|
CEFTRIAXONE 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
78580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,370.25 |
| Max. Negotiated Rate |
$1,957.50 |
| Rate for Payer: Aetna Commercial |
$1,848.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,413.75
|
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Cofinity Advantage |
$1,522.50
|
| Rate for Payer: Cofinity Commercial |
$1,870.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.00
|
| Rate for Payer: Healthscope Commercial |
$1,957.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,848.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,631.25
|
| Rate for Payer: PHP Commercial |
$1,848.75
|
| Rate for Payer: Priority Health SBD |
$1,370.25
|
|
|
CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$40.72
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$36.65 |
| Rate for Payer: Aetna Commercial |
$34.61
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna Commercial |
$60.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$32.58
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Advantage |
$28.50
|
| Rate for Payer: Cofinity Advantage |
$27.82
|
| Rate for Payer: Cofinity Advantage |
$49.44
|
| Rate for Payer: Cofinity Commercial |
$60.74
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$35.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.50
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Healthscope Commercial |
$36.65
|
| Rate for Payer: Healthscope Commercial |
$63.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.54
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$60.04
|
| Rate for Payer: PHP Commercial |
$34.61
|
| Rate for Payer: Priority Health SBD |
$44.50
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: Priority Health SBD |
$25.65
|
|
|
CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$39.74
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna Commercial |
$34.61
|
| Rate for Payer: Aetna Commercial |
$60.04
|
| Rate for Payer: Aetna Medicare |
$19.87
|
| Rate for Payer: Aetna Medicare |
$20.36
|
| Rate for Payer: Aetna Medicare |
$35.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.91
|
| Rate for Payer: BCBS Complete |
$28.25
|
| Rate for Payer: BCBS Complete |
$15.90
|
| Rate for Payer: BCBS Complete |
$16.29
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cash Price |
$32.58
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$32.58
|
| Rate for Payer: Cofinity Advantage |
$28.50
|
| Rate for Payer: Cofinity Advantage |
$27.82
|
| Rate for Payer: Cofinity Advantage |
$49.44
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$35.02
|
| Rate for Payer: Cofinity Commercial |
$60.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$63.57
|
| Rate for Payer: Healthscope Commercial |
$36.65
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.97
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$34.61
|
| Rate for Payer: PHP Commercial |
$60.04
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: Priority Health SBD |
$44.50
|
| Rate for Payer: Priority Health SBD |
$25.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
|
|
CEFTRIAXONE 1 GM IV SYRINGE
|
Facility
|
IP
|
$17.98
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
500542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Advantage |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| 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: Opus (Opus Packaging Group) HMA |
$13.48
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health SBD |
$11.33
|
|
|
CEFTRIAXONE 1 GM IV SYRINGE
|
Facility
|
OP
|
$17.98
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
500542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| 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 |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Advantage |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.48
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION
|
Facility
|
IP
|
$17.80
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
150848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$16.02 |
| Rate for Payer: Aetna Commercial |
$15.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.57
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Cofinity Advantage |
$12.46
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.24
|
| Rate for Payer: Healthscope Commercial |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.35
|
| Rate for Payer: PHP Commercial |
$15.13
|
| Rate for Payer: Priority Health SBD |
$11.21
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION
|
Facility
|
OP
|
$17.80
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
150848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$16.02 |
| Rate for Payer: Aetna Commercial |
$15.13
|
| Rate for Payer: Aetna Medicare |
$8.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.57
|
| Rate for Payer: BCBS Complete |
$7.12
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Cofinity Advantage |
$12.46
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.24
|
| Rate for Payer: Healthscope Commercial |
$16.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.35
|
| Rate for Payer: PHP Commercial |
$15.13
|
| Rate for Payer: Priority Health SBD |
$11.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM SOLUTION FOR DESENSITIZATION
|
Facility
|
IP
|
$17.98
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
180569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Advantage |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| 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: Opus (Opus Packaging Group) HMA |
$13.48
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health SBD |
$11.33
|
|
|
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 |
$0.76 |
| 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 |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Advantage |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.48
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| 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 Medicare |
$6.63
|
| Rate for Payer: Aetna Medicare |
$6.81
|
| Rate for Payer: Aetna Medicare |
$11.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.08
|
| Rate for Payer: BCBS Complete |
$9.28
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS Complete |
$5.45
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Cofinity Advantage |
$9.53
|
| Rate for Payer: Cofinity Advantage |
$9.29
|
| Rate for Payer: Cofinity Advantage |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$11.71
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$12.26
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.40
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$11.58
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: Priority Health SBD |
$14.62
|
| Rate for Payer: Priority Health SBD |
$8.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$13.62
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$12.26 |
| Rate for Payer: Aetna Commercial |
$11.58
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| 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) |
$15.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Advantage |
$9.53
|
| Rate for Payer: Cofinity Advantage |
$9.29
|
| Rate for Payer: Cofinity Advantage |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$11.71
|
| 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 |
$11.94
|
| Rate for Payer: Healthscope Commercial |
$12.26
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.21
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$11.58
|
| 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
|
OP
|
$22.08
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$19.87 |
| Rate for Payer: Aetna Commercial |
$18.77
|
| Rate for Payer: Aetna Commercial |
$21.63
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Medicare |
$11.04
|
| Rate for Payer: Aetna Medicare |
$12.72
|
| Rate for Payer: Aetna Medicare |
$12.50
|
| Rate for Payer: Aetna Medicare |
$8.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.35
|
| Rate for Payer: BCBS Complete |
$10.18
|
| Rate for Payer: BCBS Complete |
$8.83
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cofinity Advantage |
$17.82
|
| Rate for Payer: Cofinity Advantage |
$11.53
|
| Rate for Payer: Cofinity Advantage |
$17.50
|
| Rate for Payer: Cofinity Advantage |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| 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 |
$17.66
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$22.91
|
| Rate for Payer: Healthscope Commercial |
$19.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.09
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Commercial |
$18.77
|
| Rate for Payer: PHP Commercial |
$21.63
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: Priority Health SBD |
$16.03
|
| Rate for Payer: Priority Health SBD |
$13.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Commercial |
$21.63
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Commercial |
$18.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Advantage |
$17.50
|
| Rate for Payer: Cofinity Advantage |
$11.53
|
| Rate for Payer: Cofinity Advantage |
$17.82
|
| Rate for Payer: Cofinity Advantage |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Healthscope Commercial |
$22.91
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$19.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.56
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Commercial |
$18.77
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: PHP Commercial |
$21.63
|
| Rate for Payer: Priority Health SBD |
$13.91
|
| Rate for Payer: Priority Health SBD |
$16.03
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: Priority Health SBD |
$10.38
|
|
|
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 |
$0.76 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Medicare |
$8.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Advantage |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
|
|
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 Advantage |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| 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: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: PHP Commercial |
$14.00
|
| 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 Commercial |
$3.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Advantage |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health SBD |
$1.92
|
| Rate for Payer: Priority Health SBD |
$2.32
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Advantage |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health SBD |
$1.92
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
|
|
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 Advantage |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| 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: Opus (Opus Packaging Group) HMA |
$0.19
|
| Rate for Payer: PHP Commercial |
$0.21
|
| 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 |
$1.16 |
| 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 |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Advantage |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.19
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health SBD |
$0.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
|
|
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 Advantage |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| 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: Opus (Opus Packaging Group) HMA |
$2.44
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.05
|
|
|
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 |
$0.76 |
| 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 |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Advantage |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.44
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
IP
|
$147.06
|
|
|
Service Code
|
NDC 65862069960
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$132.35 |
| Rate for Payer: Aetna Commercial |
$125.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.59
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cofinity Advantage |
$102.94
|
| Rate for Payer: Cofinity Commercial |
$126.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.65
|
| Rate for Payer: Healthscope Commercial |
$132.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.30
|
| Rate for Payer: PHP Commercial |
$125.00
|
| Rate for Payer: Priority Health SBD |
$92.65
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
OP
|
$147.06
|
|
|
Service Code
|
NDC 65862069960
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.79 |
| Max. Negotiated Rate |
$132.35 |
| Rate for Payer: Aetna Commercial |
$125.00
|
| Rate for Payer: Aetna Medicare |
$73.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.59
|
| Rate for Payer: BCBS Complete |
$58.82
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cofinity Advantage |
$102.94
|
| Rate for Payer: Cofinity Commercial |
$126.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.65
|
| Rate for Payer: Healthscope Commercial |
$132.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.30
|
| Rate for Payer: PHP Commercial |
$125.00
|
| Rate for Payer: Priority Health SBD |
$92.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.59
|
| Rate for Payer: UHC Core |
$76.62
|
| Rate for Payer: UHC Exchange |
$57.79
|
|
|
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 Advantage |
$255.70
|
| Rate for Payer: Cofinity Commercial |
$314.14
|
| 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: Opus (Opus Packaging Group) HMA |
$273.96
|
| Rate for Payer: PHP Commercial |
$310.49
|
| Rate for Payer: Priority Health SBD |
$230.13
|
|
|
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 Advantage |
$2,425.02
|
| Rate for Payer: Cofinity Commercial |
$2,979.31
|
| 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: Opus (Opus Packaging Group) HMA |
$2,598.23
|
| Rate for Payer: PHP Commercial |
$2,944.66
|
| Rate for Payer: Priority Health SBD |
$2,182.52
|
|
