|
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
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$598.56
|
|
|
Service Code
|
NDC 60687-447-01
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.37 |
| Max. Negotiated Rate |
$538.70 |
| Rate for Payer: Aetna American Axle |
$389.06
|
| Rate for Payer: Aetna Commercial |
$508.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.06
|
| Rate for Payer: Cash Price |
$478.85
|
| Rate for Payer: Cofinity Commercial |
$418.99
|
| Rate for Payer: Cofinity Commercial |
$514.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.85
|
| Rate for Payer: Healthscope Commercial |
$538.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$418.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$508.78
|
| Rate for Payer: PHP Commercial |
$508.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.99
|
| Rate for Payer: Priority Health SBD |
$377.09
|
| Rate for Payer: UMR Bronson Commercial |
$263.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.92
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$501.12
|
|
|
Service Code
|
NDC 0904-6503-61
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.49 |
| Max. Negotiated Rate |
$451.01 |
| Rate for Payer: Aetna American Axle |
$325.73
|
| Rate for Payer: Aetna Commercial |
$425.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.73
|
| Rate for Payer: Cash Price |
$400.90
|
| Rate for Payer: Cofinity Commercial |
$350.78
|
| Rate for Payer: Cofinity Commercial |
$430.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.90
|
| Rate for Payer: Healthscope Commercial |
$451.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.95
|
| Rate for Payer: PHP Commercial |
$425.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.78
|
| Rate for Payer: Priority Health SBD |
$315.71
|
| Rate for Payer: UMR Bronson Commercial |
$220.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.84
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
NDC 60687-447-11
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna American Axle |
$3.89
|
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.89
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cofinity Commercial |
$4.19
|
| Rate for Payer: Cofinity Commercial |
$5.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$5.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.09
|
| Rate for Payer: PHP Commercial |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.19
|
| Rate for Payer: Priority Health SBD |
$3.77
|
| Rate for Payer: UMR Bronson Commercial |
$2.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.49
|
|
|
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
|
$921.30
|
|
|
Service Code
|
NDC 51079-215-20
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$405.37 |
| Max. Negotiated Rate |
$829.17 |
| Rate for Payer: Aetna American Axle |
$598.84
|
| Rate for Payer: Aetna Commercial |
$783.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.84
|
| Rate for Payer: Cash Price |
$737.04
|
| Rate for Payer: Cofinity Commercial |
$644.91
|
| Rate for Payer: Cofinity Commercial |
$792.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.04
|
| Rate for Payer: Healthscope Commercial |
$829.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$644.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$783.10
|
| Rate for Payer: PHP Commercial |
$783.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.91
|
| Rate for Payer: Priority Health SBD |
$580.42
|
| Rate for Payer: UMR Bronson Commercial |
$405.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.98
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$9.22
|
|
|
Service Code
|
NDC 51079-215-01
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Aetna American Axle |
$5.99
|
| Rate for Payer: Aetna Commercial |
$7.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.99
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cofinity Commercial |
$6.45
|
| Rate for Payer: Cofinity Commercial |
$7.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.38
|
| Rate for Payer: Healthscope Commercial |
$8.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.84
|
| Rate for Payer: PHP Commercial |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.45
|
| Rate for Payer: Priority Health SBD |
$5.81
|
| Rate for Payer: UMR Bronson Commercial |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.92
|
|
|
CELLULITIS WITH MCC
|
Facility
|
IP
|
$26,641.77
|
|
|
Service Code
|
MS-DRG 602
|
| Min. Negotiated Rate |
$11,376.32 |
| Max. Negotiated Rate |
$26,641.77 |
| Rate for Payer: Aetna Medicare |
$12,454.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,968.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,968.84
|
| Rate for Payer: BCBS MAPPO |
$11,975.07
|
| Rate for Payer: BCBS Trust/PPO |
$26,641.77
|
| Rate for Payer: BCN Medicare Advantage |
$11,975.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,975.07
|
| Rate for Payer: Mclaren Medicare |
$11,975.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,573.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,771.33
|
| Rate for Payer: PACE Medicare |
$11,376.32
|
| Rate for Payer: PACE SWMI |
$11,975.07
|
| Rate for Payer: PHP Medicare Advantage |
$11,975.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,345.51
|
| Rate for Payer: Priority Health Medicare |
$11,975.07
|
| Rate for Payer: Priority Health Narrow Network |
$17,076.41
|
| Rate for Payer: Railroad Medicare Medicare |
$11,975.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,690.33
|
| Rate for Payer: UHC Core |
$18,605.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,975.07
|
| Rate for Payer: UHC Exchange |
$14,791.70
|
| Rate for Payer: UHC Medicare Advantage |
$12,334.32
|
| Rate for Payer: VA VA |
$11,975.07
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
|
IP
|
$13,495.21
|
|
|
Service Code
|
MS-DRG 603
|
| Min. Negotiated Rate |
$6,963.39 |
| Max. Negotiated Rate |
$13,495.21 |
| Rate for Payer: Aetna Medicare |
$7,623.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,162.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,162.35
|
| Rate for Payer: BCBS MAPPO |
$7,329.88
|
| Rate for Payer: BCBS Trust/PPO |
$12,705.22
|
| Rate for Payer: BCN Medicare Advantage |
$7,329.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,329.88
|
| Rate for Payer: Mclaren Medicare |
$7,329.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,696.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,429.36
|
| Rate for Payer: PACE Medicare |
$6,963.39
|
| Rate for Payer: PACE SWMI |
$7,329.88
|
| Rate for Payer: PHP Medicare Advantage |
$7,329.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,695.37
|
| Rate for Payer: Priority Health Medicare |
$7,329.88
|
| Rate for Payer: Priority Health Narrow Network |
$10,156.30
|
| Rate for Payer: Railroad Medicare Medicare |
$7,329.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,495.21
|
| Rate for Payer: UHC Core |
$11,065.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,329.88
|
| Rate for Payer: UHC Exchange |
$8,797.46
|
| Rate for Payer: UHC Medicare Advantage |
$7,549.78
|
| Rate for Payer: VA VA |
$7,329.88
|
|
|
CELLULOSE, OXIDIZED 2" X 14" PADS
|
Facility
|
IP
|
$250.27
|
|
|
Service Code
|
NDC 0990-0006-02
|
| Hospital Charge Code |
169202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$225.24 |
| Rate for Payer: Aetna American Axle |
$162.68
|
| Rate for Payer: Aetna Commercial |
$212.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.68
|
| Rate for Payer: Cash Price |
$200.22
|
| Rate for Payer: Cofinity Commercial |
$175.19
|
| Rate for Payer: Cofinity Commercial |
$215.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.22
|
| Rate for Payer: Healthscope Commercial |
$225.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.73
|
| Rate for Payer: PHP Commercial |
$212.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.19
|
| Rate for Payer: Priority Health SBD |
$157.67
|
| Rate for Payer: UMR Bronson Commercial |
$110.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.70
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
IP
|
$159.91
|
|
|
Service Code
|
NDC 0990-0006-03
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.36 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna American Axle |
$103.94
|
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.94
|
| Rate for Payer: Cash Price |
$127.93
|
| Rate for Payer: Cofinity Commercial |
$111.94
|
| Rate for Payer: Cofinity Commercial |
$137.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.93
|
| Rate for Payer: Healthscope Commercial |
$143.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.92
|
| Rate for Payer: PHP Commercial |
$135.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.94
|
| Rate for Payer: Priority Health SBD |
$100.74
|
| Rate for Payer: UMR Bronson Commercial |
$70.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.93
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
IP
|
$279.50
|
|
|
Service Code
|
NDC 0990-0006-04
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$122.98 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna American Axle |
$181.68
|
| Rate for Payer: Aetna Commercial |
$237.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$237.58
|
| Rate for Payer: PHP Commercial |
$237.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.65
|
| Rate for Payer: Priority Health SBD |
$176.08
|
| Rate for Payer: UMR Bronson Commercial |
$122.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.62
|
|
|
CELLULOSE,OXIDIZED-COLLAGEN 4.34" X 4.34" 45 %-55 % BANDAGE
|
Facility
|
IP
|
$38.41
|
|
|
Service Code
|
NDC 0990-0006-05
|
| Hospital Charge Code |
169205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Aetna American Axle |
$24.97
|
| Rate for Payer: Aetna Commercial |
$32.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.97
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Cofinity Commercial |
$26.89
|
| Rate for Payer: Cofinity Commercial |
$33.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.73
|
| Rate for Payer: Healthscope Commercial |
$34.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.65
|
| Rate for Payer: PHP Commercial |
$32.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.89
|
| Rate for Payer: Priority Health SBD |
$24.20
|
| Rate for Payer: UMR Bronson Commercial |
$16.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.81
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$44,890.50
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$40,401.45 |
| Rate for Payer: Aetna American Axle |
$29,178.82
|
| Rate for Payer: Aetna Commercial |
$38,156.92
|
| Rate for Payer: Aetna Medicare |
$28.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29,178.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.33
|
| Rate for Payer: BCBS Complete |
$15.77
|
| Rate for Payer: BCBS MAPPO |
$27.46
|
| Rate for Payer: BCBS Trust/PPO |
$88.71
|
| Rate for Payer: BCN Medicare Advantage |
$27.46
|
| Rate for Payer: Cash Price |
$35,912.40
|
| Rate for Payer: Cash Price |
$35,912.40
|
| Rate for Payer: Cofinity Commercial |
$38,605.83
|
| Rate for Payer: Cofinity Commercial |
$31,423.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,912.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.46
|
| Rate for Payer: Healthscope Commercial |
$40,401.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31,423.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33,667.88
|
| Rate for Payer: Mclaren Medicaid |
$15.02
|
| Rate for Payer: Mclaren Medicare |
$27.46
|
| Rate for Payer: Meridian Medicaid |
$15.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38,156.92
|
| Rate for Payer: PACE Medicare |
$26.09
|
| Rate for Payer: PACE SWMI |
$27.46
|
| Rate for Payer: PHP Commercial |
$38,156.92
|
| Rate for Payer: PHP Medicare Advantage |
$27.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31,423.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.07
|
| Rate for Payer: Priority Health Medicare |
$27.46
|
| Rate for Payer: Priority Health Narrow Network |
$63.26
|
| Rate for Payer: Priority Health SBD |
$28,281.02
|
| Rate for Payer: Railroad Medicare Medicare |
$27.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.46
|
| Rate for Payer: UHC Medicare Advantage |
$28.28
|
| Rate for Payer: UMR Bronson Commercial |
$16,609.48
|
| Rate for Payer: VA VA |
$27.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33,667.88
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$44,890.50
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,751.82 |
| Max. Negotiated Rate |
$40,401.45 |
| Rate for Payer: Aetna American Axle |
$29,178.82
|
| Rate for Payer: Aetna Commercial |
$38,156.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29,178.82
|
| Rate for Payer: Cash Price |
$35,912.40
|
| Rate for Payer: Cofinity Commercial |
$31,423.35
|
| Rate for Payer: Cofinity Commercial |
$38,605.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,912.40
|
| Rate for Payer: Healthscope Commercial |
$40,401.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31,423.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33,667.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38,156.92
|
| Rate for Payer: PHP Commercial |
$38,156.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31,423.35
|
| Rate for Payer: Priority Health SBD |
$28,281.02
|
| Rate for Payer: UMR Bronson Commercial |
$19,751.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33,667.88
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$203.30
|
|
|
Service Code
|
NDC 0093-4177-73
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.45 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna American Axle |
$132.14
|
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.14
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Commercial |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.80
|
| Rate for Payer: PHP Commercial |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.31
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UMR Bronson Commercial |
$89.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.48
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$201.40
|
|
|
Service Code
|
NDC 68180-441-01
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.98
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$88.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,032.30
|
|
|
Service Code
|
NDC 62135-481-42
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$454.21 |
| Max. Negotiated Rate |
$929.07 |
| Rate for Payer: Aetna American Axle |
$671.00
|
| Rate for Payer: Aetna Commercial |
$877.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.00
|
| Rate for Payer: Cash Price |
$825.84
|
| Rate for Payer: Cofinity Commercial |
$722.61
|
| Rate for Payer: Cofinity Commercial |
$887.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.84
|
| Rate for Payer: Healthscope Commercial |
$929.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$722.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$774.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$877.46
|
| Rate for Payer: PHP Commercial |
$877.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.61
|
| Rate for Payer: Priority Health SBD |
$650.35
|
| Rate for Payer: UMR Bronson Commercial |
$454.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$774.22
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$427.70
|
|
|
Service Code
|
NDC 67877-545-68
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.19 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna American Axle |
$278.00
|
| Rate for Payer: Aetna Commercial |
$363.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.00
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$299.39
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.54
|
| Rate for Payer: PHP Commercial |
$363.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.39
|
| Rate for Payer: Priority Health SBD |
$269.45
|
| Rate for Payer: UMR Bronson Commercial |
$188.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.78
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$916.50
|
|
|
Service Code
|
NDC 68180-441-02
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$403.26 |
| Max. Negotiated Rate |
$824.85 |
| Rate for Payer: Aetna American Axle |
$595.72
|
| Rate for Payer: Aetna Commercial |
$779.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.72
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cofinity Commercial |
$641.55
|
| Rate for Payer: Cofinity Commercial |
$788.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.20
|
| Rate for Payer: Healthscope Commercial |
$824.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$641.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$687.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$779.02
|
| Rate for Payer: PHP Commercial |
$779.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.55
|
| Rate for Payer: Priority Health SBD |
$577.40
|
| Rate for Payer: UMR Bronson Commercial |
$403.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.38
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 50268-151-11
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$220.90
|
|
|
Service Code
|
NDC 67877-220-01
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna American Axle |
$143.58
|
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.58
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$154.63
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.76
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.63
|
| Rate for Payer: Priority Health SBD |
$139.17
|
| Rate for Payer: UMR Bronson Commercial |
$97.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.68
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$132.53
|
|
|
Service Code
|
NDC 50268-151-15
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.65
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.77
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 0093-3145-01
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$245.69
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.34
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UMR Bronson Commercial |
$127.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$397.15
|
|
|
Service Code
|
NDC 65862-019-01
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$357.44 |
| Rate for Payer: Aetna American Axle |
$258.15
|
| Rate for Payer: Aetna Commercial |
$337.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.15
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Commercial |
$278.00
|
| Rate for Payer: Cofinity Commercial |
$341.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$357.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$337.58
|
| Rate for Payer: PHP Commercial |
$337.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: Priority Health SBD |
$250.20
|
| Rate for Payer: UMR Bronson Commercial |
$174.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.86
|
|
