|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Commercial |
$10.16
|
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.88
|
| Rate for Payer: BCBS Trust/PPO |
$7.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$9.75
|
| Rate for Payer: BCN Commercial |
$3.67
|
| Rate for Payer: BCN Commercial |
$9.23
|
| Rate for Payer: BCN Commercial |
$6.65
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cofinity Commercial |
$10.28
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| 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 |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.88
|
| Rate for Payer: Healthscope Commercial |
$7.74
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$10.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.31
|
| Rate for Payer: Nomi Health Commercial |
$9.80
|
| Rate for Payer: Nomi Health Commercial |
$2.49
|
| Rate for Payer: Nomi Health Commercial |
$7.05
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$10.16
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$7.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health HMO/PPO |
$7.48
|
| Rate for Payer: Priority Health HMO/PPO |
$10.40
|
| Rate for Payer: Priority Health HMO/PPO |
$2.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Core |
$7.18
|
| Rate for Payer: UHC Core |
$2.54
|
| Rate for Payer: UHC Core |
$9.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$11.95
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: Aetna Commercial |
$10.16
|
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: Aetna Medicare |
$3.11
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna Medicare |
$2.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.73
|
| Rate for Payer: BCBS Complete |
$4.78
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS Complete |
$3.44
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$2.99
|
| Rate for Payer: BCBS MAPPO |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$2.15
|
| Rate for Payer: BCBS MAPPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$9.82
|
| Rate for Payer: BCBS Trust/PPO |
$7.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$9.29
|
| Rate for Payer: BCN Commercial |
$3.69
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Commercial |
$6.69
|
| Rate for Payer: BCN Medicare Advantage |
$0.76
|
| Rate for Payer: BCN Medicare Advantage |
$2.15
|
| Rate for Payer: BCN Medicare Advantage |
$2.99
|
| Rate for Payer: BCN Medicare Advantage |
$1.19
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Commercial |
$10.28
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$10.76
|
| Rate for Payer: Healthscope Commercial |
$7.74
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.45
|
| 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 |
$3.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$7.05
|
| Rate for Payer: Nomi Health Commercial |
$9.80
|
| Rate for Payer: Nomi Health Commercial |
$2.49
|
| Rate for Payer: PACE Senior Care Partners |
$2.84
|
| Rate for Payer: PACE Senior Care Partners |
$1.13
|
| Rate for Payer: PACE Senior Care Partners |
$2.04
|
| Rate for Payer: PACE Senior Care Partners |
$0.72
|
| Rate for Payer: PACE SWMI |
$0.76
|
| Rate for Payer: PACE SWMI |
$2.99
|
| Rate for Payer: PACE SWMI |
$1.19
|
| Rate for Payer: PACE SWMI |
$2.15
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$7.31
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$10.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.76
|
| Rate for Payer: PHP Medicare Advantage |
$2.99
|
| Rate for Payer: PHP Medicare Advantage |
$2.15
|
| Rate for Payer: PHP Medicare Advantage |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2.64
|
| Rate for Payer: Priority Health HMO/PPO |
$7.48
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health HMO/PPO |
$10.40
|
| Rate for Payer: Priority Health Medicare |
$1.20
|
| Rate for Payer: Priority Health Medicare |
$3.02
|
| Rate for Payer: Priority Health Medicare |
$0.77
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1.19
|
| Rate for Payer: Railroad Medicare Medicare |
$2.99
|
| Rate for Payer: Railroad Medicare Medicare |
$2.15
|
| 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 All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC Core |
$9.98
|
| Rate for Payer: UHC Core |
$7.18
|
| Rate for Payer: UHC Core |
$2.54
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.76
|
| Rate for Payer: UHC Exchange |
$2.15
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$1.19
|
| Rate for Payer: UHC Medicare Advantage |
$2.15
|
| Rate for Payer: UHC Medicare Advantage |
$2.99
|
| Rate for Payer: UHC Medicare Advantage |
$1.19
|
| Rate for Payer: UHC Medicare Advantage |
$0.76
|
| Rate for Payer: VA VA |
$0.76
|
| Rate for Payer: VA VA |
$2.15
|
| Rate for Payer: VA VA |
$1.19
|
| Rate for Payer: VA VA |
$2.99
|
| 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
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$365.28
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.75 |
| Max. Negotiated Rate |
$328.75 |
| Rate for Payer: Aetna Commercial |
$310.49
|
| Rate for Payer: Aetna Medicare |
$94.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.15
|
| Rate for Payer: BCBS Complete |
$146.11
|
| Rate for Payer: BCBS MAPPO |
$91.32
|
| Rate for Payer: BCBS Trust/PPO |
$300.30
|
| Rate for Payer: BCN Commercial |
$284.01
|
| Rate for Payer: BCN Medicare Advantage |
$91.32
|
| Rate for Payer: Cash Price |
$292.22
|
| Rate for Payer: Cofinity Commercial |
$314.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.32
|
| Rate for Payer: Healthscope Commercial |
$328.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: Nomi Health Commercial |
$299.53
|
| Rate for Payer: PACE Senior Care Partners |
$86.75
|
| Rate for Payer: PACE SWMI |
$91.32
|
| Rate for Payer: PHP Commercial |
$310.49
|
| Rate for Payer: PHP Medicare Advantage |
$91.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.43
|
| Rate for Payer: Priority Health HMO/PPO |
$317.79
|
| Rate for Payer: Priority Health Medicare |
$92.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.74
|
| Rate for Payer: Railroad Medicare Medicare |
$91.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.45
|
| Rate for Payer: UHC Core |
$305.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.32
|
| Rate for Payer: UHC Exchange |
$91.32
|
| Rate for Payer: UHC Medicare Advantage |
$91.32
|
| Rate for Payer: VA VA |
$91.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.96
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.72 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: BCBS Trust/PPO |
$224.44
|
| Rate for Payer: BCN Commercial |
$212.48
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.30 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$71.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.92
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: BCBS MAPPO |
$68.74
|
| Rate for Payer: BCBS Trust/PPO |
$226.04
|
| Rate for Payer: BCN Commercial |
$213.77
|
| Rate for Payer: BCN Medicare Advantage |
$68.74
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.74
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: PACE Senior Care Partners |
$65.30
|
| Rate for Payer: PACE SWMI |
$68.74
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Medicare |
$69.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.22
|
| Rate for Payer: Railroad Medicare Medicare |
$68.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.74
|
| Rate for Payer: UHC Exchange |
$68.74
|
| Rate for Payer: UHC Medicare Advantage |
$68.74
|
| Rate for Payer: VA VA |
$68.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$365.28
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.43 |
| Max. Negotiated Rate |
$328.75 |
| Rate for Payer: Aetna Commercial |
$310.49
|
| Rate for Payer: BCBS Trust/PPO |
$298.18
|
| Rate for Payer: BCN Commercial |
$282.29
|
| Rate for Payer: Cash Price |
$292.22
|
| 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: Lakeland Regional Health Systems Commercial |
$273.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: Nomi Health Commercial |
$299.53
|
| Rate for Payer: PHP Commercial |
$310.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.43
|
| Rate for Payer: Priority Health HMO/PPO |
$317.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.45
|
| Rate for Payer: UHC Core |
$305.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.96
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$506.40
|
|
|
Service Code
|
NDC 00904650361
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.16 |
| Max. Negotiated Rate |
$455.76 |
| Rate for Payer: Aetna Commercial |
$430.44
|
| Rate for Payer: BCBS Trust/PPO |
$413.37
|
| Rate for Payer: BCN Commercial |
$391.35
|
| Rate for Payer: Cash Price |
$405.12
|
| Rate for Payer: Cofinity Commercial |
$435.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.12
|
| Rate for Payer: Healthscope Commercial |
$455.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.44
|
| Rate for Payer: Nomi Health Commercial |
$415.25
|
| Rate for Payer: PHP Commercial |
$430.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.16
|
| Rate for Payer: Priority Health HMO/PPO |
$440.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$445.63
|
| Rate for Payer: UHC Core |
$422.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.80
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$506.40
|
|
|
Service Code
|
NDC 00904650361
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.27 |
| Max. Negotiated Rate |
$455.76 |
| Rate for Payer: Aetna Commercial |
$430.44
|
| Rate for Payer: Aetna Medicare |
$131.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$158.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$158.25
|
| Rate for Payer: BCBS Complete |
$202.56
|
| Rate for Payer: BCBS MAPPO |
$126.60
|
| Rate for Payer: BCBS Trust/PPO |
$416.31
|
| Rate for Payer: BCN Commercial |
$393.73
|
| Rate for Payer: BCN Medicare Advantage |
$126.60
|
| Rate for Payer: Cash Price |
$405.12
|
| Rate for Payer: Cofinity Commercial |
$435.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.60
|
| Rate for Payer: Healthscope Commercial |
$455.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.44
|
| Rate for Payer: Nomi Health Commercial |
$415.25
|
| Rate for Payer: PACE Senior Care Partners |
$120.27
|
| Rate for Payer: PACE SWMI |
$126.60
|
| Rate for Payer: PHP Commercial |
$430.44
|
| Rate for Payer: PHP Medicare Advantage |
$126.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.16
|
| Rate for Payer: Priority Health HMO/PPO |
$440.57
|
| Rate for Payer: Priority Health Medicare |
$127.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.29
|
| Rate for Payer: Railroad Medicare Medicare |
$126.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$445.63
|
| Rate for Payer: UHC Core |
$422.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.60
|
| Rate for Payer: UHC Exchange |
$126.60
|
| Rate for Payer: UHC Medicare Advantage |
$126.60
|
| Rate for Payer: VA VA |
$126.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.80
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
IP
|
$159.91
|
|
|
Service Code
|
NDC 09900000603
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: BCBS Trust/PPO |
$130.53
|
| 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 Commercial |
$135.92
|
| Rate for Payer: Nomi Health Commercial |
$131.13
|
| Rate for Payer: PHP Commercial |
$135.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.94
|
| Rate for Payer: Priority Health HMO/PPO |
$139.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.14
|
| 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
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
OP
|
$159.91
|
|
|
Service Code
|
NDC 09900000603
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.98 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Aetna Medicare |
$41.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.97
|
| Rate for Payer: BCBS Complete |
$63.96
|
| Rate for Payer: BCBS MAPPO |
$39.98
|
| Rate for Payer: BCBS Trust/PPO |
$131.46
|
| Rate for Payer: BCN Commercial |
$124.33
|
| Rate for Payer: BCN Medicare Advantage |
$39.98
|
| 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: Health Alliance Plan Medicare Advantage |
$39.98
|
| Rate for Payer: Healthscope Commercial |
$143.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.92
|
| Rate for Payer: Nomi Health Commercial |
$131.13
|
| Rate for Payer: PACE Senior Care Partners |
$37.98
|
| Rate for Payer: PACE SWMI |
$39.98
|
| Rate for Payer: PHP Commercial |
$135.92
|
| Rate for Payer: PHP Medicare Advantage |
$39.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.94
|
| Rate for Payer: Priority Health HMO/PPO |
$139.12
|
| Rate for Payer: Priority Health Medicare |
$40.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.14
|
| Rate for Payer: Railroad Medicare Medicare |
$39.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.72
|
| Rate for Payer: UHC Core |
$133.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.98
|
| Rate for Payer: UHC Exchange |
$39.98
|
| Rate for Payer: UHC Medicare Advantage |
$39.98
|
| Rate for Payer: VA VA |
$39.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.93
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 67877054588
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.30 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$71.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.92
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: BCBS MAPPO |
$68.74
|
| Rate for Payer: BCBS Trust/PPO |
$226.04
|
| Rate for Payer: BCN Commercial |
$213.77
|
| Rate for Payer: BCN Medicare Advantage |
$68.74
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.74
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: PACE Senior Care Partners |
$65.30
|
| Rate for Payer: PACE SWMI |
$68.74
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Medicare |
$69.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.22
|
| Rate for Payer: Railroad Medicare Medicare |
$68.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.74
|
| Rate for Payer: UHC Exchange |
$68.74
|
| Rate for Payer: UHC Medicare Advantage |
$68.74
|
| Rate for Payer: VA VA |
$68.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$201.40
|
|
|
Service Code
|
NDC 68180044101
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.83 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna Medicare |
$52.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.94
|
| Rate for Payer: BCBS Complete |
$80.56
|
| Rate for Payer: BCBS MAPPO |
$50.35
|
| Rate for Payer: BCBS Trust/PPO |
$165.57
|
| Rate for Payer: BCN Commercial |
$156.59
|
| Rate for Payer: BCN Medicare Advantage |
$50.35
|
| 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: Health Alliance Plan Medicare Advantage |
$50.35
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: Nomi Health Commercial |
$165.15
|
| Rate for Payer: PACE Senior Care Partners |
$47.83
|
| Rate for Payer: PACE SWMI |
$50.35
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: PHP Medicare Advantage |
$50.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health HMO/PPO |
$175.22
|
| Rate for Payer: Priority Health Medicare |
$50.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.94
|
| Rate for Payer: Railroad Medicare Medicare |
$50.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.23
|
| Rate for Payer: UHC Core |
$168.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.35
|
| Rate for Payer: UHC Exchange |
$50.35
|
| Rate for Payer: UHC Medicare Advantage |
$50.35
|
| Rate for Payer: VA VA |
$50.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 67877054588
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.72 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: BCBS Trust/PPO |
$224.44
|
| Rate for Payer: BCN Commercial |
$212.48
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$203.30
|
|
|
Service Code
|
NDC 00093417773
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Medicare |
$52.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.53
|
| Rate for Payer: BCBS Complete |
$81.32
|
| Rate for Payer: BCBS MAPPO |
$50.82
|
| Rate for Payer: BCBS Trust/PPO |
$167.13
|
| Rate for Payer: BCN Commercial |
$158.07
|
| Rate for Payer: BCN Medicare Advantage |
$50.82
|
| 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: Health Alliance Plan Medicare Advantage |
$50.82
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.80
|
| Rate for Payer: Nomi Health Commercial |
$166.71
|
| Rate for Payer: PACE Senior Care Partners |
$48.28
|
| Rate for Payer: PACE SWMI |
$50.82
|
| Rate for Payer: PHP Commercial |
$172.80
|
| Rate for Payer: PHP Medicare Advantage |
$50.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.14
|
| Rate for Payer: Priority Health HMO/PPO |
$176.87
|
| Rate for Payer: Priority Health Medicare |
$51.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.21
|
| Rate for Payer: Railroad Medicare Medicare |
$50.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.90
|
| Rate for Payer: UHC Core |
$169.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.82
|
| Rate for Payer: UHC Exchange |
$50.82
|
| Rate for Payer: UHC Medicare Advantage |
$50.82
|
| Rate for Payer: VA VA |
$50.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.48
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$203.30
|
|
|
Service Code
|
NDC 00093417773
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.14 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: BCBS Trust/PPO |
$165.95
|
| 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 Commercial |
$172.80
|
| Rate for Payer: Nomi Health Commercial |
$166.71
|
| Rate for Payer: PHP Commercial |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.14
|
| Rate for Payer: Priority Health HMO/PPO |
$176.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.21
|
| 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 68180044101
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.91 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: BCBS Trust/PPO |
$164.40
|
| 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 Commercial |
$171.19
|
| Rate for Payer: Nomi Health Commercial |
$165.15
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health HMO/PPO |
$175.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.94
|
| 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
|
$2.85
|
|
|
Service Code
|
NDC 60687015211
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.51
|
| Rate for Payer: UHC Core |
$2.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 67877022001
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.56 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$79.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.47
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: BCBS MAPPO |
$76.38
|
| Rate for Payer: BCBS Trust/PPO |
$251.15
|
| Rate for Payer: BCN Commercial |
$237.53
|
| Rate for Payer: BCN Medicare Advantage |
$76.38
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.38
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: PACE Senior Care Partners |
$72.56
|
| Rate for Payer: PACE SWMI |
$76.38
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: PHP Medicare Advantage |
$76.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.58
|
| Rate for Payer: Priority Health HMO/PPO |
$265.78
|
| Rate for Payer: Priority Health Medicare |
$77.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.68
|
| Rate for Payer: Railroad Medicare Medicare |
$76.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.84
|
| Rate for Payer: UHC Core |
$255.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.38
|
| Rate for Payer: UHC Exchange |
$76.38
|
| Rate for Payer: UHC Medicare Advantage |
$76.38
|
| Rate for Payer: VA VA |
$76.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$289.05
|
|
|
Service Code
|
NDC 00093314501
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.65 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna Medicare |
$75.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.33
|
| Rate for Payer: BCBS Complete |
$115.62
|
| Rate for Payer: BCBS MAPPO |
$72.26
|
| Rate for Payer: BCBS Trust/PPO |
$237.63
|
| Rate for Payer: BCN Commercial |
$224.74
|
| Rate for Payer: BCN Medicare Advantage |
$72.26
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.26
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Nomi Health Commercial |
$237.02
|
| Rate for Payer: PACE Senior Care Partners |
$68.65
|
| Rate for Payer: PACE SWMI |
$72.26
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: PHP Medicare Advantage |
$72.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.88
|
| Rate for Payer: Priority Health HMO/PPO |
$251.47
|
| Rate for Payer: Priority Health Medicare |
$72.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.66
|
| Rate for Payer: Railroad Medicare Medicare |
$72.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.36
|
| Rate for Payer: UHC Core |
$241.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.26
|
| Rate for Payer: UHC Exchange |
$72.26
|
| Rate for Payer: UHC Medicare Advantage |
$72.26
|
| Rate for Payer: VA VA |
$72.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$284.05
|
|
|
Service Code
|
NDC 60687015201
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.63 |
| Max. Negotiated Rate |
$255.64 |
| Rate for Payer: Aetna Commercial |
$241.44
|
| Rate for Payer: BCBS Trust/PPO |
$231.87
|
| Rate for Payer: BCN Commercial |
$219.51
|
| Rate for Payer: Cash Price |
$227.24
|
| Rate for Payer: Cofinity Commercial |
$244.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.24
|
| Rate for Payer: Healthscope Commercial |
$255.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.44
|
| Rate for Payer: Nomi Health Commercial |
$232.92
|
| Rate for Payer: PHP Commercial |
$241.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.63
|
| Rate for Payer: Priority Health HMO/PPO |
$247.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.96
|
| Rate for Payer: UHC Core |
$237.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.04
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$2.85
|
|
|
Service Code
|
NDC 60687015211
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.89
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS MAPPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: BCN Medicare Advantage |
$0.71
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.71
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: PACE Senior Care Partners |
$0.68
|
| Rate for Payer: PACE SWMI |
$0.71
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: PHP Medicare Advantage |
$0.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2.48
|
| Rate for Payer: Priority Health Medicare |
$0.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.91
|
| Rate for Payer: Railroad Medicare Medicare |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.51
|
| Rate for Payer: UHC Core |
$2.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Medicare Advantage |
$0.71
|
| Rate for Payer: VA VA |
$0.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 00093314501
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: BCBS Trust/PPO |
$235.95
|
| Rate for Payer: BCN Commercial |
$223.38
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Nomi Health Commercial |
$237.02
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.88
|
| Rate for Payer: Priority Health HMO/PPO |
$251.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.36
|
| Rate for Payer: UHC Core |
$241.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$284.05
|
|
|
Service Code
|
NDC 60687015201
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.46 |
| Max. Negotiated Rate |
$255.64 |
| Rate for Payer: Aetna Commercial |
$241.44
|
| Rate for Payer: Aetna Medicare |
$73.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.77
|
| Rate for Payer: BCBS Complete |
$113.62
|
| Rate for Payer: BCBS MAPPO |
$71.01
|
| Rate for Payer: BCBS Trust/PPO |
$233.52
|
| Rate for Payer: BCN Commercial |
$220.85
|
| Rate for Payer: BCN Medicare Advantage |
$71.01
|
| Rate for Payer: Cash Price |
$227.24
|
| Rate for Payer: Cofinity Commercial |
$244.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.01
|
| Rate for Payer: Healthscope Commercial |
$255.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.44
|
| Rate for Payer: Nomi Health Commercial |
$232.92
|
| Rate for Payer: PACE Senior Care Partners |
$67.46
|
| Rate for Payer: PACE SWMI |
$71.01
|
| Rate for Payer: PHP Commercial |
$241.44
|
| Rate for Payer: PHP Medicare Advantage |
$71.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.63
|
| Rate for Payer: Priority Health HMO/PPO |
$247.12
|
| Rate for Payer: Priority Health Medicare |
$71.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.31
|
| Rate for Payer: Railroad Medicare Medicare |
$71.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.96
|
| Rate for Payer: UHC Core |
$237.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.01
|
| Rate for Payer: UHC Exchange |
$71.01
|
| Rate for Payer: UHC Medicare Advantage |
$71.01
|
| Rate for Payer: VA VA |
$71.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.04
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 67877022001
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.58 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: BCBS Trust/PPO |
$249.38
|
| Rate for Payer: BCN Commercial |
$236.09
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.58
|
| Rate for Payer: Priority Health HMO/PPO |
$265.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.84
|
| Rate for Payer: UHC Core |
$255.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.36 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: BCBS Trust/PPO |
$104.69
|
| Rate for Payer: BCN Commercial |
$99.11
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: Nomi Health Commercial |
$105.16
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: Priority Health HMO/PPO |
$111.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.86
|
| Rate for Payer: UHC Core |
$107.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
