|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 51079-978-01
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$331.55
|
|
|
Service Code
|
NDC 62756-461-88
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.21 |
| Max. Negotiated Rate |
$298.40 |
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: BCBS Trust/PPO |
$256.22
|
| Rate for Payer: BCN Commercial |
$256.22
|
| Rate for Payer: Cash Price |
$265.24
|
| Rate for Payer: Cofinity Commercial |
$285.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.24
|
| Rate for Payer: Healthscope Commercial |
$298.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.82
|
| Rate for Payer: PHP Commercial |
$281.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.76
|
| Rate for Payer: UHC Core |
$276.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.66
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$337.44
|
|
|
Service Code
|
NDC 68084-281-01
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$303.70 |
| Rate for Payer: Aetna Commercial |
$286.82
|
| Rate for Payer: BCBS Trust/PPO |
$260.77
|
| Rate for Payer: BCN Commercial |
$260.77
|
| Rate for Payer: Cash Price |
$269.95
|
| Rate for Payer: Cofinity Commercial |
$290.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.95
|
| Rate for Payer: Healthscope Commercial |
$303.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$286.82
|
| Rate for Payer: PHP Commercial |
$286.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$293.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.95
|
| Rate for Payer: UHC Core |
$281.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.08
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$308.64
|
|
|
Service Code
|
NDC 0378-0088-01
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.24 |
| Max. Negotiated Rate |
$277.78 |
| Rate for Payer: Aetna Commercial |
$262.34
|
| Rate for Payer: BCBS Trust/PPO |
$238.52
|
| Rate for Payer: BCN Commercial |
$238.52
|
| Rate for Payer: Cash Price |
$246.91
|
| Rate for Payer: Cofinity Commercial |
$265.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.91
|
| Rate for Payer: Healthscope Commercial |
$277.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.34
|
| Rate for Payer: PHP Commercial |
$262.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.60
|
| Rate for Payer: UHC Core |
$257.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.48
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 51079-923-01
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.41
|
| Rate for Payer: UHC Core |
$2.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$273.12
|
|
|
Service Code
|
NDC 51079-923-20
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.58 |
| Max. Negotiated Rate |
$245.81 |
| Rate for Payer: Aetna Commercial |
$232.15
|
| Rate for Payer: BCBS Trust/PPO |
$211.07
|
| Rate for Payer: BCN Commercial |
$211.07
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cofinity Commercial |
$234.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.50
|
| Rate for Payer: Healthscope Commercial |
$245.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.15
|
| Rate for Payer: PHP Commercial |
$232.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.35
|
| Rate for Payer: UHC Core |
$228.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.84
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS
|
Facility
|
IP
|
$28.25
|
|
|
Service Code
|
NDC 0023-9205-15
|
| Hospital Charge Code |
27992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$25.42 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: BCBS Trust/PPO |
$21.83
|
| Rate for Payer: BCN Commercial |
$21.83
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.01
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.86
|
| Rate for Payer: UHC Core |
$23.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$42.30
|
|
|
Service Code
|
NDC 68382-094-01
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Aetna Commercial |
$35.96
|
| Rate for Payer: BCBS Trust/PPO |
$32.69
|
| Rate for Payer: BCN Commercial |
$32.69
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Commercial |
$36.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$38.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.96
|
| Rate for Payer: PHP Commercial |
$35.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.22
|
| Rate for Payer: UHC Core |
$35.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.72
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$180.95
|
|
|
Service Code
|
NDC 0904-6302-61
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.36 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: BCBS Trust/PPO |
$139.84
|
| Rate for Payer: BCN Commercial |
$139.84
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.81
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.24
|
| Rate for Payer: UHC Core |
$151.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.71
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$180.95
|
|
|
Service Code
|
NDC 0904-6300-61
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.36 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: BCBS Trust/PPO |
$139.84
|
| Rate for Payer: BCN Commercial |
$139.84
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.81
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.24
|
| Rate for Payer: UHC Core |
$151.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.71
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$220.90
|
|
|
Service Code
|
NDC 43547-254-10
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.73 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: BCBS Trust/PPO |
$170.71
|
| Rate for Payer: BCN Commercial |
$170.71
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.76
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.39
|
| Rate for Payer: UHC Core |
$184.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.68
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 0904-6301-61
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.23 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: BCBS Trust/PPO |
$143.47
|
| Rate for Payer: BCN Commercial |
$143.47
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.80
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.37
|
| Rate for Payer: UHC Core |
$155.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
CEFAZOLIN 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$301.75
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
31086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$184.04 |
| Max. Negotiated Rate |
$271.58 |
| Rate for Payer: Aetna Commercial |
$256.49
|
| Rate for Payer: BCBS Trust/PPO |
$233.19
|
| Rate for Payer: BCN Commercial |
$233.19
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cofinity Commercial |
$259.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.40
|
| Rate for Payer: Healthscope Commercial |
$271.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.49
|
| Rate for Payer: PHP Commercial |
$256.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$262.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.54
|
| Rate for Payer: UHC Core |
$251.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.31
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$13.46
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$12.11 |
| Rate for Payer: Aetna Commercial |
$11.44
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: BCBS Trust/PPO |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$10.78
|
| Rate for Payer: BCN Commercial |
$10.40
|
| Rate for Payer: BCN Commercial |
$10.78
|
| Rate for Payer: BCN Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$11.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Healthscope Commercial |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.86
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$11.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.28
|
| Rate for Payer: UHC Core |
$11.65
|
| Rate for Payer: UHC Core |
$11.24
|
| Rate for Payer: UHC Core |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
|
|
CEFAZOLIN 300 G SOLUTION FOR INJECTION
|
Facility
|
IP
|
$798.75
|
|
|
Service Code
|
NDC 66288-1300-1
|
| Hospital Charge Code |
31087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$487.16 |
| Max. Negotiated Rate |
$718.88 |
| Rate for Payer: Aetna Commercial |
$678.94
|
| Rate for Payer: BCBS Trust/PPO |
$617.27
|
| Rate for Payer: BCN Commercial |
$617.27
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cofinity Commercial |
$686.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.00
|
| Rate for Payer: Healthscope Commercial |
$718.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$678.94
|
| Rate for Payer: PHP Commercial |
$678.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$694.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$487.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$702.90
|
| Rate for Payer: UHC Core |
$666.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$599.06
|
|
|
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 |
$4.76 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: Cash Price |
$6.25
|
| 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: Lakeland Regional Health Systems Commercial |
$5.86
|
| 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 HMO/PPO/Tiered Network |
$6.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.87
|
| Rate for Payer: UHC Core |
$6.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.86
|
|
|
CEFAZOLIN INJECTION (DISCOGRAPHY)
|
Facility
|
IP
|
$23.43
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
158561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$21.09 |
| Rate for Payer: Aetna Commercial |
$19.92
|
| Rate for Payer: BCBS Trust/PPO |
$18.11
|
| Rate for Payer: BCN Commercial |
$18.11
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.74
|
| Rate for Payer: Healthscope Commercial |
$21.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.92
|
| Rate for Payer: PHP Commercial |
$19.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.62
|
| Rate for Payer: UHC Core |
$19.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.57
|
|
|
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 |
$1.84 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$18.42
|
| Rate for Payer: BCN Commercial |
$18.42
|
| Rate for Payer: BCN Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.57
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.97
|
| Rate for Payer: UHC Core |
$19.90
|
| Rate for Payer: UHC Core |
$2.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.26
|
|
|
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 |
$3.68 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: BCBS Trust/PPO |
$4.67
|
| Rate for Payer: BCN Commercial |
$4.67
|
| Rate for Payer: Cash Price |
$4.83
|
| 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: Lakeland Regional Health Systems Commercial |
$4.53
|
| 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 HMO/PPO/Tiered Network |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.32
|
| Rate for Payer: UHC Core |
$5.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.53
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$176.70
|
|
|
Service Code
|
NDC 65862-218-60
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.77 |
| Max. Negotiated Rate |
$159.03 |
| Rate for Payer: Aetna Commercial |
$150.20
|
| Rate for Payer: BCBS Trust/PPO |
$136.55
|
| Rate for Payer: BCN Commercial |
$136.55
|
| Rate for Payer: Cash Price |
$141.36
|
| Rate for Payer: Cofinity Commercial |
$151.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.36
|
| Rate for Payer: Healthscope Commercial |
$159.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.20
|
| Rate for Payer: PHP Commercial |
$150.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.50
|
| Rate for Payer: UHC Core |
$147.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.52
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$176.70
|
|
|
Service Code
|
NDC 68180-722-04
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.77 |
| Max. Negotiated Rate |
$159.03 |
| Rate for Payer: Aetna Commercial |
$150.20
|
| Rate for Payer: BCBS Trust/PPO |
$136.55
|
| Rate for Payer: BCN Commercial |
$136.55
|
| Rate for Payer: Cash Price |
$141.36
|
| Rate for Payer: Cofinity Commercial |
$151.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.36
|
| Rate for Payer: Healthscope Commercial |
$159.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.20
|
| Rate for Payer: PHP Commercial |
$150.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.50
|
| Rate for Payer: UHC Core |
$147.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.52
|
|
|
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 |
$133.29 |
| Max. Negotiated Rate |
$196.70 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: BCBS Trust/PPO |
$168.90
|
| Rate for Payer: BCN Commercial |
$168.90
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| 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 HMO/PPO/Tiered Network |
$190.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.32
|
| Rate for Payer: UHC Core |
$182.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
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 |
$164.78 |
| Max. Negotiated Rate |
$243.16 |
| Rate for Payer: Aetna Commercial |
$229.65
|
| Rate for Payer: BCBS Trust/PPO |
$208.80
|
| Rate for Payer: BCN Commercial |
$208.80
|
| Rate for Payer: Cash Price |
$216.14
|
| Rate for Payer: Cofinity Commercial |
$232.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.14
|
| Rate for Payer: Healthscope Commercial |
$243.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.64
|
| 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 HMO/PPO/Tiered Network |
$235.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.76
|
| Rate for Payer: UHC Core |
$225.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.64
|
|
|
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 |
$134.90 |
| Max. Negotiated Rate |
$199.07 |
| Rate for Payer: Aetna Commercial |
$188.01
|
| Rate for Payer: BCBS Trust/PPO |
$170.94
|
| Rate for Payer: BCN Commercial |
$170.94
|
| Rate for Payer: Cash Price |
$176.95
|
| Rate for Payer: Cofinity Commercial |
$190.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.95
|
| Rate for Payer: Healthscope Commercial |
$199.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.89
|
| 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 HMO/PPO/Tiered Network |
$192.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.65
|
| Rate for Payer: UHC Core |
$184.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.89
|
|
|
CEFEPIME 1 GRAM/50 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$57.82
|
|
|
Service Code
|
HCPCS J0703
|
| Hospital Charge Code |
105551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.26 |
| Max. Negotiated Rate |
$52.04 |
| Rate for Payer: Aetna Commercial |
$49.15
|
| Rate for Payer: BCBS Trust/PPO |
$44.68
|
| Rate for Payer: BCN Commercial |
$44.68
|
| Rate for Payer: Cash Price |
$46.26
|
| Rate for Payer: Cofinity Commercial |
$49.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.26
|
| Rate for Payer: Healthscope Commercial |
$52.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.15
|
| Rate for Payer: PHP Commercial |
$49.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.88
|
| Rate for Payer: UHC Core |
$48.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.36
|
|
