|
CEFAZOLIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
27297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna Commercial |
$13.46
|
| Rate for Payer: Aetna Medicare |
$7.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.29
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cofinity Advantage |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$13.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$14.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.87
|
| Rate for Payer: PHP Commercial |
$13.46
|
| Rate for Payer: Priority Health SBD |
$9.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
|
|
CEFAZOLIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
27297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna Commercial |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.29
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cofinity Advantage |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$13.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.87
|
| Rate for Payer: PHP Commercial |
$13.46
|
| Rate for Payer: Priority Health SBD |
$9.97
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$9.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.62
|
| Rate for Payer: BCBS Complete |
$7.76
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cofinity Advantage |
$9.81
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Advantage |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$12.61
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.56
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$11.91
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$12.23
|
| Rate for Payer: Priority Health SBD |
$8.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$14.01
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Advantage |
$9.81
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Advantage |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$12.61
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.51
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$11.91
|
| Rate for Payer: Priority Health SBD |
$12.23
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$8.83
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health SBD |
$8.79
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
|
|
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 Advantage |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.86
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health SBD |
$4.92
|
|
|
CEFAZOLIN 50 MG/0.5 ML IN NS FOR DISCOGRAM
|
Facility
|
OP
|
$7.81
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: BCBS Complete |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Advantage |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.86
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health SBD |
$4.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
|
|
CEFAZOLIN IV SYRINGE 1 G PMX
|
Facility
|
OP
|
$23.83
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: UHC Core |
$1.37
|
| 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 Medicare |
$11.91
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Aetna Medicare |
$2.40
|
| 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: BCBS Complete |
$1.92
|
| Rate for Payer: BCBS Complete |
$9.53
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Advantage |
$2.11
|
| Rate for Payer: Cofinity Advantage |
$16.68
|
| Rate for Payer: Cofinity Advantage |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$4.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Healthscope Commercial |
$4.32
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.60
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: PHP Commercial |
$4.08
|
| Rate for Payer: Priority Health SBD |
$15.01
|
| Rate for Payer: Priority Health SBD |
$3.02
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
|
|
CEFAZOLIN IV SYRINGE 1 G PMX
|
Facility
|
IP
|
$3.02
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna Commercial |
$4.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cofinity Advantage |
$2.11
|
| Rate for Payer: Cofinity Advantage |
$16.68
|
| Rate for Payer: Cofinity Advantage |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$4.13
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.84
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$4.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: PHP Commercial |
$4.08
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health SBD |
$3.02
|
| Rate for Payer: Priority Health SBD |
$15.01
|
| Rate for Payer: Priority Health SBD |
$1.90
|
|
|
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 Advantage |
$4.23
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.83
|
| Rate for Payer: Healthscope Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.53
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: Priority Health SBD |
$3.81
|
|
|
CEFAZOLIN IV SYRINGE 2 G PMX
|
Facility
|
OP
|
$6.04
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
500665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: Aetna Medicare |
$3.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.93
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cofinity Advantage |
$4.23
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.83
|
| Rate for Payer: Healthscope Commercial |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.53
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: Priority Health SBD |
$3.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$221.37
|
|
|
Service Code
|
NDC 67877054798
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$199.23 |
| Rate for Payer: Aetna Commercial |
$188.16
|
| Rate for Payer: Aetna Medicare |
$110.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.89
|
| Rate for Payer: BCBS Complete |
$88.55
|
| Rate for Payer: Cash Price |
$177.10
|
| Rate for Payer: Cofinity Advantage |
$154.96
|
| Rate for Payer: Cofinity Commercial |
$190.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.10
|
| Rate for Payer: Healthscope Commercial |
$199.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.03
|
| Rate for Payer: PHP Commercial |
$188.16
|
| Rate for Payer: Priority Health SBD |
$139.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.89
|
| Rate for Payer: UHC Core |
$115.33
|
| Rate for Payer: UHC Exchange |
$87.00
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$221.37
|
|
|
Service Code
|
NDC 67877054798
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.46 |
| Max. Negotiated Rate |
$199.23 |
| Rate for Payer: Aetna Commercial |
$188.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.89
|
| Rate for Payer: Cash Price |
$177.10
|
| Rate for Payer: Cofinity Advantage |
$154.96
|
| Rate for Payer: Cofinity Commercial |
$190.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.10
|
| Rate for Payer: Healthscope Commercial |
$199.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.03
|
| Rate for Payer: PHP Commercial |
$188.16
|
| Rate for Payer: Priority Health SBD |
$139.46
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
OP
|
$262.20
|
|
|
Service Code
|
NDC 65862017760
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna Medicare |
$131.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: BCBS Complete |
$104.88
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.43
|
| Rate for Payer: UHC Core |
$136.61
|
| Rate for Payer: UHC Exchange |
$103.04
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$262.20
|
|
|
Service Code
|
NDC 65862017760
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.19 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$187.49
|
|
|
Service Code
|
NDC 68180071160
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$168.74 |
| Rate for Payer: Aetna Commercial |
$159.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.87
|
| Rate for Payer: Cash Price |
$149.99
|
| Rate for Payer: Cofinity Advantage |
$131.24
|
| Rate for Payer: Cofinity Commercial |
$161.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.99
|
| Rate for Payer: Healthscope Commercial |
$168.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.62
|
| Rate for Payer: PHP Commercial |
$159.37
|
| Rate for Payer: Priority Health SBD |
$118.12
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
OP
|
$187.49
|
|
|
Service Code
|
NDC 68180071160
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.68 |
| Max. Negotiated Rate |
$168.74 |
| Rate for Payer: Aetna Commercial |
$159.37
|
| Rate for Payer: Aetna Medicare |
$93.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.87
|
| Rate for Payer: BCBS Complete |
$75.00
|
| Rate for Payer: Cash Price |
$149.99
|
| Rate for Payer: Cofinity Advantage |
$131.24
|
| Rate for Payer: Cofinity Commercial |
$161.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.99
|
| Rate for Payer: Healthscope Commercial |
$168.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.62
|
| Rate for Payer: PHP Commercial |
$159.37
|
| Rate for Payer: Priority Health SBD |
$118.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.87
|
| Rate for Payer: UHC Core |
$97.68
|
| Rate for Payer: UHC Exchange |
$73.68
|
|
|
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 Advantage |
$896.00
|
| Rate for Payer: Cofinity Commercial |
$1,100.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,024.00
|
| Rate for Payer: Healthscope Commercial |
$1,152.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,088.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$960.00
|
| Rate for Payer: PHP Commercial |
$1,088.00
|
| Rate for Payer: Priority Health SBD |
$806.40
|
|
|
CEFEPIME 100 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
188964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$1,088.00
|
| Rate for Payer: Aetna Medicare |
$640.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$832.00
|
| Rate for Payer: BCBS Complete |
$512.00
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cofinity Advantage |
$896.00
|
| Rate for Payer: Cofinity Commercial |
$1,100.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,024.00
|
| Rate for Payer: Healthscope Commercial |
$1,152.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,024.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,088.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$960.00
|
| Rate for Payer: PHP Commercial |
$1,088.00
|
| Rate for Payer: Priority Health SBD |
$806.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
|
|
CEFEPIME 1 GRAM CUSTOM SOLUTION FOR DESENSITIZATION
|
Facility
|
OP
|
$29.64
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
180570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$25.19
|
| Rate for Payer: Aetna Medicare |
$14.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.27
|
| Rate for Payer: BCBS Complete |
$11.86
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$23.71
|
| Rate for Payer: Cash Price |
$23.71
|
| Rate for Payer: Cofinity Advantage |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.71
|
| Rate for Payer: Healthscope Commercial |
$26.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.23
|
| Rate for Payer: PHP Commercial |
$25.19
|
| Rate for Payer: Priority Health SBD |
$18.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
|
|
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 Advantage |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.71
|
| Rate for Payer: Healthscope Commercial |
$26.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.23
|
| Rate for Payer: PHP Commercial |
$25.19
|
| Rate for Payer: Priority Health SBD |
$18.67
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$18.08
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Aetna Commercial |
$17.54
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Medicare |
$9.04
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: BCBS Complete |
$8.96
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cofinity Advantage |
$14.45
|
| Rate for Payer: Cofinity Advantage |
$12.66
|
| Rate for Payer: Cofinity Advantage |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$16.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: PHP Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$17.54
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: Priority Health SBD |
$11.39
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: Priority Health SBD |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$18.08
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Aetna Commercial |
$17.54
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cofinity Advantage |
$14.45
|
| Rate for Payer: Cofinity Advantage |
$12.66
|
| Rate for Payer: Cofinity Advantage |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$16.27
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.56
|
| Rate for Payer: PHP Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$17.54
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: Priority Health SBD |
$13.00
|
| Rate for Payer: Priority Health SBD |
$11.39
|
| Rate for Payer: Priority Health SBD |
$14.11
|
|
|
CEFEPIME 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$20.64
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna Commercial |
$17.54
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cofinity Advantage |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.51
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.48
|
| Rate for Payer: PHP Commercial |
$17.54
|
| Rate for Payer: Priority Health SBD |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
|
