|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
OP
|
$451.88
|
|
|
Service Code
|
NDC 68180030260
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$406.69 |
| Rate for Payer: Aetna American Axle |
$293.72
|
| Rate for Payer: Aetna Commercial |
$384.10
|
| Rate for Payer: Aetna Medicare |
$225.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.72
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cofinity Commercial |
$316.32
|
| Rate for Payer: Cofinity Commercial |
$388.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$316.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.50
|
| Rate for Payer: Healthscope Commercial |
$406.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.10
|
| Rate for Payer: PHP Commercial |
$384.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.72
|
| Rate for Payer: Priority Health SBD |
$284.68
|
| Rate for Payer: UMR Bronson Commercial |
$167.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.91
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
IP
|
$451.88
|
|
|
Service Code
|
NDC 68180030260
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.83 |
| Max. Negotiated Rate |
$406.69 |
| Rate for Payer: Aetna American Axle |
$293.72
|
| Rate for Payer: Aetna Commercial |
$384.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.72
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cofinity Commercial |
$316.32
|
| Rate for Payer: Cofinity Commercial |
$388.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$316.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.50
|
| Rate for Payer: Healthscope Commercial |
$406.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.10
|
| Rate for Payer: PHP Commercial |
$384.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.72
|
| Rate for Payer: Priority Health SBD |
$284.68
|
| Rate for Payer: UMR Bronson Commercial |
$198.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.91
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
OP
|
$266.49
|
|
|
Service Code
|
NDC 65862069960
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$239.84 |
| Rate for Payer: Aetna American Axle |
$173.22
|
| Rate for Payer: Aetna Commercial |
$226.52
|
| Rate for Payer: Aetna Medicare |
$133.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.22
|
| Rate for Payer: BCBS Complete |
$106.60
|
| Rate for Payer: Cash Price |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$186.54
|
| Rate for Payer: Cofinity Commercial |
$229.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.19
|
| Rate for Payer: Healthscope Commercial |
$239.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.52
|
| Rate for Payer: PHP Commercial |
$226.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.22
|
| Rate for Payer: Priority Health SBD |
$167.89
|
| Rate for Payer: UMR Bronson Commercial |
$98.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.87
|
|
|
CEFUROXIME AXETIL 250 MG TABLET
|
Facility
|
IP
|
$241.06
|
|
|
Service Code
|
NDC 57237005860
|
| Hospital Charge Code |
9495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.07 |
| Max. Negotiated Rate |
$216.95 |
| Rate for Payer: Aetna American Axle |
$156.69
|
| Rate for Payer: Aetna Commercial |
$204.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.69
|
| Rate for Payer: Cash Price |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$168.74
|
| Rate for Payer: Cofinity Commercial |
$207.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.85
|
| Rate for Payer: Healthscope Commercial |
$216.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.90
|
| Rate for Payer: PHP Commercial |
$204.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.69
|
| Rate for Payer: Priority Health SBD |
$151.87
|
| Rate for Payer: UMR Bronson Commercial |
$106.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.79
|
|
|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.57
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.57
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$365.28
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$328.75 |
| Rate for Payer: Aetna American Axle |
$237.43
|
| Rate for Payer: Aetna Commercial |
$310.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.43
|
| Rate for Payer: Cash Price |
$292.22
|
| Rate for Payer: Cofinity Commercial |
$255.70
|
| Rate for Payer: Cofinity Commercial |
$314.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.22
|
| Rate for Payer: Healthscope Commercial |
$328.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: PHP Commercial |
$310.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.43
|
| Rate for Payer: Priority Health SBD |
$230.13
|
| Rate for Payer: UMR Bronson Commercial |
$160.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.96
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$365.28
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$328.75 |
| Rate for Payer: Aetna American Axle |
$237.43
|
| Rate for Payer: Aetna Commercial |
$310.49
|
| Rate for Payer: Aetna Medicare |
$182.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.43
|
| Rate for Payer: BCBS Complete |
$146.11
|
| Rate for Payer: Cash Price |
$292.22
|
| Rate for Payer: Cofinity Commercial |
$255.70
|
| Rate for Payer: Cofinity Commercial |
$314.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.22
|
| Rate for Payer: Healthscope Commercial |
$328.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: PHP Commercial |
$310.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.43
|
| Rate for Payer: Priority Health SBD |
$230.13
|
| Rate for Payer: UMR Bronson Commercial |
$135.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.96
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 33342015611
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.24 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.81
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.81
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UMR Bronson Commercial |
$68.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 33342015611
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.81
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.81
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UMR Bronson Commercial |
$57.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.73 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$137.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$192.47
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UMR Bronson Commercial |
$101.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$192.47
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$345.10
|
|
|
Service Code
|
NDC 00025152034
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.84 |
| Max. Negotiated Rate |
$310.59 |
| Rate for Payer: Aetna American Axle |
$224.31
|
| Rate for Payer: Aetna Commercial |
$293.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.31
|
| Rate for Payer: Cash Price |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$241.57
|
| Rate for Payer: Cofinity Commercial |
$296.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.57
|
| 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: Multiplan/Beech St/PHCS Commercial |
$293.33
|
| Rate for Payer: PHP Commercial |
$293.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.31
|
| Rate for Payer: Priority Health SBD |
$217.41
|
| Rate for Payer: UMR Bronson Commercial |
$151.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.82
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 62332014131
|
| Hospital Charge Code |
24500
|
|
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 Commercial |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.53
|
| 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: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
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 Commercial |
$241.57
|
| Rate for Payer: Cofinity Commercial |
$296.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.57
|
| 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: Multiplan/Beech St/PHCS Commercial |
$293.33
|
| Rate for Payer: PHP Commercial |
$293.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.31
|
| Rate for Payer: Priority Health SBD |
$217.41
|
| 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
|
$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 Commercial |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.53
|
| 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: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| 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 200 MG CAPSULE
|
Facility
|
OP
|
$5,682.09
|
|
|
Service Code
|
NDC 00025152534
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,102.37 |
| 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 Medicare |
$2,841.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,693.36
|
| Rate for Payer: BCBS Complete |
$2,272.84
|
| Rate for Payer: Cash Price |
$4,545.67
|
| Rate for Payer: Cofinity Commercial |
$3,977.46
|
| Rate for Payer: Cofinity Commercial |
$4,886.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,977.46
|
| 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: PHP Commercial |
$4,829.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,693.36
|
| Rate for Payer: Priority Health SBD |
$3,579.72
|
| Rate for Payer: UMR Bronson Commercial |
$2,102.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,261.57
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$557.76
|
|
|
Service Code
|
NDC 60687044701
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.41 |
| Max. Negotiated Rate |
$501.98 |
| Rate for Payer: Aetna American Axle |
$362.54
|
| Rate for Payer: Aetna Commercial |
$474.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.54
|
| Rate for Payer: Cash Price |
$446.21
|
| Rate for Payer: Cofinity Commercial |
$390.43
|
| Rate for Payer: Cofinity Commercial |
$479.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$390.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$446.21
|
| Rate for Payer: Healthscope Commercial |
$501.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$390.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$418.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$474.10
|
| Rate for Payer: PHP Commercial |
$474.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.54
|
| Rate for Payer: Priority Health SBD |
$351.39
|
| Rate for Payer: UMR Bronson Commercial |
$245.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$418.32
|
|
|
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 Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.49
|
| 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: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$99.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$9.22
|
|
|
Service Code
|
NDC 51079021501
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Aetna American Axle |
$5.99
|
| Rate for Payer: Aetna Commercial |
$7.84
|
| Rate for Payer: Aetna Medicare |
$4.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.99
|
| Rate for Payer: BCBS Complete |
$3.69
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cofinity Commercial |
$6.45
|
| Rate for Payer: Cofinity Commercial |
$7.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.38
|
| Rate for Payer: Healthscope Commercial |
$8.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.84
|
| Rate for Payer: PHP Commercial |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.99
|
| Rate for Payer: Priority Health SBD |
$5.81
|
| Rate for Payer: UMR Bronson Commercial |
$3.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.92
|
|
|
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 Commercial |
$644.91
|
| Rate for Payer: Cofinity Commercial |
$792.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$644.91
|
| 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: PHP Commercial |
$783.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.85
|
| 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
|
IP
|
$9.22
|
|
|
Service Code
|
NDC 51079021501
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Aetna American Axle |
$5.99
|
| Rate for Payer: Aetna Commercial |
$7.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.99
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cofinity Commercial |
$6.45
|
| Rate for Payer: Cofinity Commercial |
$7.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.38
|
| Rate for Payer: Healthscope Commercial |
$8.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.84
|
| Rate for Payer: PHP Commercial |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.99
|
| Rate for Payer: Priority Health SBD |
$5.81
|
| Rate for Payer: UMR Bronson Commercial |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.92
|
|
|
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 Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.49
|
| 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: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| 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
|
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 Commercial |
$354.48
|
| Rate for Payer: Cofinity Commercial |
$435.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$354.48
|
| 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: PHP Commercial |
$430.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.16
|
| 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
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 42571014401
|
| Hospital Charge Code |
24501
|
|
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 Commercial |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.53
|
| 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: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| 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
|
|
