |
$12.46
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$20.41
|
| Rate for Payer: Cofinity Commercial |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$20.86
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$16.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.40
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Healthscope Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$21.82
|
| Rate for Payer: Healthscope Commercial |
$26.24
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.28
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$15.13
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$20.61
|
| Rate for Payer: PHP Commercial |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.46
|
| Rate for Payer: Priority Health SBD |
$11.21
|
| Rate for Payer: Priority Health SBD |
$18.37
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: Priority Health SBD |
$15.28
|
| Rate for Payer: Priority Health SBD |
$14.62
|
| Rate for Payer: UMR Bronson Commercial |
$8.97
|
| Rate for Payer: UMR Bronson Commercial |
$8.58
|
| Rate for Payer: UMR Bronson Commercial |
$6.59
|
| Rate for Payer: UMR Bronson Commercial |
$4.91
|
| Rate for Payer: UMR Bronson Commercial |
$10.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$27.21
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$24.49 |
| Rate for Payer: Aetna American Axle |
$17.69
|
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna American Axle |
$16.25
|
| Rate for Payer: Aetna American Axle |
$14.47
|
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna American Axle |
$16.12
|
| Rate for Payer: Aetna American Axle |
$29.78
|
| Rate for Payer: Aetna American Axle |
$10.82
|
| Rate for Payer: Aetna Commercial |
$23.13
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Commercial |
$38.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Cash Price |
$36.66
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$21.77
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$39.41
|
| Rate for Payer: Cofinity Commercial |
$32.07
|
| Rate for Payer: Cofinity Commercial |
$17.36
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Cofinity Commercial |
$19.05
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$24.49
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Healthscope Commercial |
$41.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.92
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Commercial |
$23.13
|
| Rate for Payer: PHP Commercial |
$38.95
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.13
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: Priority Health SBD |
$17.14
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: Priority Health SBD |
$28.87
|
| Rate for Payer: UMR Bronson Commercial |
$7.33
|
| Rate for Payer: UMR Bronson Commercial |
$20.16
|
| Rate for Payer: UMR Bronson Commercial |
$11.00
|
| Rate for Payer: UMR Bronson Commercial |
$7.25
|
| Rate for Payer: UMR Bronson Commercial |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$9.79
|
| Rate for Payer: UMR Bronson Commercial |
$11.97
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.60
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna American Axle |
$16.25
|
| Rate for Payer: Aetna American Axle |
$10.82
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.66
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: UMR Bronson Commercial |
$6.16
|
| Rate for Payer: UMR Bronson Commercial |
$9.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna American Axle |
$2.73
|
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna American Axle |
$5.04
|
| Rate for Payer: Aetna American Axle |
$5.59
|
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna Commercial |
$6.59
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Aetna Commercial |
$8.02
|
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Cofinity Commercial |
$6.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.55
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$6.98
|
| Rate for Payer: Healthscope Commercial |
$7.74
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.59
|
| Rate for Payer: PHP Commercial |
$7.31
|
| Rate for Payer: PHP Commercial |
$3.57
|
| Rate for Payer: PHP Commercial |
$6.59
|
| Rate for Payer: PHP Commercial |
$8.02
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.61
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: Priority Health SBD |
$5.42
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: Priority Health SBD |
$4.88
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: UMR Bronson Commercial |
$3.41
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$3.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: UMR Bronson Commercial |
$4.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.15
|
|
|
CEFTRIAXONE IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.21
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.18
|
| Rate for Payer: Priority Health SBD |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$0.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.19
|
|
|
CEFTRIAXONE IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna American Axle |
$2.11
|
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.28
|
| Rate for Payer: Priority Health SBD |
$2.05
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.44
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
IP
|
$241.06
|
|
|
Service Code
|
NDC 57237-058-60
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.07 |
| Max. Negotiated Rate |
$216.95 |
| Rate for Payer: Aetna American Axle |
$156.69
|
| Rate for Payer: Aetna Commercial |
$204.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.69
|
| Rate for Payer: Cash Price |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$168.74
|
| Rate for Payer: Cofinity Commercial |
$207.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.85
|
| Rate for Payer: Healthscope Commercial |
$216.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.90
|
| Rate for Payer: PHP Commercial |
$204.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.74
|
| Rate for Payer: Priority Health SBD |
$151.87
|
| Rate for Payer: UMR Bronson Commercial |
$106.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.80
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 65862-699-60
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna American Axle |
$169.55
|
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$182.60
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.72
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
| Rate for Payer: Priority Health SBD |
$164.34
|
| Rate for Payer: UMR Bronson Commercial |
$114.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
IP
|
$451.88
|
|
|
Service Code
|
NDC 68180-302-60
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.83 |
| Max. Negotiated Rate |
$406.69 |
| Rate for Payer: Aetna American Axle |
$293.72
|
| Rate for Payer: Aetna Commercial |
$384.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.72
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cofinity Commercial |
$316.32
|
| Rate for Payer: Cofinity Commercial |
$388.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.50
|
| Rate for Payer: Healthscope Commercial |
$406.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.10
|
| Rate for Payer: PHP Commercial |
$384.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.32
|
| Rate for Payer: Priority Health SBD |
$284.68
|
| Rate for Payer: UMR Bronson Commercial |
$198.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.91
|
|
|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 69097-422-07
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.91 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna American Axle |
$175.66
|
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$189.18
|
| Rate for Payer: Cofinity Commercial |
$232.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.71
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.18
|
| Rate for Payer: Priority Health SBD |
$170.26
|
| Rate for Payer: UMR Bronson Commercial |
$118.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$356.16
|
|
|
Service Code
|
NDC 0904-6502-61
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.71 |
| Max. Negotiated Rate |
$320.54 |
| Rate for Payer: Aetna American Axle |
$231.50
|
| Rate for Payer: Aetna Commercial |
$302.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.50
|
| Rate for Payer: Cash Price |
$284.93
|
| Rate for Payer: Cofinity Commercial |
$249.31
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.93
|
| Rate for Payer: Healthscope Commercial |
$320.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.74
|
| Rate for Payer: PHP Commercial |
$302.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.31
|
| Rate for Payer: Priority Health SBD |
$224.38
|
| Rate for Payer: UMR Bronson Commercial |
$156.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.12
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 62332-141-31
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.54
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.54
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$328.01
|
|
|
Service Code
|
NDC 0025-1520-34
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.32 |
| Max. Negotiated Rate |
$295.21 |
| Rate for Payer: Aetna American Axle |
$213.21
|
| Rate for Payer: Aetna Commercial |
$278.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.21
|
| Rate for Payer: Cash Price |
$262.41
|
| Rate for Payer: Cofinity Commercial |
$229.61
|
| Rate for Payer: Cofinity Commercial |
$282.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.41
|
| Rate for Payer: Healthscope Commercial |
$295.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$278.81
|
| Rate for Payer: PHP Commercial |
$278.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.61
|
| Rate for Payer: Priority Health SBD |
$206.65
|
| Rate for Payer: UMR Bronson Commercial |
$144.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.01
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 33342-156-11
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$279.65
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.30
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UMR Bronson Commercial |
$144.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 69097-421-07
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.63 |
| Max. Negotiated Rate |
$412.42 |
| Rate for Payer: Aetna American Axle |
$297.86
|
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$320.78
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.51
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.78
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UMR Bronson Commercial |
$201.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$5,380.17
|
|
|
Service Code
|
NDC 0025-1525-34
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,367.27 |
| Max. Negotiated Rate |
$4,842.15 |
| Rate for Payer: Aetna American Axle |
$3,497.11
|
| Rate for Payer: Aetna Commercial |
$4,573.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,497.11
|
| Rate for Payer: Cash Price |
$4,304.14
|
| Rate for Payer: Cofinity Commercial |
$3,766.12
|
| Rate for Payer: Cofinity Commercial |
$4,626.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,304.14
|
| Rate for Payer: Healthscope Commercial |
$4,842.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,766.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,035.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,573.14
|
| Rate for Payer: PHP Commercial |
$4,573.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,766.12
|
| Rate for Payer: Priority Health SBD |
$3,389.51
|
| Rate for Payer: UMR Bronson Commercial |
$2,367.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,035.13
|
|
