|
CEFTRIAXONE 1 GRAM CUSTOM SOLUTION FOR DESENSITIZATION
|
Facility
|
OP
|
$17.98
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: BCBS Complete |
$7.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health SBD |
$11.33
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$23.20
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$20.88 |
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Commercial |
$11.58
|
| Rate for Payer: Aetna Medicare |
$6.64
|
| Rate for Payer: Aetna Medicare |
$6.81
|
| Rate for Payer: Aetna Medicare |
$11.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.08
|
| Rate for Payer: BCBS Complete |
$5.45
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS Complete |
$9.28
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cofinity Commercial |
$11.71
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$9.53
|
| Rate for Payer: Cofinity Commercial |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Healthscope Commercial |
$12.26
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$11.58
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: Priority Health SBD |
$14.62
|
| Rate for Payer: Priority Health SBD |
$8.58
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Commercial |
$11.58
|
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.08
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cofinity Commercial |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$11.71
|
| Rate for Payer: Cofinity Commercial |
$9.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Healthscope Commercial |
$12.26
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$11.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.85
|
| Rate for Payer: Priority Health SBD |
$14.62
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: Priority Health SBD |
$8.58
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$21.39
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$19.25 |
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$14.97
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Healthscope Commercial |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: PHP Commercial |
$18.18
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: Priority Health SBD |
$13.48
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: Priority Health SBD |
$15.75
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Medicare |
$10.70
|
| Rate for Payer: Aetna Medicare |
$8.24
|
| Rate for Payer: Aetna Medicare |
$12.50
|
| Rate for Payer: Aetna Medicare |
$8.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: BCBS Complete |
$8.56
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$14.97
|
| Rate for Payer: Cofinity Commercial |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Healthscope Commercial |
$19.25
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$18.18
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: Priority Health SBD |
$13.48
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$16.47
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Medicare |
$8.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$10.38
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$16.47
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$10.38
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$3.04
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.98
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cofinity Commercial |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.98
|
| Rate for Payer: Priority Health SBD |
$1.92
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$3.04
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.98
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cofinity Commercial |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.98
|
| Rate for Payer: Priority Health SBD |
$1.92
|
|
|
CEFTRIAXONE IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.21
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.16
|
|
|
CEFTRIAXONE IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Aetna Medicare |
$0.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.21
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.16
|
|
|
CEFTRIAXONE IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$3.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health SBD |
$2.05
|
|
|
CEFTRIAXONE IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health SBD |
$2.05
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$8.08
|
|
|
Service Code
|
NDC 51079019901
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$7.27 |
| Rate for Payer: Aetna Commercial |
$6.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.25
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Cofinity Commercial |
$5.66
|
| Rate for Payer: Cofinity Commercial |
$6.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$7.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.87
|
| Rate for Payer: PHP Commercial |
$6.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.25
|
| Rate for Payer: Priority Health SBD |
$5.09
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$807.71
|
|
|
Service Code
|
NDC 51079019920
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$508.86 |
| Max. Negotiated Rate |
$726.94 |
| Rate for Payer: Aetna Commercial |
$686.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.01
|
| Rate for Payer: Cash Price |
$646.17
|
| Rate for Payer: Cofinity Commercial |
$565.40
|
| Rate for Payer: Cofinity Commercial |
$694.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$565.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.17
|
| Rate for Payer: Healthscope Commercial |
$726.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.55
|
| Rate for Payer: PHP Commercial |
$686.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.01
|
| Rate for Payer: Priority Health SBD |
$508.86
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$266.40
|
|
|
Service Code
|
NDC 59762151601
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.83 |
| Max. Negotiated Rate |
$239.76 |
| Rate for Payer: Aetna Commercial |
$226.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.16
|
| Rate for Payer: Cash Price |
$213.12
|
| Rate for Payer: Cofinity Commercial |
$186.48
|
| Rate for Payer: Cofinity Commercial |
$229.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.12
|
| Rate for Payer: Healthscope Commercial |
$239.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.44
|
| Rate for Payer: PHP Commercial |
$226.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.16
|
| Rate for Payer: Priority Health SBD |
$167.83
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$3,464.31
|
|
|
Service Code
|
NDC 00025152031
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,182.52 |
| Max. Negotiated Rate |
$3,117.88 |
| Rate for Payer: Aetna Commercial |
$2,944.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,251.80
|
| Rate for Payer: Cash Price |
$2,771.45
|
| Rate for Payer: Cofinity Commercial |
$2,425.02
|
| Rate for Payer: Cofinity Commercial |
$2,979.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,425.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,771.45
|
| Rate for Payer: Healthscope Commercial |
$3,117.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,944.66
|
| Rate for Payer: PHP Commercial |
$2,944.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,251.80
|
| Rate for Payer: Priority Health SBD |
$2,182.52
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$365.28
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.11 |
| Max. Negotiated Rate |
$328.75 |
| Rate for Payer: Aetna Commercial |
$310.49
|
| Rate for Payer: Aetna Medicare |
$182.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.43
|
| Rate for Payer: BCBS Complete |
$146.11
|
| Rate for Payer: Cash Price |
$292.22
|
| Rate for Payer: Cofinity Commercial |
$255.70
|
| Rate for Payer: Cofinity Commercial |
$314.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.22
|
| Rate for Payer: Healthscope Commercial |
$328.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: PHP Commercial |
$310.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.43
|
| Rate for Payer: Priority Health SBD |
$230.13
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$807.71
|
|
|
Service Code
|
NDC 51079019920
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.08 |
| Max. Negotiated Rate |
$726.94 |
| Rate for Payer: Aetna Commercial |
$686.55
|
| Rate for Payer: Aetna Medicare |
$403.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.01
|
| Rate for Payer: BCBS Complete |
$323.08
|
| Rate for Payer: Cash Price |
$646.17
|
| Rate for Payer: Cofinity Commercial |
$565.40
|
| Rate for Payer: Cofinity Commercial |
$694.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$565.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.17
|
| Rate for Payer: Healthscope Commercial |
$726.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.55
|
| Rate for Payer: PHP Commercial |
$686.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.01
|
| Rate for Payer: Priority Health SBD |
$508.86
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$365.28
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.13 |
| Max. Negotiated Rate |
$328.75 |
| Rate for Payer: Aetna Commercial |
$310.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.43
|
| Rate for Payer: Cash Price |
$292.22
|
| Rate for Payer: Cofinity Commercial |
$255.70
|
| Rate for Payer: Cofinity Commercial |
$314.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.22
|
| Rate for Payer: Healthscope Commercial |
$328.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: PHP Commercial |
$310.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.43
|
| Rate for Payer: Priority Health SBD |
$230.13
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$8.08
|
|
|
Service Code
|
NDC 51079019901
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$7.27 |
| Rate for Payer: Aetna Commercial |
$6.87
|
| Rate for Payer: Aetna Medicare |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.25
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Cofinity Commercial |
$5.66
|
| Rate for Payer: Cofinity Commercial |
$6.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$7.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.87
|
| Rate for Payer: PHP Commercial |
$6.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.25
|
| Rate for Payer: Priority Health SBD |
$5.09
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$3,464.31
|
|
|
Service Code
|
NDC 00025152031
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,385.72 |
| Max. Negotiated Rate |
$3,117.88 |
| Rate for Payer: Aetna Commercial |
$2,944.66
|
| Rate for Payer: Aetna Medicare |
$1,732.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,251.80
|
| Rate for Payer: BCBS Complete |
$1,385.72
|
| Rate for Payer: Cash Price |
$2,771.45
|
| Rate for Payer: Cofinity Commercial |
$2,425.02
|
| Rate for Payer: Cofinity Commercial |
$2,979.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,425.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,771.45
|
| Rate for Payer: Healthscope Commercial |
$3,117.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,944.66
|
| Rate for Payer: PHP Commercial |
$2,944.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,251.80
|
| Rate for Payer: Priority Health SBD |
$2,182.52
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$266.40
|
|
|
Service Code
|
NDC 59762151601
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.56 |
| Max. Negotiated Rate |
$239.76 |
| Rate for Payer: Aetna Commercial |
$226.44
|
| Rate for Payer: Aetna Medicare |
$133.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.16
|
| Rate for Payer: BCBS Complete |
$106.56
|
| Rate for Payer: Cash Price |
$213.12
|
| Rate for Payer: Cofinity Commercial |
$186.48
|
| Rate for Payer: Cofinity Commercial |
$229.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.12
|
| Rate for Payer: Healthscope Commercial |
$239.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.44
|
| Rate for Payer: PHP Commercial |
$226.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.16
|
| Rate for Payer: Priority Health SBD |
$167.83
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$5.05
|
|
|
Service Code
|
NDC 50268016911
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna Commercial |
$4.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: Cash Price |
$4.04
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Cofinity Commercial |
$4.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.04
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.29
|
| Rate for Payer: PHP Commercial |
$4.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health SBD |
$3.18
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$557.76
|
|
|
Service Code
|
NDC 60687044701
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$351.39 |
| Max. Negotiated Rate |
$501.98 |
| Rate for Payer: Aetna Commercial |
$474.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.54
|
| Rate for Payer: Cash Price |
$446.21
|
| Rate for Payer: Cofinity Commercial |
$390.43
|
| Rate for Payer: Cofinity Commercial |
$479.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$390.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$446.21
|
| Rate for Payer: Healthscope Commercial |
$501.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$474.10
|
| Rate for Payer: PHP Commercial |
$474.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.54
|
| Rate for Payer: Priority Health SBD |
$351.39
|
|
