|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$180.95
|
|
|
Service Code
|
NDC 00904630061
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: Aetna Medicare |
$90.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.62
|
| Rate for Payer: BCBS Complete |
$72.38
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$126.66
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.62
|
| Rate for Payer: Priority Health SBD |
$114.00
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$204.45
|
|
|
Service Code
|
NDC 00904730661
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.78 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$173.78
|
| Rate for Payer: Aetna Medicare |
$102.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.89
|
| Rate for Payer: BCBS Complete |
$81.78
|
| Rate for Payer: Cash Price |
$163.56
|
| Rate for Payer: Cofinity Commercial |
$143.12
|
| Rate for Payer: Cofinity Commercial |
$175.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.56
|
| Rate for Payer: Healthscope Commercial |
$184.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.78
|
| Rate for Payer: PHP Commercial |
$173.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.89
|
| Rate for Payer: Priority Health SBD |
$128.80
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$220.90
|
|
|
Service Code
|
NDC 43547025510
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.17 |
| Max. Negotiated Rate |
$198.81 |
| 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: Cofinity Medicare Advantage |
$154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.58
|
| Rate for Payer: Priority Health SBD |
$139.17
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$987.00
|
|
|
Service Code
|
NDC 43547025550
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$621.81 |
| Max. Negotiated Rate |
$888.30 |
| Rate for Payer: Aetna Commercial |
$838.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.55
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cofinity Commercial |
$690.90
|
| Rate for Payer: Cofinity Commercial |
$848.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$690.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.60
|
| Rate for Payer: Healthscope Commercial |
$888.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.95
|
| Rate for Payer: PHP Commercial |
$838.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.55
|
| Rate for Payer: Priority Health SBD |
$621.81
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$204.45
|
|
|
Service Code
|
NDC 00904730661
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$173.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.89
|
| Rate for Payer: Cash Price |
$163.56
|
| Rate for Payer: Cofinity Commercial |
$143.12
|
| Rate for Payer: Cofinity Commercial |
$175.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.56
|
| Rate for Payer: Healthscope Commercial |
$184.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.78
|
| Rate for Payer: PHP Commercial |
$173.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.89
|
| Rate for Payer: Priority Health SBD |
$128.80
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 00904630161
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health SBD |
$118.44
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$220.90
|
|
|
Service Code
|
NDC 43547025510
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.36 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna Medicare |
$110.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.58
|
| Rate for Payer: BCBS Complete |
$88.36
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$154.63
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.58
|
| Rate for Payer: Priority Health SBD |
$139.17
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$987.00
|
|
|
Service Code
|
NDC 43547025550
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$394.80 |
| Max. Negotiated Rate |
$888.30 |
| Rate for Payer: Aetna Commercial |
$838.95
|
| Rate for Payer: Aetna Medicare |
$493.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.55
|
| Rate for Payer: BCBS Complete |
$394.80
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cofinity Commercial |
$690.90
|
| Rate for Payer: Cofinity Commercial |
$848.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$690.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.60
|
| Rate for Payer: Healthscope Commercial |
$888.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.95
|
| Rate for Payer: PHP Commercial |
$838.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.55
|
| Rate for Payer: Priority Health SBD |
$621.81
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 00904630161
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health SBD |
$118.44
|
|
|
CATHETERIZATION AND INTRODUCTION OF SALINE OR CONTRAST MATERIAL FOR SALINE INFUSION SONOHYSTEROGRAPHY (SIS) OR HYSTEROSALPINGOGRAPHY
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 58340
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$60.91 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: BCBS Trust/PPO |
$326.08
|
| Rate for Payer: BCN Commercial |
$326.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.91
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
CAUTERY OF CERVIX; ELECTRO OR THERMAL
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 57510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$43.32
|
| Rate for Payer: BCN Commercial |
$43.32
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.00
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,753.88
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
CEFAZOLIN 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$301.75
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
31086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.10 |
| Max. Negotiated Rate |
$271.58 |
| Rate for Payer: Aetna Commercial |
$256.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.14
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cofinity Commercial |
$211.22
|
| Rate for Payer: Cofinity Commercial |
$259.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.40
|
| Rate for Payer: Healthscope Commercial |
$271.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.49
|
| Rate for Payer: PHP Commercial |
$256.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.14
|
| Rate for Payer: Priority Health SBD |
$190.10
|
|
|
CEFAZOLIN 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$301.75
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
31086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$271.58 |
| Rate for Payer: Aetna Commercial |
$256.49
|
| Rate for Payer: Aetna Medicare |
$150.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.14
|
| Rate for Payer: BCBS Complete |
$120.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cofinity Commercial |
$211.22
|
| Rate for Payer: Cofinity Commercial |
$259.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.40
|
| Rate for Payer: Healthscope Commercial |
$271.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.49
|
| Rate for Payer: PHP Commercial |
$256.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.14
|
| Rate for Payer: Priority Health SBD |
$190.10
|
|
|
CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$29.07
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$26.16 |
| Rate for Payer: Aetna Commercial |
$24.71
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna Medicare |
$14.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: BCBS Complete |
$19.87
|
| Rate for Payer: BCBS Complete |
$11.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$23.26
|
| Rate for Payer: Cash Price |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$20.35
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$34.77
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.71
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.29
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$18.31
|
|
|
CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$29.07
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$26.16 |
| Rate for Payer: Aetna Commercial |
$24.71
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Cash Price |
$23.26
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cofinity Commercial |
$20.35
|
| Rate for Payer: Cofinity Commercial |
$34.77
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$24.71
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$18.31
|
|
|
CEFAZOLIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
27297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna Commercial |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.29
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$13.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: PHP Commercial |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.29
|
| Rate for Payer: Priority Health SBD |
$9.97
|
|
|
CEFAZOLIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
27297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna Commercial |
$13.46
|
| Rate for Payer: Aetna Medicare |
$7.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.29
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$13.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: PHP Commercial |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.29
|
| Rate for Payer: Priority Health SBD |
$9.97
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$13.88
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.62
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$9.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$12.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$11.80
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health SBD |
$12.23
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Priority Health SBD |
$8.79
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$19.41
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$17.47 |
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Medicare |
$6.94
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Aetna Medicare |
$9.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.62
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Complete |
$5.55
|
| Rate for Payer: BCBS Complete |
$7.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$9.76
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$11.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Priority Health SBD |
$12.23
|
| Rate for Payer: Priority Health SBD |
$8.79
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$9.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health SBD |
$8.79
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$9.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health SBD |
$8.79
|
|
|
CEFAZOLIN 50 MG/0.5 ML IN NS FOR DISCOGRAM
|
Facility
|
IP
|
$7.81
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.08
|
| Rate for Payer: Priority Health SBD |
$4.92
|
|
|
CEFAZOLIN 50 MG/0.5 ML IN NS FOR DISCOGRAM
|
Facility
|
OP
|
$7.81
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: BCBS Complete |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.08
|
| Rate for Payer: Priority Health SBD |
$4.92
|
|
|
CEFAZOLIN IV SYRINGE 1 G PMX
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$4.08
|
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Medicare |
$11.92
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Aetna Medicare |
$2.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.12
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS Complete |
$9.53
|
| Rate for Payer: BCBS Complete |
$1.92
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$4.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.84
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Healthscope Commercial |
$4.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.08
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: PHP Commercial |
$4.08
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.49
|
| Rate for Payer: Priority Health SBD |
$15.01
|
| Rate for Payer: Priority Health SBD |
$3.02
|
| Rate for Payer: Priority Health SBD |
$1.90
|
|
|
CEFAZOLIN IV SYRINGE 1 G PMX
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Commercial |
$4.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.12
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Cofinity Commercial |
$4.13
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.84
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$4.32
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.08
|
| Rate for Payer: PHP Commercial |
$4.08
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.96
|
| Rate for Payer: Priority Health SBD |
$3.02
|
| Rate for Payer: Priority Health SBD |
$15.01
|
| Rate for Payer: Priority Health SBD |
$1.90
|
|
