|
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 |
$7.67 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Medicare |
$9.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.46
|
| Rate for Payer: BCBS Complete |
$7.67
|
| 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 |
$1.57 |
| 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: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.23
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.57
|
| 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 |
$1.57 |
| 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 |
$1.23
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.57
|
| 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
|
OP
|
$16.75
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$15.07 |
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna Medicare |
$8.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.89
|
| Rate for Payer: BCBS Complete |
$6.70
|
| 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 |
$15.07
|
| 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
|
|
|
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 |
$15.07 |
| 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 |
$15.07
|
| 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
|
|
|
CEFEPIME (MAXIPIME) 4 GRAM /540 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
IP
|
$45.66
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.77 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna Commercial |
$38.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.68
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.53
|
| Rate for Payer: Healthscope Commercial |
$41.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.81
|
| Rate for Payer: PHP Commercial |
$38.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.68
|
| Rate for Payer: Priority Health SBD |
$28.77
|
|
|
CEFEPIME (MAXIPIME) 4 GRAM /540 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
OP
|
$45.66
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna Commercial |
$38.81
|
| Rate for Payer: Aetna Medicare |
$22.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.68
|
| Rate for Payer: BCBS Complete |
$18.26
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.53
|
| Rate for Payer: Healthscope Commercial |
$41.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.81
|
| Rate for Payer: PHP Commercial |
$38.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.68
|
| Rate for Payer: Priority Health SBD |
$28.77
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$17.21
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
301721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health SBD |
$10.84
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$17.21
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
301721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health SBD |
$10.84
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.21
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health SBD |
$10.84
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.21
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.19
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health SBD |
$10.84
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
NDC 25021011020
|
| Hospital Charge Code |
301722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna Medicare |
$14.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$18.52
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$29.39
|
|
|
Service Code
|
NDC 25021011020
|
| Hospital Charge Code |
301722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$18.52
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
NDC 25021011020
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna Medicare |
$14.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$18.52
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.39
|
|
|
Service Code
|
NDC 25021011020
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$18.52
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
NDC 44567024625
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna Medicare |
$14.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$18.52
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.39
|
|
|
Service Code
|
NDC 44567024625
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.10
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$18.52
|
|
|
CEFTAROLINE FOSAMIL 0.06 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 09900000955
|
| Hospital Charge Code |
180576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.03
|
| Rate for Payer: Priority Health SBD |
$0.03
|
|
|
CEFTAROLINE FOSAMIL 0.06 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 09900000955
|
| Hospital Charge Code |
180576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.03
|
| Rate for Payer: Priority Health SBD |
$0.03
|
|
|
CEFTAROLINE FOSAMIL 0.6 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 09900000956
|
| Hospital Charge Code |
180577
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.03
|
| Rate for Payer: Priority Health SBD |
$0.03
|
|
|
CEFTAROLINE FOSAMIL 0.6 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 09900000956
|
| Hospital Charge Code |
180577
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.03
|
| Rate for Payer: Priority Health SBD |
$0.03
|
|
|
CEFTAROLINE FOSAMIL 600 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 09900000958
|
| Hospital Charge Code |
180579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.34
|
| Rate for Payer: Priority Health SBD |
$2.27
|
|
|
CEFTAROLINE FOSAMIL 600 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 09900000958
|
| Hospital Charge Code |
180579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.34
|
| Rate for Payer: Priority Health SBD |
$2.27
|
|
|
CEFTAROLINE FOSAMIL 600 MG CUSTOM INTRAVENOUS SOLUTION FOR DESENSITIZATION
|
Facility
|
IP
|
$513.76
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
180582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$323.67 |
| Max. Negotiated Rate |
$462.38 |
| Rate for Payer: Aetna Commercial |
$436.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.94
|
| Rate for Payer: Cash Price |
$411.01
|
| Rate for Payer: Cofinity Commercial |
$359.63
|
| Rate for Payer: Cofinity Commercial |
$441.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.01
|
| Rate for Payer: Healthscope Commercial |
$462.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.70
|
| Rate for Payer: PHP Commercial |
$436.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.94
|
| Rate for Payer: Priority Health SBD |
$323.67
|
|
|
CEFTAROLINE FOSAMIL 600 MG CUSTOM INTRAVENOUS SOLUTION FOR DESENSITIZATION
|
Facility
|
OP
|
$513.76
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
180582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$462.38 |
| Rate for Payer: Aetna Commercial |
$436.70
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.29
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: BCBS MAPPO |
$4.23
|
| Rate for Payer: BCN Medicare Advantage |
$4.23
|
| Rate for Payer: Cash Price |
$411.01
|
| Rate for Payer: Cash Price |
$411.01
|
| Rate for Payer: Cofinity Commercial |
$441.83
|
| Rate for Payer: Cofinity Commercial |
$359.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.23
|
| Rate for Payer: Healthscope Commercial |
$462.38
|
| Rate for Payer: Mclaren Medicaid |
$2.27
|
| Rate for Payer: Mclaren Medicare |
$4.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.44
|
| Rate for Payer: Meridian Medicaid |
$2.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.70
|
| Rate for Payer: PACE Medicare |
$4.02
|
| Rate for Payer: PACE SWMI |
$4.23
|
| Rate for Payer: PHP Commercial |
$436.70
|
| Rate for Payer: PHP Medicare Advantage |
$4.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.94
|
| Rate for Payer: Priority Health Medicare |
$4.23
|
| Rate for Payer: Priority Health SBD |
$323.67
|
| Rate for Payer: Railroad Medicare Medicare |
$4.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.23
|
| Rate for Payer: UHC Medicare Advantage |
$4.23
|
| Rate for Payer: UHCCP Medicaid |
$2.38
|
| Rate for Payer: VA VA |
$4.23
|
|
