|
CEFAZOLIN 50 MG/0.5 ML IN NS FOR DISCOGRAM
|
Facility
|
IP
|
$7.81
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.64
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.47
|
| Rate for Payer: Priority Health SBD |
$4.92
|
|
|
CEFAZOLIN IV SYRINGE 1 G PMX
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Commercial |
$4.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.12
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Healthscope Commercial |
$4.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.57
|
| Rate for Payer: PHP Commercial |
$4.08
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: Priority Health SBD |
$15.01
|
| Rate for Payer: Priority Health SBD |
$3.02
|
|
|
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: Healthscope Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.13
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.23
|
| Rate for Payer: Priority Health SBD |
$3.81
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 67877-547-98
|
| 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: Healthscope Commercial |
$196.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.77
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.98
|
| Rate for Payer: Priority Health SBD |
$137.69
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$192.10
|
|
|
Service Code
|
NDC 68180-711-60
|
| 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: Healthscope Commercial |
$172.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.28
|
| Rate for Payer: PHP Commercial |
$163.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.47
|
| Rate for Payer: Priority Health SBD |
$121.02
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$221.19
|
|
|
Service Code
|
NDC 0781-2176-60
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.35 |
| Max. Negotiated Rate |
$199.07 |
| Rate for Payer: Aetna Commercial |
$188.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.77
|
| Rate for Payer: Cash Price |
$176.95
|
| Rate for Payer: Cofinity Commercial |
$154.83
|
| Rate for Payer: Cofinity Commercial |
$190.22
|
| Rate for Payer: Healthscope Commercial |
$199.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.01
|
| Rate for Payer: PHP Commercial |
$188.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.83
|
| Rate for Payer: Priority Health SBD |
$139.35
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$270.18
|
|
|
Service Code
|
NDC 65862-177-60
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$243.16 |
| Rate for Payer: Aetna Commercial |
$229.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.62
|
| Rate for Payer: Cash Price |
$216.14
|
| Rate for Payer: Cofinity Commercial |
$189.13
|
| Rate for Payer: Cofinity Commercial |
$232.35
|
| Rate for Payer: Healthscope Commercial |
$243.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.65
|
| Rate for Payer: PHP Commercial |
$229.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.13
|
| Rate for Payer: Priority Health SBD |
$170.21
|
|
|
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: Healthscope Commercial |
$1,152.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,088.00
|
| Rate for Payer: PHP Commercial |
$1,088.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$896.00
|
| 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: Healthscope Commercial |
$26.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.19
|
| Rate for Payer: PHP Commercial |
$25.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health SBD |
$18.67
|
|
|
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) |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.05
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| 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 |
$12.66
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Healthscope Commercial |
$16.27
|
| Rate for Payer: Healthscope Commercial |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.45
|
| Rate for Payer: PHP Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$14.47
|
| Rate for Payer: PHP Commercial |
$14.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.66
|
| Rate for Payer: Priority Health SBD |
$11.39
|
| Rate for Payer: Priority Health SBD |
$10.71
|
| Rate for Payer: Priority Health SBD |
$10.72
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Commercial |
$27.57
|
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Commercial |
$21.29
|
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.08
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$20.04
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$20.53
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Cofinity Commercial |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Cofinity Commercial |
$28.41
|
| Rate for Payer: Cofinity Commercial |
$22.70
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$22.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.57
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Commercial |
$21.81
|
| Rate for Payer: PHP Commercial |
$27.57
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: PHP Commercial |
$21.29
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.12
|
| Rate for Payer: Priority Health SBD |
$16.17
|
| Rate for Payer: Priority Health SBD |
$15.78
|
| 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
|
|
|
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: Healthscope Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.22
|
| 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: Healthscope Commercial |
$15.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.24
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.72
|
| Rate for Payer: Priority Health SBD |
$10.55
|
|
|
CEFOTAXIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$22.41
|
|
|
Service Code
|
HCPCS J0698
|
| Hospital Charge Code |
9454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$20.17 |
| Rate for Payer: Aetna Commercial |
$19.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.57
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Cofinity Commercial |
$15.69
|
| Rate for Payer: Cofinity Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$20.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.05
|
| Rate for Payer: PHP Commercial |
$19.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.69
|
| Rate for Payer: Priority Health SBD |
$14.12
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.49
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.65
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: Priority Health SBD |
$13.08
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 44567-246-25
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: Priority Health SBD |
$15.65
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.39
|
|
|
Service Code
|
NDC 25021-110-20
|
| 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: Healthscope Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.98
|
| Rate for Payer: PHP Commercial |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.57
|
| Rate for Payer: Priority Health SBD |
$18.52
|
|
|
CEFTAROLINE FOSAMIL 0.06 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 9900-0009-55
|
| 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: Healthscope Commercial |
$0.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.04
|
| Rate for Payer: Priority Health SBD |
$0.03
|
|
|
CEFTAROLINE FOSAMIL 0.6 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 9900-0009-56
|
| 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: Healthscope Commercial |
$0.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.04
|
| Rate for Payer: Priority Health SBD |
$0.03
|
|
|
CEFTAROLINE FOSAMIL 600 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 9900-0009-58
|
| 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: Healthscope Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.06
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| 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: Healthscope Commercial |
$462.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$436.70
|
| Rate for Payer: PHP Commercial |
$436.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.63
|
| Rate for Payer: Priority Health SBD |
$323.67
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$647.63
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$408.01 |
| Max. Negotiated Rate |
$582.87 |
| Rate for Payer: Aetna Commercial |
$550.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.96
|
| Rate for Payer: Cash Price |
$518.10
|
| Rate for Payer: Cofinity Commercial |
$453.34
|
| Rate for Payer: Cofinity Commercial |
$556.96
|
| Rate for Payer: Healthscope Commercial |
$582.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$550.49
|
| Rate for Payer: PHP Commercial |
$550.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.34
|
| Rate for Payer: Priority Health SBD |
$408.01
|
|
|
CEFTAROLINE FOSAMIL 60 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 9900-0009-54
|
| Hospital Charge Code |
168966
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna Commercial |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.23
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cofinity Commercial |
$0.25
|
| Rate for Payer: Cofinity Commercial |
$0.30
|
| Rate for Payer: Healthscope Commercial |
$0.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.30
|
| Rate for Payer: PHP Commercial |
$0.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.25
|
| Rate for Payer: Priority Health SBD |
$0.22
|
|
|
CEFTAROLINE FOSAMIL 6 MCG CUSTOM IV FOR DESENSITIZATION
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 9900-0009-57
|
| Hospital Charge Code |
180578
|
|
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: Healthscope Commercial |
$0.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.04
|
| Rate for Payer: Priority Health SBD |
$0.03
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
9474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.55
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health SBD |
$13.01
|
|
