|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 62332014131
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 60687043611
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna American Axle |
$3.03
|
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.03
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Advantage |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health SBD |
$2.94
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 69367030101
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.73 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Advantage |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UMR Bronson Commercial |
$143.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$465.60
|
|
|
Service Code
|
NDC 60687043601
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.27 |
| Max. Negotiated Rate |
$419.04 |
| Rate for Payer: Aetna American Axle |
$302.64
|
| Rate for Payer: Aetna Commercial |
$395.76
|
| Rate for Payer: Aetna Medicare |
$232.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.64
|
| Rate for Payer: BCBS Complete |
$186.24
|
| Rate for Payer: Cash Price |
$372.48
|
| Rate for Payer: Cofinity Advantage |
$325.92
|
| Rate for Payer: Cofinity Commercial |
$400.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.48
|
| Rate for Payer: Healthscope Commercial |
$419.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.20
|
| Rate for Payer: PHP Commercial |
$395.76
|
| Rate for Payer: Priority Health SBD |
$293.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.64
|
| Rate for Payer: UHC Core |
$242.58
|
| Rate for Payer: UHC Exchange |
$182.98
|
| Rate for Payer: UMR Bronson Commercial |
$172.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.20
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$345.10
|
|
|
Service Code
|
NDC 00025152034
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.69 |
| Max. Negotiated Rate |
$310.59 |
| Rate for Payer: Aetna American Axle |
$224.31
|
| Rate for Payer: Aetna Commercial |
$293.33
|
| Rate for Payer: Aetna Medicare |
$172.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.31
|
| Rate for Payer: BCBS Complete |
$138.04
|
| Rate for Payer: Cash Price |
$276.08
|
| Rate for Payer: Cofinity Advantage |
$241.57
|
| Rate for Payer: Cofinity Commercial |
$296.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.08
|
| Rate for Payer: Healthscope Commercial |
$310.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.82
|
| Rate for Payer: PHP Commercial |
$293.33
|
| Rate for Payer: Priority Health SBD |
$217.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.31
|
| Rate for Payer: UHC Core |
$179.80
|
| Rate for Payer: UHC Exchange |
$135.62
|
| Rate for Payer: UMR Bronson Commercial |
$127.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.82
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$465.60
|
|
|
Service Code
|
NDC 60687043601
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.86 |
| Max. Negotiated Rate |
$419.04 |
| Rate for Payer: Aetna American Axle |
$302.64
|
| Rate for Payer: Aetna Commercial |
$395.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.64
|
| Rate for Payer: Cash Price |
$372.48
|
| Rate for Payer: Cofinity Advantage |
$325.92
|
| Rate for Payer: Cofinity Commercial |
$400.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.48
|
| Rate for Payer: Healthscope Commercial |
$419.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.20
|
| Rate for Payer: PHP Commercial |
$395.76
|
| Rate for Payer: Priority Health SBD |
$293.33
|
| Rate for Payer: UMR Bronson Commercial |
$204.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.20
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 69367030101
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.86 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Advantage |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.32
|
| Rate for Payer: UHC Core |
$170.18
|
| Rate for Payer: UHC Exchange |
$128.37
|
| Rate for Payer: UMR Bronson Commercial |
$120.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.01 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna American Axle |
$180.25
|
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.25
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Advantage |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health SBD |
$174.70
|
| Rate for Payer: UMR Bronson Commercial |
$122.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 62332014231
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.10
|
| Rate for Payer: UHC Core |
$139.54
|
| Rate for Payer: UHC Exchange |
$105.26
|
| Rate for Payer: UMR Bronson Commercial |
$99.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 62332014231
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 65862090901
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.09
|
| Rate for Payer: UHC Core |
$204.47
|
| Rate for Payer: UHC Exchange |
$154.23
|
| Rate for Payer: UMR Bronson Commercial |
$145.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$5,649.53
|
|
|
Service Code
|
NDC 58151008488
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,485.79 |
| Max. Negotiated Rate |
$5,084.58 |
| Rate for Payer: Aetna American Axle |
$3,672.19
|
| Rate for Payer: Aetna Commercial |
$4,802.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,672.19
|
| Rate for Payer: Cash Price |
$4,519.62
|
| Rate for Payer: Cofinity Advantage |
$3,954.67
|
| Rate for Payer: Cofinity Commercial |
$4,858.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,519.62
|
| Rate for Payer: Healthscope Commercial |
$5,084.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,954.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,237.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,802.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,237.15
|
| Rate for Payer: PHP Commercial |
$4,802.10
|
| Rate for Payer: Priority Health SBD |
$3,559.20
|
| Rate for Payer: UMR Bronson Commercial |
$2,485.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,237.15
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$56.50
|
|
|
Service Code
|
NDC 58151008432
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$50.85 |
| Rate for Payer: Aetna American Axle |
$36.73
|
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.73
|
| Rate for Payer: Cash Price |
$45.20
|
| Rate for Payer: Cofinity Advantage |
$39.55
|
| Rate for Payer: Cofinity Commercial |
$48.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.20
|
| Rate for Payer: Healthscope Commercial |
$50.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.38
|
| Rate for Payer: PHP Commercial |
$48.02
|
| Rate for Payer: Priority Health SBD |
$35.59
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.38
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$762.24
|
|
|
Service Code
|
NDC 60687044701
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$335.39 |
| Max. Negotiated Rate |
$686.02 |
| Rate for Payer: Aetna American Axle |
$495.46
|
| Rate for Payer: Aetna Commercial |
$647.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.46
|
| Rate for Payer: Cash Price |
$609.79
|
| Rate for Payer: Cofinity Advantage |
$533.57
|
| Rate for Payer: Cofinity Commercial |
$655.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.79
|
| Rate for Payer: Healthscope Commercial |
$686.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$533.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$571.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$647.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$571.68
|
| Rate for Payer: PHP Commercial |
$647.90
|
| Rate for Payer: Priority Health SBD |
$480.21
|
| Rate for Payer: UMR Bronson Commercial |
$335.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$571.68
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 50268016911
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna American Axle |
$3.04
|
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Advantage |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health SBD |
$2.95
|
| Rate for Payer: UMR Bronson Commercial |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.51
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$387.75
|
|
|
Service Code
|
NDC 69097042107
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.47 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna American Axle |
$252.04
|
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna Medicare |
$193.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.04
|
| Rate for Payer: BCBS Complete |
$155.10
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Advantage |
$271.43
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$310.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.81
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health SBD |
$244.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.04
|
| Rate for Payer: UHC Core |
$202.02
|
| Rate for Payer: UHC Exchange |
$152.39
|
| Rate for Payer: UMR Bronson Commercial |
$143.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$233.76
|
|
|
Service Code
|
NDC 50268016915
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.85 |
| Max. Negotiated Rate |
$210.38 |
| Rate for Payer: Aetna American Axle |
$151.94
|
| Rate for Payer: Aetna Commercial |
$198.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.94
|
| Rate for Payer: Cash Price |
$187.01
|
| Rate for Payer: Cofinity Advantage |
$163.63
|
| Rate for Payer: Cofinity Commercial |
$201.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.01
|
| Rate for Payer: Healthscope Commercial |
$210.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.32
|
| Rate for Payer: PHP Commercial |
$198.70
|
| Rate for Payer: Priority Health SBD |
$147.27
|
| Rate for Payer: UMR Bronson Commercial |
$102.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.32
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$506.40
|
|
|
Service Code
|
NDC 00904650361
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.82 |
| Max. Negotiated Rate |
$455.76 |
| Rate for Payer: Aetna American Axle |
$329.16
|
| Rate for Payer: Aetna Commercial |
$430.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.16
|
| Rate for Payer: Cash Price |
$405.12
|
| Rate for Payer: Cofinity Advantage |
$354.48
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$354.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.80
|
| Rate for Payer: PHP Commercial |
$430.44
|
| Rate for Payer: Priority Health SBD |
$319.03
|
| Rate for Payer: UMR Bronson Commercial |
$222.82
|
| 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 |
$187.37 |
| Max. Negotiated Rate |
$455.76 |
| Rate for Payer: Aetna American Axle |
$329.16
|
| Rate for Payer: Aetna Commercial |
$430.44
|
| Rate for Payer: Aetna Medicare |
$253.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.16
|
| Rate for Payer: BCBS Complete |
$202.56
|
| Rate for Payer: Cash Price |
$405.12
|
| Rate for Payer: Cofinity Advantage |
$354.48
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$354.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.80
|
| Rate for Payer: PHP Commercial |
$430.44
|
| Rate for Payer: Priority Health SBD |
$319.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.16
|
| Rate for Payer: UHC Core |
$263.83
|
| Rate for Payer: UHC Exchange |
$199.02
|
| Rate for Payer: UMR Bronson Commercial |
$187.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.80
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$5,682.09
|
|
|
Service Code
|
NDC 00025152534
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,500.12 |
| Max. Negotiated Rate |
$5,113.88 |
| Rate for Payer: Aetna American Axle |
$3,693.36
|
| Rate for Payer: Aetna Commercial |
$4,829.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,693.36
|
| Rate for Payer: Cash Price |
$4,545.67
|
| Rate for Payer: Cofinity Advantage |
$3,977.46
|
| Rate for Payer: Cofinity Commercial |
$4,886.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,545.67
|
| Rate for Payer: Healthscope Commercial |
$5,113.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,977.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,261.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,829.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,261.57
|
| Rate for Payer: PHP Commercial |
$4,829.78
|
| Rate for Payer: Priority Health SBD |
$3,579.72
|
| Rate for Payer: UMR Bronson Commercial |
$2,500.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,261.57
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$921.30
|
|
|
Service Code
|
NDC 51079021520
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$405.37 |
| Max. Negotiated Rate |
$829.17 |
| Rate for Payer: Aetna American Axle |
$598.85
|
| Rate for Payer: Aetna Commercial |
$783.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.85
|
| Rate for Payer: Cash Price |
$737.04
|
| Rate for Payer: Cofinity Advantage |
$644.91
|
| Rate for Payer: Cofinity Commercial |
$792.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.04
|
| Rate for Payer: Healthscope Commercial |
$829.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$644.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$690.98
|
| Rate for Payer: PHP Commercial |
$783.11
|
| Rate for Payer: Priority Health SBD |
$580.42
|
| Rate for Payer: UMR Bronson Commercial |
$405.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.98
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 42571014401
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.28
|
| Rate for Payer: UHC Core |
$138.09
|
| Rate for Payer: UHC Exchange |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$233.76
|
|
|
Service Code
|
NDC 50268016915
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.49 |
| Max. Negotiated Rate |
$210.38 |
| Rate for Payer: Aetna American Axle |
$151.94
|
| Rate for Payer: Aetna Commercial |
$198.70
|
| Rate for Payer: Aetna Medicare |
$116.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.94
|
| Rate for Payer: BCBS Complete |
$93.50
|
| Rate for Payer: Cash Price |
$187.01
|
| Rate for Payer: Cofinity Advantage |
$163.63
|
| Rate for Payer: Cofinity Commercial |
$201.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.01
|
| Rate for Payer: Healthscope Commercial |
$210.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.32
|
| Rate for Payer: PHP Commercial |
$198.70
|
| Rate for Payer: Priority Health SBD |
$147.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.94
|
| Rate for Payer: UHC Core |
$121.79
|
| Rate for Payer: UHC Exchange |
$91.87
|
| Rate for Payer: UMR Bronson Commercial |
$86.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.32
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$387.75
|
|
|
Service Code
|
NDC 69097042107
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna American Axle |
$252.04
|
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.04
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Advantage |
$271.43
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.81
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health SBD |
$244.28
|
| Rate for Payer: UMR Bronson Commercial |
$170.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 50268016911
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna American Axle |
$3.04
|
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: BCBS Complete |
$1.87
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Advantage |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health SBD |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.04
|
| Rate for Payer: UHC Core |
$2.44
|
| Rate for Payer: UHC Exchange |
$1.84
|
| Rate for Payer: UMR Bronson Commercial |
$1.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.51
|
|
