|
CEFAZOLIN IV SYRINGE 2 G PMX
|
Facility
|
IP
|
$6.04
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.93
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.83
|
| Rate for Payer: Healthscope Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.13
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: Priority Health SBD |
$3.81
|
|
|
CEFAZOLIN IV SYRINGE 2 G PMX
|
Facility
|
OP
|
$6.04
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: Aetna Medicare |
$3.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.93
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.83
|
| Rate for Payer: Healthscope Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.13
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: Priority Health SBD |
$3.81
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 67877054798
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$196.70 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$152.98
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.06
|
| Rate for Payer: Priority Health SBD |
$137.69
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$218.55
|
|
|
Service Code
|
NDC 67877054798
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$196.70 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna Medicare |
$109.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: BCBS Complete |
$87.42
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$152.98
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.06
|
| Rate for Payer: Priority Health SBD |
$137.69
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
OP
|
$192.10
|
|
|
Service Code
|
NDC 68180071160
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$172.89 |
| Rate for Payer: Aetna Commercial |
$163.28
|
| Rate for Payer: Aetna Medicare |
$96.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.86
|
| Rate for Payer: BCBS Complete |
$76.84
|
| Rate for Payer: Cash Price |
$153.68
|
| Rate for Payer: Cofinity Commercial |
$134.47
|
| Rate for Payer: Cofinity Commercial |
$165.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.68
|
| Rate for Payer: Healthscope Commercial |
$172.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.28
|
| Rate for Payer: PHP Commercial |
$163.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.86
|
| Rate for Payer: Priority Health SBD |
$121.02
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
OP
|
$163.01
|
|
|
Service Code
|
NDC 65862017760
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$146.71 |
| Rate for Payer: Aetna Commercial |
$138.56
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.96
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: Cash Price |
$130.41
|
| Rate for Payer: Cofinity Commercial |
$114.11
|
| Rate for Payer: Cofinity Commercial |
$140.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.41
|
| Rate for Payer: Healthscope Commercial |
$146.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.56
|
| Rate for Payer: PHP Commercial |
$138.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.96
|
| Rate for Payer: Priority Health SBD |
$102.70
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$163.01
|
|
|
Service Code
|
NDC 65862017760
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$146.71 |
| Rate for Payer: Aetna Commercial |
$138.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.96
|
| Rate for Payer: Cash Price |
$130.41
|
| Rate for Payer: Cofinity Commercial |
$114.11
|
| Rate for Payer: Cofinity Commercial |
$140.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.41
|
| Rate for Payer: Healthscope Commercial |
$146.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.56
|
| Rate for Payer: PHP Commercial |
$138.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.96
|
| Rate for Payer: Priority Health SBD |
$102.70
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$192.10
|
|
|
Service Code
|
NDC 68180071160
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.02 |
| Max. Negotiated Rate |
$172.89 |
| Rate for Payer: Aetna Commercial |
$163.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.86
|
| Rate for Payer: Cash Price |
$153.68
|
| Rate for Payer: Cofinity Commercial |
$134.47
|
| Rate for Payer: Cofinity Commercial |
$165.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.68
|
| Rate for Payer: Healthscope Commercial |
$172.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.28
|
| Rate for Payer: PHP Commercial |
$163.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.86
|
| Rate for Payer: Priority Health SBD |
$121.02
|
|
|
CEFEPIME 100 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
188964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$1,088.00
|
| Rate for Payer: Aetna Medicare |
$640.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$832.00
|
| Rate for Payer: BCBS Complete |
$512.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cofinity Commercial |
$1,100.80
|
| Rate for Payer: Cofinity Commercial |
$896.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$896.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,024.00
|
| Rate for Payer: Healthscope Commercial |
$1,152.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,088.00
|
| Rate for Payer: PHP Commercial |
$1,088.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.00
|
| Rate for Payer: Priority Health SBD |
$806.40
|
|
|
CEFEPIME 100 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
188964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$806.40 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$1,088.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$832.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cofinity Commercial |
$1,100.80
|
| Rate for Payer: Cofinity Commercial |
$896.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$896.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,024.00
|
| Rate for Payer: Healthscope Commercial |
$1,152.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,088.00
|
| Rate for Payer: PHP Commercial |
$1,088.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.00
|
| Rate for Payer: Priority Health SBD |
$806.40
|
|
|
CEFEPIME 1 GRAM CUSTOM SOLUTION FOR DESENSITIZATION
|
Facility
|
IP
|
$29.64
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$25.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.27
|
| Rate for Payer: Cash Price |
$23.71
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.71
|
| Rate for Payer: Healthscope Commercial |
$26.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.19
|
| Rate for Payer: PHP Commercial |
$25.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.27
|
| Rate for Payer: Priority Health SBD |
$18.67
|
|
|
CEFEPIME 1 GRAM CUSTOM SOLUTION FOR DESENSITIZATION
|
Facility
|
OP
|
$29.64
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$25.19
|
| Rate for Payer: Aetna Medicare |
$14.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.27
|
| Rate for Payer: BCBS Complete |
$11.86
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: Cash Price |
$23.71
|
| Rate for Payer: Cash Price |
$23.71
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.71
|
| Rate for Payer: Healthscope Commercial |
$26.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.19
|
| Rate for Payer: PHP Commercial |
$25.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.27
|
| Rate for Payer: Priority Health SBD |
$18.67
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$18.08
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Commercial |
$14.47
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: Aetna Medicare |
$8.51
|
| Rate for Payer: Aetna Medicare |
$9.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: BCBS Complete |
$6.81
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$11.91
|
| Rate for Payer: Cofinity Commercial |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$12.66
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$14.47
|
| Rate for Payer: PHP Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$14.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health SBD |
$10.71
|
| Rate for Payer: Priority Health SBD |
$11.39
|
| Rate for Payer: Priority Health SBD |
$10.72
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$17.02
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: Aetna Commercial |
$14.47
|
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cofinity Commercial |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$11.91
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$12.66
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$14.47
|
| Rate for Payer: PHP Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$14.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health SBD |
$11.39
|
| Rate for Payer: Priority Health SBD |
$10.72
|
| Rate for Payer: Priority Health SBD |
$10.71
|
|
|
CEFEPIME 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.05
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.45
|
| Rate for Payer: PHP Commercial |
$14.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health SBD |
$10.71
|
|
|
CEFEPIME 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.05
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.45
|
| Rate for Payer: PHP Commercial |
$14.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health SBD |
$10.71
|
|
|
CEFEPIME 2 GM IVPB (IV PREMIX)
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health SBD |
$14.02
|
|
|
CEFEPIME 2 GM IVPB (IV PREMIX)
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health SBD |
$14.02
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$19.18
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$17.26 |
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Commercial |
$21.41
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Commercial |
$27.57
|
| Rate for Payer: Aetna Medicare |
$9.58
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Aetna Medicare |
$16.52
|
| Rate for Payer: Aetna Medicare |
$16.22
|
| Rate for Payer: Aetna Medicare |
$9.59
|
| Rate for Payer: Aetna Medicare |
$12.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.47
|
| Rate for Payer: BCBS Complete |
$10.08
|
| Rate for Payer: BCBS Complete |
$12.97
|
| Rate for Payer: BCBS Complete |
$10.26
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS Complete |
$13.21
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$17.63
|
| Rate for Payer: Cofinity Commercial |
$21.66
|
| Rate for Payer: Cofinity Commercial |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$22.70
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$22.67
|
| Rate for Payer: Healthscope Commercial |
$23.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$27.57
|
| Rate for Payer: PHP Commercial |
$21.81
|
| Rate for Payer: PHP Commercial |
$21.41
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.37
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: Priority Health SBD |
$16.17
|
| Rate for Payer: Priority Health SBD |
$20.43
|
| Rate for Payer: Priority Health SBD |
$15.87
|
| Rate for Payer: Priority Health SBD |
$20.81
|
| Rate for Payer: Priority Health SBD |
$12.08
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$25.19
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$22.67 |
| Rate for Payer: Aetna Commercial |
$21.41
|
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Commercial |
$27.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.47
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$22.70
|
| Rate for Payer: Cofinity Commercial |
$17.63
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$21.66
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.53
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$22.67
|
| Rate for Payer: Healthscope Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$21.41
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$21.81
|
| Rate for Payer: PHP Commercial |
$27.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.47
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: Priority Health SBD |
$20.43
|
| Rate for Payer: Priority Health SBD |
$20.81
|
| Rate for Payer: Priority Health SBD |
$16.17
|
| Rate for Payer: Priority Health SBD |
$15.87
|
|
|
CEFEPIME 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Medicare |
$9.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.46
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.46
|
| Rate for Payer: Priority Health SBD |
$12.08
|
|
|
CEFEPIME 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.08 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.46
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.46
|
| Rate for Payer: Priority Health SBD |
$12.08
|
|
|
CEFEPIME IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$1.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: BCBS Complete |
$0.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.14
|
| Rate for Payer: Priority Health SBD |
$1.10
|
|
|
CEFEPIME IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$1.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.14
|
| Rate for Payer: Priority Health SBD |
$1.10
|
|
|
CEFEPIME IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$16.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$15.08 |
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.89
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Healthscope Commercial |
$15.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.24
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.89
|
| Rate for Payer: Priority Health SBD |
$10.55
|
|
