|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$20.65
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$18.35
|
| Rate for Payer: BCBS Trust/PPO |
$15.96
|
| Rate for Payer: BCN Commercial |
$18.35
|
| Rate for Payer: BCN Commercial |
$15.96
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.55
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: PHP Commercial |
$20.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: UHC Core |
$19.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.81
|
|
|
CEFOXITIN 2 GRAM/50 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK
|
Facility
IP
|
$98.97
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
91040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.36 |
| Max. Negotiated Rate |
$89.07 |
| Rate for Payer: Aetna Commercial |
$84.12
|
| Rate for Payer: BCBS Trust/PPO |
$76.48
|
| Rate for Payer: BCN Commercial |
$76.48
|
| Rate for Payer: Cash Price |
$79.18
|
| Rate for Payer: Cofinity Commercial |
$85.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.18
|
| Rate for Payer: Healthscope Commercial |
$89.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.12
|
| Rate for Payer: PHP Commercial |
$84.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.09
|
| Rate for Payer: UHC Core |
$82.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.23
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$24.59
|
|
|
Service Code
|
NDC 0143-9877-01
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.00
|
| Rate for Payer: BCN Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$19.67
|
| Rate for Payer: Cofinity Commercial |
$21.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.67
|
| Rate for Payer: Healthscope Commercial |
$22.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.90
|
| Rate for Payer: PHP Commercial |
$20.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.64
|
| Rate for Payer: UHC Core |
$20.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.44
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$24.59
|
|
|
Service Code
|
NDC 0143-9877-25
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.00
|
| Rate for Payer: BCN Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$19.67
|
| Rate for Payer: Cofinity Commercial |
$21.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.67
|
| Rate for Payer: Healthscope Commercial |
$22.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.90
|
| Rate for Payer: PHP Commercial |
$20.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.64
|
| Rate for Payer: UHC Core |
$20.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.44
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$57.74
|
|
|
Service Code
|
NDC 63323-342-25
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$51.97 |
| Rate for Payer: Aetna Commercial |
$49.08
|
| Rate for Payer: BCBS Trust/PPO |
$44.62
|
| Rate for Payer: BCN Commercial |
$44.62
|
| Rate for Payer: Cash Price |
$46.19
|
| Rate for Payer: Cofinity Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.19
|
| Rate for Payer: Healthscope Commercial |
$51.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.08
|
| Rate for Payer: PHP Commercial |
$49.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.81
|
| Rate for Payer: UHC Core |
$48.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.30
|
|
|
CEFPODOXIME 100 MG TABLET
|
Facility
IP
|
$186.82
|
|
|
Service Code
|
NDC 65862-095-20
|
| Hospital Charge Code |
9468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.94 |
| Max. Negotiated Rate |
$168.14 |
| Rate for Payer: Aetna Commercial |
$158.80
|
| Rate for Payer: BCBS Trust/PPO |
$144.37
|
| Rate for Payer: BCN Commercial |
$144.37
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$160.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Healthscope Commercial |
$168.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.80
|
| Rate for Payer: PHP Commercial |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.40
|
| Rate for Payer: UHC Core |
$155.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.12
|
|
|
CEFPODOXIME 100 MG TABLET
|
Facility
IP
|
$370.97
|
|
|
Service Code
|
NDC 0781-5438-20
|
| Hospital Charge Code |
9468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.25 |
| Max. Negotiated Rate |
$333.87 |
| Rate for Payer: Aetna Commercial |
$315.32
|
| Rate for Payer: BCBS Trust/PPO |
$286.69
|
| Rate for Payer: BCN Commercial |
$286.69
|
| Rate for Payer: Cash Price |
$296.78
|
| Rate for Payer: Cofinity Commercial |
$319.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.78
|
| Rate for Payer: Healthscope Commercial |
$333.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.32
|
| Rate for Payer: PHP Commercial |
$315.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.45
|
| Rate for Payer: UHC Core |
$309.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.23
|
|
|
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 |
$1,326.53 |
| Max. Negotiated Rate |
$1,957.50 |
| Rate for Payer: Aetna Commercial |
$1,848.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,680.84
|
| Rate for Payer: BCN Commercial |
$1,680.84
|
| Rate for Payer: Cash Price |
$1,740.00
|
| 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: Lakeland Regional Health Systems Commercial |
$1,631.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,848.75
|
| Rate for Payer: PHP Commercial |
$1,848.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,892.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,326.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,914.00
|
| Rate for Payer: UHC Core |
$1,816.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,631.25
|
|
|
CEFTRIAXONE 1 GM IV SYRINGE
|
Facility
IP
|
$17.98
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
500542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: BCBS Trust/PPO |
$13.89
|
| Rate for Payer: BCN Commercial |
$13.89
|
| Rate for Payer: Cash Price |
$14.38
|
| 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: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.28
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.82
|
| Rate for Payer: UHC Core |
$15.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION
|
Facility
IP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
150848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: BCBS Trust/PPO |
$10.26
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.28
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.68
|
| Rate for Payer: UHC Core |
$11.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Commercial |
$15.13
|
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: BCBS Trust/PPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$13.76
|
| Rate for Payer: BCBS Trust/PPO |
$10.26
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: BCN Commercial |
$17.93
|
| Rate for Payer: BCN Commercial |
$13.76
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.24
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Healthscope Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.72
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$15.13
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.42
|
| Rate for Payer: UHC Core |
$14.86
|
| Rate for Payer: UHC Core |
$11.08
|
| Rate for Payer: UHC Core |
$19.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.35
|
|
|
CEFTRIAXONE 250 MG SOLUTION FOR INJECTION
|
Facility
IP
|
$12.80
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$11.52 |
| Rate for Payer: Aetna Commercial |
$10.88
|
| Rate for Payer: BCBS Trust/PPO |
$9.89
|
| Rate for Payer: BCN Commercial |
$9.89
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$11.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.88
|
| Rate for Payer: PHP Commercial |
$10.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.26
|
| Rate for Payer: UHC Core |
$10.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.60
|
|
|
CEFTRIAXONE 2 GRAM/50 ML IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK
|
Facility
IP
|
$83.35
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.84 |
| Max. Negotiated Rate |
$75.02 |
| Rate for Payer: Aetna Commercial |
$70.85
|
| Rate for Payer: BCBS Trust/PPO |
$64.41
|
| Rate for Payer: BCN Commercial |
$64.41
|
| Rate for Payer: Cash Price |
$66.68
|
| Rate for Payer: Cofinity Commercial |
$71.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.68
|
| Rate for Payer: Healthscope Commercial |
$75.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.85
|
| Rate for Payer: PHP Commercial |
$70.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.35
|
| Rate for Payer: UHC Core |
$69.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.51
|
|
|
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 |
$15.25 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$19.32
|
| Rate for Payer: BCN Commercial |
$12.87
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$19.32
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| 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 |
$13.32
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.15
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.49
|
| Rate for Payer: UHC Core |
$20.88
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: UHC Core |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
IP
|
$11.95
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: Aetna Commercial |
$10.16
|
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.35
|
| Rate for Payer: BCBS Trust/PPO |
$9.23
|
| Rate for Payer: BCBS Trust/PPO |
$6.65
|
| Rate for Payer: BCN Commercial |
$6.65
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: BCN Commercial |
$9.23
|
| Rate for Payer: BCN Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$10.28
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.88
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$10.76
|
| Rate for Payer: Healthscope Commercial |
$7.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.16
|
| Rate for Payer: PHP Commercial |
$10.16
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$7.31
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Core |
$2.54
|
| Rate for Payer: UHC Core |
$9.98
|
| Rate for Payer: UHC Core |
$7.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.96
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
IP
|
$356.16
|
|
|
Service Code
|
NDC 0904-6502-61
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.22 |
| Max. Negotiated Rate |
$320.54 |
| Rate for Payer: Aetna Commercial |
$302.74
|
| Rate for Payer: BCBS Trust/PPO |
$275.24
|
| Rate for Payer: BCN Commercial |
$275.24
|
| Rate for Payer: Cash Price |
$284.93
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.93
|
| Rate for Payer: Healthscope Commercial |
$320.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.74
|
| Rate for Payer: PHP Commercial |
$302.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.42
|
| Rate for Payer: UHC Core |
$297.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.12
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
IP
|
$270.25
|
|
|
Service Code
|
NDC 69097-422-07
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.83 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: BCBS Trust/PPO |
$208.85
|
| Rate for Payer: BCN Commercial |
$208.85
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.71
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.82
|
| Rate for Payer: UHC Core |
$225.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
IP
|
$501.12
|
|
|
Service Code
|
NDC 0904-6503-61
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.63 |
| Max. Negotiated Rate |
$451.01 |
| Rate for Payer: Aetna Commercial |
$425.95
|
| Rate for Payer: BCBS Trust/PPO |
$387.27
|
| Rate for Payer: BCN Commercial |
$387.27
|
| Rate for Payer: Cash Price |
$400.90
|
| Rate for Payer: Cofinity Commercial |
$430.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.90
|
| Rate for Payer: Healthscope Commercial |
$451.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.95
|
| Rate for Payer: PHP Commercial |
$425.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.99
|
| Rate for Payer: UHC Core |
$418.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.84
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
IP
|
$159.91
|
|
|
Service Code
|
NDC 0990-0006-03
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.53 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: BCBS Trust/PPO |
$123.58
|
| Rate for Payer: BCN Commercial |
$123.58
|
| Rate for Payer: Cash Price |
$127.93
|
| Rate for Payer: Cofinity Commercial |
$137.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.93
|
| Rate for Payer: Healthscope Commercial |
$143.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.92
|
| Rate for Payer: PHP Commercial |
$135.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.72
|
| Rate for Payer: UHC Core |
$133.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.93
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$270.25
|
|
|
Service Code
|
NDC 67877-545-88
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.83 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: BCBS Trust/PPO |
$208.85
|
| Rate for Payer: BCN Commercial |
$208.85
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.71
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.82
|
| Rate for Payer: UHC Core |
$225.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$203.30
|
|
|
Service Code
|
NDC 0093-4177-73
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.99 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: BCBS Trust/PPO |
$157.11
|
| Rate for Payer: BCN Commercial |
$157.11
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.80
|
| Rate for Payer: PHP Commercial |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.90
|
| Rate for Payer: UHC Core |
$169.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.48
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$201.40
|
|
|
Service Code
|
NDC 68180-441-01
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.83 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: BCBS Trust/PPO |
$155.64
|
| Rate for Payer: BCN Commercial |
$155.64
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.23
|
| Rate for Payer: UHC Core |
$168.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
IP
|
$220.90
|
|
|
Service Code
|
NDC 67877-220-01
|
| Hospital Charge Code |
9499
|
|
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
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
IP
|
$276.45
|
|
|
Service Code
|
NDC 60687-152-01
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.61 |
| Max. Negotiated Rate |
$248.80 |
| Rate for Payer: Aetna Commercial |
$234.98
|
| Rate for Payer: BCBS Trust/PPO |
$213.64
|
| Rate for Payer: BCN Commercial |
$213.64
|
| Rate for Payer: Cash Price |
$221.16
|
| Rate for Payer: Cofinity Commercial |
$237.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.16
|
| Rate for Payer: Healthscope Commercial |
$248.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.98
|
| Rate for Payer: PHP Commercial |
$234.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.28
|
| Rate for Payer: UHC Core |
$230.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.34
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
IP
|
$2.77
|
|
|
Service Code
|
NDC 60687-152-11
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: BCBS Trust/PPO |
$2.14
|
| Rate for Payer: BCN Commercial |
$2.14
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.44
|
| Rate for Payer: UHC Core |
$2.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
