|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$506.40
|
|
|
Service Code
|
NDC 00904650361
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.56 |
| Max. Negotiated Rate |
$455.76 |
| Rate for Payer: Aetna Commercial |
$430.44
|
| Rate for Payer: Aetna Medicare |
$253.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.16
|
| Rate for Payer: BCBS Complete |
$202.56
|
| Rate for Payer: Cash Price |
$405.12
|
| Rate for Payer: Cofinity Commercial |
$354.48
|
| Rate for Payer: Cofinity Commercial |
$435.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$354.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.12
|
| Rate for Payer: Healthscope Commercial |
$455.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.44
|
| Rate for Payer: PHP Commercial |
$430.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.16
|
| Rate for Payer: Priority Health SBD |
$319.03
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$5,682.09
|
|
|
Service Code
|
NDC 00025152534
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,272.84 |
| Max. Negotiated Rate |
$5,113.88 |
| Rate for Payer: Aetna Commercial |
$4,829.78
|
| Rate for Payer: Aetna Medicare |
$2,841.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,693.36
|
| Rate for Payer: BCBS Complete |
$2,272.84
|
| Rate for Payer: Cash Price |
$4,545.67
|
| Rate for Payer: Cofinity Commercial |
$3,977.46
|
| Rate for Payer: Cofinity Commercial |
$4,886.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,977.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,545.67
|
| Rate for Payer: Healthscope Commercial |
$5,113.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,829.78
|
| Rate for Payer: PHP Commercial |
$4,829.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,693.36
|
| Rate for Payer: Priority Health SBD |
$3,579.72
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$252.48
|
|
|
Service Code
|
NDC 50268016915
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.06 |
| Max. Negotiated Rate |
$227.23 |
| Rate for Payer: Aetna Commercial |
$214.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.11
|
| Rate for Payer: Cash Price |
$201.98
|
| Rate for Payer: Cofinity Commercial |
$176.74
|
| Rate for Payer: Cofinity Commercial |
$217.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.98
|
| Rate for Payer: Healthscope Commercial |
$227.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.61
|
| Rate for Payer: PHP Commercial |
$214.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.11
|
| Rate for Payer: Priority Health SBD |
$159.06
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$202.10
|
|
|
Service Code
|
NDC 33342015711
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.32 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.36
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Cofinity Commercial |
$173.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$181.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.78
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.36
|
| Rate for Payer: Priority Health SBD |
$127.32
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$5,682.09
|
|
|
Service Code
|
NDC 00025152534
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,579.72 |
| Max. Negotiated Rate |
$5,113.88 |
| Rate for Payer: Aetna Commercial |
$4,829.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,693.36
|
| Rate for Payer: Cash Price |
$4,545.67
|
| Rate for Payer: Cofinity Commercial |
$3,977.46
|
| Rate for Payer: Cofinity Commercial |
$4,886.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,977.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,545.67
|
| Rate for Payer: Healthscope Commercial |
$5,113.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,829.78
|
| Rate for Payer: PHP Commercial |
$4,829.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,693.36
|
| Rate for Payer: Priority Health SBD |
$3,579.72
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$5.58
|
|
|
Service Code
|
NDC 60687044711
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Aetna Commercial |
$4.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.63
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Cofinity Commercial |
$4.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.74
|
| Rate for Payer: PHP Commercial |
$4.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health SBD |
$3.52
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$202.10
|
|
|
Service Code
|
NDC 33342015711
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.84 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna Medicare |
$101.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.36
|
| Rate for Payer: BCBS Complete |
$80.84
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Cofinity Commercial |
$173.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$181.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.78
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.36
|
| Rate for Payer: Priority Health SBD |
$127.32
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$5.05
|
|
|
Service Code
|
NDC 50268016911
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna Commercial |
$4.29
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: BCBS Complete |
$2.02
|
| 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
|
OP
|
$252.48
|
|
|
Service Code
|
NDC 50268016915
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.99 |
| Max. Negotiated Rate |
$227.23 |
| Rate for Payer: Aetna Commercial |
$214.61
|
| Rate for Payer: Aetna Medicare |
$126.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.11
|
| Rate for Payer: BCBS Complete |
$100.99
|
| Rate for Payer: Cash Price |
$201.98
|
| Rate for Payer: Cofinity Commercial |
$176.74
|
| Rate for Payer: Cofinity Commercial |
$217.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.98
|
| Rate for Payer: Healthscope Commercial |
$227.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.61
|
| Rate for Payer: PHP Commercial |
$214.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.11
|
| Rate for Payer: Priority Health SBD |
$159.06
|
|
|
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
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$465.30
|
|
|
Service Code
|
NDC 69097042107
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.14 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Commercial |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.44
|
| Rate for Payer: Priority Health SBD |
$293.14
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$557.76
|
|
|
Service Code
|
NDC 60687044701
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.10 |
| Max. Negotiated Rate |
$501.98 |
| Rate for Payer: Aetna Commercial |
$474.10
|
| Rate for Payer: Aetna Medicare |
$278.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.54
|
| Rate for Payer: BCBS Complete |
$223.10
|
| 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
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$5.58
|
|
|
Service Code
|
NDC 60687044711
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Aetna Commercial |
$4.74
|
| Rate for Payer: Aetna Medicare |
$2.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.63
|
| Rate for Payer: BCBS Complete |
$2.23
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Cofinity Commercial |
$4.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.74
|
| Rate for Payer: PHP Commercial |
$4.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health SBD |
$3.52
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$465.30
|
|
|
Service Code
|
NDC 69097042107
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.12 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna Medicare |
$232.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: BCBS Complete |
$186.12
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Commercial |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.44
|
| Rate for Payer: Priority Health SBD |
$293.14
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
IP
|
$185.25
|
|
|
Service Code
|
NDC 65862091060
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.71 |
| Max. Negotiated Rate |
$166.72 |
| Rate for Payer: Aetna Commercial |
$157.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.41
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cofinity Commercial |
$129.68
|
| Rate for Payer: Cofinity Commercial |
$159.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.20
|
| Rate for Payer: Healthscope Commercial |
$166.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.46
|
| Rate for Payer: PHP Commercial |
$157.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.41
|
| Rate for Payer: Priority Health SBD |
$116.71
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
IP
|
$502.56
|
|
|
Service Code
|
NDC 59762151802
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.61 |
| Max. Negotiated Rate |
$452.30 |
| Rate for Payer: Aetna Commercial |
$427.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.66
|
| Rate for Payer: Cash Price |
$402.05
|
| Rate for Payer: Cofinity Commercial |
$351.79
|
| Rate for Payer: Cofinity Commercial |
$432.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$351.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.05
|
| Rate for Payer: Healthscope Commercial |
$452.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.18
|
| Rate for Payer: PHP Commercial |
$427.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.66
|
| Rate for Payer: Priority Health SBD |
$316.61
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
OP
|
$312.48
|
|
|
Service Code
|
NDC 13668031060
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.99 |
| Max. Negotiated Rate |
$281.23 |
| Rate for Payer: Aetna Commercial |
$265.61
|
| Rate for Payer: Aetna Medicare |
$156.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.11
|
| Rate for Payer: BCBS Complete |
$124.99
|
| Rate for Payer: Cash Price |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$218.74
|
| Rate for Payer: Cofinity Commercial |
$268.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.98
|
| Rate for Payer: Healthscope Commercial |
$281.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.61
|
| Rate for Payer: PHP Commercial |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.11
|
| Rate for Payer: Priority Health SBD |
$196.86
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
OP
|
$502.56
|
|
|
Service Code
|
NDC 59762151802
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.02 |
| Max. Negotiated Rate |
$452.30 |
| Rate for Payer: Aetna Commercial |
$427.18
|
| Rate for Payer: Aetna Medicare |
$251.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.66
|
| Rate for Payer: BCBS Complete |
$201.02
|
| Rate for Payer: Cash Price |
$402.05
|
| Rate for Payer: Cofinity Commercial |
$351.79
|
| Rate for Payer: Cofinity Commercial |
$432.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$351.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.05
|
| Rate for Payer: Healthscope Commercial |
$452.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.18
|
| Rate for Payer: PHP Commercial |
$427.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.66
|
| Rate for Payer: Priority Health SBD |
$316.61
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
OP
|
$185.25
|
|
|
Service Code
|
NDC 65862091060
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$166.72 |
| Rate for Payer: Aetna Commercial |
$157.46
|
| Rate for Payer: Aetna Medicare |
$92.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.41
|
| Rate for Payer: BCBS Complete |
$74.10
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cofinity Commercial |
$129.68
|
| Rate for Payer: Cofinity Commercial |
$159.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.20
|
| Rate for Payer: Healthscope Commercial |
$166.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.46
|
| Rate for Payer: PHP Commercial |
$157.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.41
|
| Rate for Payer: Priority Health SBD |
$116.71
|
|
|
CELECOXIB 400 MG CAPSULE
|
Facility
|
IP
|
$312.48
|
|
|
Service Code
|
NDC 13668031060
|
| Hospital Charge Code |
33653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.86 |
| Max. Negotiated Rate |
$281.23 |
| Rate for Payer: Aetna Commercial |
$265.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.11
|
| Rate for Payer: Cash Price |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$218.74
|
| Rate for Payer: Cofinity Commercial |
$268.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.98
|
| Rate for Payer: Healthscope Commercial |
$281.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.61
|
| Rate for Payer: PHP Commercial |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.11
|
| Rate for Payer: Priority Health SBD |
$196.86
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
IP
|
$279.50
|
|
|
Service Code
|
NDC 09900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$176.08 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna Commercial |
$237.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.58
|
| Rate for Payer: PHP Commercial |
$237.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.68
|
| Rate for Payer: Priority Health SBD |
$176.08
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
OP
|
$279.50
|
|
|
Service Code
|
NDC 09900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna Commercial |
$237.58
|
| Rate for Payer: Aetna Medicare |
$139.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: BCBS Complete |
$111.80
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.58
|
| Rate for Payer: PHP Commercial |
$237.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.68
|
| Rate for Payer: Priority Health SBD |
$176.08
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47,624.34
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30,003.33 |
| Max. Negotiated Rate |
$42,861.91 |
| Rate for Payer: Aetna Commercial |
$40,480.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,955.82
|
| Rate for Payer: Cash Price |
$38,099.47
|
| Rate for Payer: Cofinity Commercial |
$33,337.04
|
| Rate for Payer: Cofinity Commercial |
$40,956.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$33,337.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,099.47
|
| Rate for Payer: Healthscope Commercial |
$42,861.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,480.69
|
| Rate for Payer: PHP Commercial |
$40,480.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,955.82
|
| Rate for Payer: Priority Health SBD |
$30,003.33
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47,624.34
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
188612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$42,861.91 |
| Rate for Payer: Aetna Commercial |
$40,480.69
|
| Rate for Payer: Aetna Medicare |
$29.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,955.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.26
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$28.21
|
| Rate for Payer: BCBS Trust/PPO |
$79.76
|
| Rate for Payer: BCN Commercial |
$79.76
|
| Rate for Payer: BCN Medicare Advantage |
$28.21
|
| Rate for Payer: Cash Price |
$38,099.47
|
| Rate for Payer: Cash Price |
$38,099.47
|
| Rate for Payer: Cofinity Commercial |
$33,337.04
|
| Rate for Payer: Cofinity Commercial |
$40,956.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$33,337.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,099.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$42,861.91
|
| Rate for Payer: Mclaren Medicaid |
$15.12
|
| Rate for Payer: Mclaren Medicare |
$28.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.62
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,480.69
|
| Rate for Payer: Nomi Health Commercial |
$84.63
|
| Rate for Payer: PACE Medicare |
$26.80
|
| Rate for Payer: PACE SWMI |
$28.21
|
| Rate for Payer: PHP Commercial |
$40,480.69
|
| Rate for Payer: PHP Medicare Advantage |
$28.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,955.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.27
|
| Rate for Payer: Priority Health Medicare |
$28.21
|
| Rate for Payer: Priority Health Narrow Network |
$65.02
|
| Rate for Payer: Priority Health SBD |
$30,003.33
|
| Rate for Payer: Railroad Medicare Medicare |
$28.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.21
|
| Rate for Payer: UHC Medicare Advantage |
$28.21
|
| Rate for Payer: UHCCP Medicaid |
$15.88
|
| Rate for Payer: VA VA |
$28.21
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$203.30
|
|
|
Service Code
|
NDC 00093417773
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.32 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Medicare |
$101.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.14
|
| Rate for Payer: BCBS Complete |
$81.32
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Commercial |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.80
|
| Rate for Payer: PHP Commercial |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.14
|
| Rate for Payer: Priority Health SBD |
$128.08
|
|
