|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$140.49
|
|
|
Service Code
|
NDC 70860-119-99
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.82 |
| Max. Negotiated Rate |
$126.44 |
| Rate for Payer: Aetna American Axle |
$91.32
|
| Rate for Payer: Aetna Commercial |
$119.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.32
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cofinity Commercial |
$120.82
|
| Rate for Payer: Cofinity Commercial |
$98.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.39
|
| Rate for Payer: Healthscope Commercial |
$126.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.42
|
| Rate for Payer: PHP Commercial |
$119.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.34
|
| Rate for Payer: Priority Health SBD |
$88.51
|
| Rate for Payer: UMR Bronson Commercial |
$61.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.37
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$478.69
|
|
|
Service Code
|
NDC 44567-223-01
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$210.62 |
| Max. Negotiated Rate |
$430.82 |
| Rate for Payer: Aetna American Axle |
$311.15
|
| Rate for Payer: Aetna Commercial |
$406.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.15
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Cofinity Commercial |
$335.08
|
| Rate for Payer: Cofinity Commercial |
$411.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.95
|
| Rate for Payer: Healthscope Commercial |
$430.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$406.89
|
| Rate for Payer: PHP Commercial |
$406.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.08
|
| Rate for Payer: Priority Health SBD |
$301.57
|
| Rate for Payer: UMR Bronson Commercial |
$210.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.02
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$221.70
|
|
|
Service Code
|
NDC 0781-3126-95
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$199.53 |
| Rate for Payer: Aetna American Axle |
$144.10
|
| Rate for Payer: Aetna Commercial |
$188.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.10
|
| Rate for Payer: BCBS Complete |
$88.68
|
| Rate for Payer: Cash Price |
$177.36
|
| Rate for Payer: Cofinity Commercial |
$155.19
|
| Rate for Payer: Cofinity Commercial |
$190.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.36
|
| Rate for Payer: Healthscope Commercial |
$199.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.44
|
| Rate for Payer: PHP Commercial |
$188.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.19
|
| Rate for Payer: Priority Health SBD |
$139.67
|
| Rate for Payer: UMR Bronson Commercial |
$82.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.28
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$190.90
|
|
|
Service Code
|
NDC 0409-3715-10
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.63 |
| Max. Negotiated Rate |
$171.81 |
| Rate for Payer: Aetna American Axle |
$124.08
|
| Rate for Payer: Aetna Commercial |
$162.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.08
|
| Rate for Payer: BCBS Complete |
$76.36
|
| Rate for Payer: Cash Price |
$152.72
|
| Rate for Payer: Cofinity Commercial |
$133.63
|
| Rate for Payer: Cofinity Commercial |
$164.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.72
|
| Rate for Payer: Healthscope Commercial |
$171.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.26
|
| Rate for Payer: PHP Commercial |
$162.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.63
|
| Rate for Payer: Priority Health SBD |
$120.27
|
| Rate for Payer: UMR Bronson Commercial |
$70.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.18
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$467.29
|
|
|
Service Code
|
NDC 63323-330-60
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$420.56 |
| Rate for Payer: Aetna American Axle |
$303.74
|
| Rate for Payer: Aetna Commercial |
$397.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.74
|
| Rate for Payer: BCBS Complete |
$186.92
|
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Cofinity Commercial |
$327.10
|
| Rate for Payer: Cofinity Commercial |
$401.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.83
|
| Rate for Payer: Healthscope Commercial |
$420.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.20
|
| Rate for Payer: PHP Commercial |
$397.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.10
|
| Rate for Payer: Priority Health SBD |
$294.39
|
| Rate for Payer: UMR Bronson Commercial |
$172.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.47
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$467.29
|
|
|
Service Code
|
NDC 63323-330-60
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$205.61 |
| Max. Negotiated Rate |
$420.56 |
| Rate for Payer: Aetna American Axle |
$303.74
|
| Rate for Payer: Aetna Commercial |
$397.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.74
|
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Cofinity Commercial |
$327.10
|
| Rate for Payer: Cofinity Commercial |
$401.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.83
|
| Rate for Payer: Healthscope Commercial |
$420.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.20
|
| Rate for Payer: PHP Commercial |
$397.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.10
|
| Rate for Payer: Priority Health SBD |
$294.39
|
| Rate for Payer: UMR Bronson Commercial |
$205.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.47
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$221.70
|
|
|
Service Code
|
NDC 0781-3126-95
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.55 |
| Max. Negotiated Rate |
$199.53 |
| Rate for Payer: Aetna American Axle |
$144.10
|
| Rate for Payer: Aetna Commercial |
$188.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.10
|
| Rate for Payer: Cash Price |
$177.36
|
| Rate for Payer: Cofinity Commercial |
$155.19
|
| Rate for Payer: Cofinity Commercial |
$190.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.36
|
| Rate for Payer: Healthscope Commercial |
$199.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.44
|
| Rate for Payer: PHP Commercial |
$188.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.19
|
| Rate for Payer: Priority Health SBD |
$139.67
|
| Rate for Payer: UMR Bronson Commercial |
$97.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.28
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$147.74
|
|
|
Service Code
|
NDC 55150-124-99
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.01 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna American Axle |
$96.03
|
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.03
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.58
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.42
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: UMR Bronson Commercial |
$65.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.80
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$363.17
|
|
|
Service Code
|
NDC 25021-141-99
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$326.85 |
| Rate for Payer: Aetna American Axle |
$236.06
|
| Rate for Payer: Aetna Commercial |
$308.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.06
|
| Rate for Payer: BCBS Complete |
$145.27
|
| Rate for Payer: Cash Price |
$290.54
|
| Rate for Payer: Cofinity Commercial |
$254.22
|
| Rate for Payer: Cofinity Commercial |
$312.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.54
|
| Rate for Payer: Healthscope Commercial |
$326.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.69
|
| Rate for Payer: PHP Commercial |
$308.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.22
|
| Rate for Payer: Priority Health SBD |
$228.80
|
| Rate for Payer: UMR Bronson Commercial |
$134.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.38
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$190.90
|
|
|
Service Code
|
NDC 0409-3715-01
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.63 |
| Max. Negotiated Rate |
$171.81 |
| Rate for Payer: Aetna American Axle |
$124.08
|
| Rate for Payer: Aetna Commercial |
$162.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.08
|
| Rate for Payer: BCBS Complete |
$76.36
|
| Rate for Payer: Cash Price |
$152.72
|
| Rate for Payer: Cofinity Commercial |
$133.63
|
| Rate for Payer: Cofinity Commercial |
$164.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.72
|
| Rate for Payer: Healthscope Commercial |
$171.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.26
|
| Rate for Payer: PHP Commercial |
$162.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.63
|
| Rate for Payer: Priority Health SBD |
$120.27
|
| Rate for Payer: UMR Bronson Commercial |
$70.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.18
|
|
|
NAFCILLIN 1 GRAM IVPB (INTRA-OP)
|
Facility
|
IP
|
$5.70
|
|
|
Service Code
|
NDC 9900-0005-60
|
| Hospital Charge Code |
168910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna American Axle |
$3.70
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.70
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.99
|
| Rate for Payer: Priority Health SBD |
$3.59
|
| Rate for Payer: UMR Bronson Commercial |
$2.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.28
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$47.88
|
|
|
Service Code
|
NDC 0781-9124-85
|
| Hospital Charge Code |
5333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.07 |
| Max. Negotiated Rate |
$43.09 |
| Rate for Payer: Aetna American Axle |
$31.12
|
| Rate for Payer: Aetna Commercial |
$40.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$33.52
|
| Rate for Payer: Cofinity Commercial |
$41.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$43.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.70
|
| Rate for Payer: PHP Commercial |
$40.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.52
|
| Rate for Payer: Priority Health SBD |
$30.16
|
| Rate for Payer: UMR Bronson Commercial |
$21.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.91
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$47.88
|
|
|
Service Code
|
NDC 0781-3124-95
|
| Hospital Charge Code |
5333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.07 |
| Max. Negotiated Rate |
$43.09 |
| Rate for Payer: Aetna American Axle |
$31.12
|
| Rate for Payer: Aetna Commercial |
$40.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$33.52
|
| Rate for Payer: Cofinity Commercial |
$41.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$43.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.70
|
| Rate for Payer: PHP Commercial |
$40.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.52
|
| Rate for Payer: Priority Health SBD |
$30.16
|
| Rate for Payer: UMR Bronson Commercial |
$21.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.91
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$47.88
|
|
|
Service Code
|
NDC 0781-9124-95
|
| Hospital Charge Code |
5333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.07 |
| Max. Negotiated Rate |
$43.09 |
| Rate for Payer: Aetna American Axle |
$31.12
|
| Rate for Payer: Aetna Commercial |
$40.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$33.52
|
| Rate for Payer: Cofinity Commercial |
$41.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$43.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.70
|
| Rate for Payer: PHP Commercial |
$40.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.52
|
| Rate for Payer: Priority Health SBD |
$30.16
|
| Rate for Payer: UMR Bronson Commercial |
$21.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.91
|
|
|
NAFCILLIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.29
|
|
|
Service Code
|
NDC 0781-3129-92
|
| Hospital Charge Code |
27285
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.89 |
| Max. Negotiated Rate |
$116.36 |
| Rate for Payer: Aetna American Axle |
$84.04
|
| Rate for Payer: Aetna Commercial |
$109.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.04
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Cofinity Commercial |
$111.19
|
| Rate for Payer: Cofinity Commercial |
$90.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.43
|
| Rate for Payer: Healthscope Commercial |
$116.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.90
|
| Rate for Payer: PHP Commercial |
$109.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.50
|
| Rate for Payer: Priority Health SBD |
$81.45
|
| Rate for Payer: UMR Bronson Commercial |
$56.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.97
|
|
|
NAFCILLIN 2 GRAM IVPB (INTRA-OP)
|
Facility
|
IP
|
$21.20
|
|
|
Service Code
|
NDC 9900-0005-61
|
| Hospital Charge Code |
168911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna American Axle |
$13.78
|
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.02
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.84
|
| Rate for Payer: Priority Health SBD |
$13.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.90
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$39.48
|
|
|
Service Code
|
NDC 0409-3714-01
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$35.53 |
| Rate for Payer: Aetna American Axle |
$25.66
|
| Rate for Payer: Aetna Commercial |
$33.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.66
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$33.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$35.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.56
|
| Rate for Payer: PHP Commercial |
$33.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.64
|
| Rate for Payer: Priority Health SBD |
$24.87
|
| Rate for Payer: UMR Bronson Commercial |
$17.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.61
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
NDC 25021-140-10
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.97 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna American Axle |
$60.53
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.15
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.18
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: UMR Bronson Commercial |
$40.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$20.32
|
|
|
Service Code
|
NDC 70860-117-41
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$18.29 |
| Rate for Payer: Aetna American Axle |
$13.21
|
| Rate for Payer: Aetna Commercial |
$17.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.21
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.26
|
| Rate for Payer: Healthscope Commercial |
$18.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.27
|
| Rate for Payer: PHP Commercial |
$17.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health SBD |
$12.80
|
| Rate for Payer: UMR Bronson Commercial |
$8.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.24
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
NDC 55150-123-16
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna American Axle |
$15.66
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.48
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: UMR Bronson Commercial |
$10.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$39.48
|
|
|
Service Code
|
NDC 0409-3714-01
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$35.53 |
| Rate for Payer: Aetna American Axle |
$25.66
|
| Rate for Payer: Aetna Commercial |
$33.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.66
|
| Rate for Payer: BCBS Complete |
$15.79
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$33.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$35.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.56
|
| Rate for Payer: PHP Commercial |
$33.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.64
|
| Rate for Payer: Priority Health SBD |
$24.87
|
| Rate for Payer: UMR Bronson Commercial |
$14.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.61
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$39.48
|
|
|
Service Code
|
NDC 0409-3714-10
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$35.53 |
| Rate for Payer: Aetna American Axle |
$25.66
|
| Rate for Payer: Aetna Commercial |
$33.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.66
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$33.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$35.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.56
|
| Rate for Payer: PHP Commercial |
$33.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.64
|
| Rate for Payer: Priority Health SBD |
$24.87
|
| Rate for Payer: UMR Bronson Commercial |
$17.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.61
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$20.32
|
|
|
Service Code
|
NDC 70860-117-26
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$18.29 |
| Rate for Payer: Aetna American Axle |
$13.21
|
| Rate for Payer: Aetna Commercial |
$17.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.21
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.26
|
| Rate for Payer: Healthscope Commercial |
$18.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.27
|
| Rate for Payer: PHP Commercial |
$17.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health SBD |
$12.80
|
| Rate for Payer: UMR Bronson Commercial |
$8.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.24
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$93.12
|
|
|
Service Code
|
NDC 25021-140-10
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.45 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna American Axle |
$60.53
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.15
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.18
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: UMR Bronson Commercial |
$34.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$39.48
|
|
|
Service Code
|
NDC 0409-3714-10
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$35.53 |
| Rate for Payer: Aetna American Axle |
$25.66
|
| Rate for Payer: Aetna Commercial |
$33.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.66
|
| Rate for Payer: BCBS Complete |
$15.79
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$33.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$35.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.56
|
| Rate for Payer: PHP Commercial |
$33.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.64
|
| Rate for Payer: Priority Health SBD |
$24.87
|
| Rate for Payer: UMR Bronson Commercial |
$14.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.61
|
|
