|
CAROTID ARTERY STENT PROCEDURES WITH MCC
|
Facility
IP
|
$50,093.98
|
|
|
Service Code
|
MS-DRG 034
|
| Min. Negotiated Rate |
$32,976.15 |
| Max. Negotiated Rate |
$50,093.98 |
| Rate for Payer: Aetna Medicare |
$34,711.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,389.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,389.68
|
| Rate for Payer: BCBS MAPPO |
$34,711.74
|
| Rate for Payer: BCN Medicare Advantage |
$34,711.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,711.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$34,711.74
|
| Rate for Payer: Mclaren Medicare |
$34,711.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36,447.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,918.50
|
| Rate for Payer: PACE Medicare |
$32,976.15
|
| Rate for Payer: PACE SWMI |
$34,711.74
|
| Rate for Payer: PHP Commercial |
$38,182.91
|
| Rate for Payer: PHP Medicare Advantage |
$34,711.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50,093.98
|
| Rate for Payer: Priority Health Medicare |
$34,711.74
|
| Rate for Payer: Priority Health Narrow Network |
$40,075.18
|
| Rate for Payer: Railroad Medicare Medicare |
$34,711.74
|
| Rate for Payer: UHC Medicare Advantage |
$35,753.09
|
| Rate for Payer: VA VA |
$34,711.74
|
|
|
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$23,217.29
|
|
|
Service Code
|
MS-DRG 036
|
| Min. Negotiated Rate |
$16,140.39 |
| Max. Negotiated Rate |
$23,217.29 |
| Rate for Payer: Aetna Medicare |
$16,989.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,237.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,237.35
|
| Rate for Payer: BCBS MAPPO |
$16,989.88
|
| Rate for Payer: BCN Medicare Advantage |
$16,989.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,989.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,989.88
|
| Rate for Payer: Mclaren Medicare |
$16,989.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,839.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,538.36
|
| Rate for Payer: PACE Medicare |
$16,140.39
|
| Rate for Payer: PACE SWMI |
$16,989.88
|
| Rate for Payer: PHP Commercial |
$18,688.87
|
| Rate for Payer: PHP Medicare Advantage |
$16,989.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,217.29
|
| Rate for Payer: Priority Health Medicare |
$16,989.88
|
| Rate for Payer: Priority Health Narrow Network |
$18,573.83
|
| Rate for Payer: Railroad Medicare Medicare |
$16,989.88
|
| Rate for Payer: UHC Medicare Advantage |
$17,499.58
|
| Rate for Payer: VA VA |
$16,989.88
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
IP
|
$246.75
|
|
|
Service Code
|
NDC 68084-843-01
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.72 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna Commercial |
$222.08
|
| Rate for Payer: ASR ASR |
$239.35
|
| Rate for Payer: BCBS Trust/PPO |
$191.31
|
| Rate for Payer: BCN Commercial |
$191.31
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Healthscope Whirlpool |
$239.35
|
| Rate for Payer: Mclaren Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.14
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
IP
|
$1.86
|
|
|
Service Code
|
NDC 51079-771-01
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: ASR ASR |
$1.80
|
| Rate for Payer: BCBS Trust/PPO |
$1.44
|
| Rate for Payer: BCN Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.49
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Healthscope Whirlpool |
$1.80
|
| Rate for Payer: Mclaren Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.64
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
IP
|
$180.95
|
|
|
Service Code
|
NDC 0904-6300-61
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.66 |
| Max. Negotiated Rate |
$180.95 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: ASR ASR |
$175.52
|
| Rate for Payer: BCBS Trust/PPO |
$140.29
|
| Rate for Payer: BCN Commercial |
$140.29
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$170.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$180.95
|
| Rate for Payer: Healthscope Whirlpool |
$175.52
|
| Rate for Payer: Mclaren Commercial |
$162.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.24
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
IP
|
$2.47
|
|
|
Service Code
|
NDC 68084-843-11
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: ASR ASR |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Healthscope Whirlpool |
$2.40
|
| Rate for Payer: Mclaren Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.17
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
IP
|
$185.65
|
|
|
Service Code
|
NDC 0904-6301-61
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.96 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: BCBS Trust/PPO |
$143.93
|
| Rate for Payer: BCN Commercial |
$143.93
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$174.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$185.65
|
| Rate for Payer: Healthscope Whirlpool |
$180.08
|
| Rate for Payer: Mclaren Commercial |
$167.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.37
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
IP
|
$2.14
|
|
|
Service Code
|
NDC 51079-930-01
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna Commercial |
$1.93
|
| Rate for Payer: ASR ASR |
$2.08
|
| Rate for Payer: BCBS Trust/PPO |
$1.66
|
| Rate for Payer: BCN Commercial |
$1.66
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cofinity Commercial |
$2.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$2.14
|
| Rate for Payer: Healthscope Whirlpool |
$2.08
|
| Rate for Payer: Mclaren Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.88
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
IP
|
$220.90
|
|
|
Service Code
|
NDC 43547-255-10
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.63 |
| Max. Negotiated Rate |
$220.90 |
| Rate for Payer: Aetna Commercial |
$198.81
|
| Rate for Payer: ASR ASR |
$214.27
|
| Rate for Payer: BCBS Trust/PPO |
$171.26
|
| Rate for Payer: BCN Commercial |
$171.26
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$207.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$220.90
|
| Rate for Payer: Healthscope Whirlpool |
$214.27
|
| Rate for Payer: Mclaren Commercial |
$198.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.39
|
|
|
CEFADROXIL 500 MG CAPSULE
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
NDC 68180-180-08
|
| Hospital Charge Code |
9436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: ASR ASR |
$182.36
|
| Rate for Payer: BCBS Trust/PPO |
$145.76
|
| Rate for Payer: BCN Commercial |
$145.76
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$188.00
|
| Rate for Payer: Healthscope Whirlpool |
$182.36
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.44
|
|
|
CEFAZOLIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.10
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
27297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna Commercial |
$14.49
|
| Rate for Payer: ASR ASR |
$15.62
|
| Rate for Payer: BCBS Trust/PPO |
$12.48
|
| Rate for Payer: BCN Commercial |
$12.48
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Healthscope Whirlpool |
$15.62
|
| Rate for Payer: Mclaren Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.17
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$14.22
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: Aetna Commercial |
$14.94
|
| Rate for Payer: ASR ASR |
$18.31
|
| Rate for Payer: ASR ASR |
$13.79
|
| Rate for Payer: ASR ASR |
$16.10
|
| Rate for Payer: ASR ASR |
$18.85
|
| Rate for Payer: BCBS Trust/PPO |
$14.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$11.02
|
| Rate for Payer: BCN Commercial |
$11.02
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: BCN Commercial |
$15.06
|
| Rate for Payer: BCN Commercial |
$12.87
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$15.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$16.60
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.31
|
| Rate for Payer: Healthscope Whirlpool |
$18.85
|
| Rate for Payer: Healthscope Whirlpool |
$13.79
|
| Rate for Payer: Healthscope Whirlpool |
$16.10
|
| Rate for Payer: Mclaren Commercial |
$14.94
|
| Rate for Payer: Mclaren Commercial |
$17.49
|
| Rate for Payer: Mclaren Commercial |
$16.99
|
| Rate for Payer: Mclaren Commercial |
$12.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.51
|
|
|
CEFAZOLIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$27.19
|
|
|
Service Code
|
HCPCS J0688
|
| Hospital Charge Code |
203261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$27.19 |
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: ASR ASR |
$26.37
|
| Rate for Payer: BCBS Trust/PPO |
$21.08
|
| Rate for Payer: BCN Commercial |
$21.08
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cofinity Commercial |
$25.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Healthscope Commercial |
$27.19
|
| Rate for Payer: Healthscope Whirlpool |
$26.37
|
| Rate for Payer: Mclaren Commercial |
$24.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.93
|
|
|
CEFAZOLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$18.62
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
199467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: ASR ASR |
$18.06
|
| Rate for Payer: BCBS Trust/PPO |
$14.44
|
| Rate for Payer: BCN Commercial |
$14.44
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$18.62
|
| Rate for Payer: Healthscope Whirlpool |
$18.06
|
| Rate for Payer: Mclaren Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.39
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$305.50
|
|
|
Service Code
|
NDC 67877-547-88
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.85 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$274.95
|
| Rate for Payer: ASR ASR |
$296.34
|
| Rate for Payer: BCBS Trust/PPO |
$236.85
|
| Rate for Payer: BCN Commercial |
$236.85
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$287.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$305.50
|
| Rate for Payer: Healthscope Whirlpool |
$296.34
|
| Rate for Payer: Mclaren Commercial |
$274.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.84
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$221.35
|
|
|
Service Code
|
NDC 68180-722-05
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.94 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna Commercial |
$199.22
|
| Rate for Payer: ASR ASR |
$214.71
|
| Rate for Payer: BCBS Trust/PPO |
$171.61
|
| Rate for Payer: BCN Commercial |
$171.61
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$208.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$221.35
|
| Rate for Payer: Healthscope Whirlpool |
$214.71
|
| Rate for Payer: Mclaren Commercial |
$199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.79
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$218.55
|
|
|
Service Code
|
NDC 67877-547-98
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.98 |
| Max. Negotiated Rate |
$218.55 |
| Rate for Payer: Aetna Commercial |
$196.70
|
| Rate for Payer: ASR ASR |
$211.99
|
| Rate for Payer: BCBS Trust/PPO |
$169.44
|
| Rate for Payer: BCN Commercial |
$169.44
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$205.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$218.55
|
| Rate for Payer: Healthscope Whirlpool |
$211.99
|
| Rate for Payer: Mclaren Commercial |
$196.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.32
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$367.65
|
|
|
Service Code
|
NDC 0781-6077-46
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.36 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna Commercial |
$330.88
|
| Rate for Payer: ASR ASR |
$356.62
|
| Rate for Payer: BCBS Trust/PPO |
$285.04
|
| Rate for Payer: BCN Commercial |
$285.04
|
| Rate for Payer: Cash Price |
$294.12
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.12
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Healthscope Whirlpool |
$356.62
|
| Rate for Payer: Mclaren Commercial |
$330.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.53
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$176.70
|
|
|
Service Code
|
NDC 68180-722-04
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.69 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$159.03
|
| Rate for Payer: ASR ASR |
$171.40
|
| Rate for Payer: BCBS Trust/PPO |
$137.00
|
| Rate for Payer: BCN Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$141.36
|
| Rate for Payer: Cofinity Commercial |
$166.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.36
|
| Rate for Payer: Healthscope Commercial |
$176.70
|
| Rate for Payer: Healthscope Whirlpool |
$171.40
|
| Rate for Payer: Mclaren Commercial |
$159.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.50
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
IP
|
$11.61
|
|
|
Service Code
|
NDC 60687-699-11
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Aetna Commercial |
$10.45
|
| Rate for Payer: ASR ASR |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$9.00
|
| Rate for Payer: BCN Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$10.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$11.61
|
| Rate for Payer: Healthscope Whirlpool |
$11.26
|
| Rate for Payer: Mclaren Commercial |
$10.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.22
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
IP
|
$348.32
|
|
|
Service Code
|
NDC 60687-699-21
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.82 |
| Max. Negotiated Rate |
$348.32 |
| Rate for Payer: Aetna Commercial |
$313.49
|
| Rate for Payer: ASR ASR |
$337.87
|
| Rate for Payer: BCBS Trust/PPO |
$270.05
|
| Rate for Payer: BCN Commercial |
$270.05
|
| Rate for Payer: Cash Price |
$278.65
|
| Rate for Payer: Cofinity Commercial |
$327.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.66
|
| Rate for Payer: Healthscope Commercial |
$348.32
|
| Rate for Payer: Healthscope Whirlpool |
$337.87
|
| Rate for Payer: Mclaren Commercial |
$313.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$296.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.52
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$22.94
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.94 |
| Rate for Payer: Aetna Commercial |
$20.65
|
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna Commercial |
$15.62
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: ASR ASR |
$22.25
|
| Rate for Payer: ASR ASR |
$16.83
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: ASR ASR |
$17.54
|
| Rate for Payer: BCBS Trust/PPO |
$13.45
|
| Rate for Payer: BCBS Trust/PPO |
$13.43
|
| Rate for Payer: BCBS Trust/PPO |
$17.79
|
| Rate for Payer: BCBS Trust/PPO |
$14.02
|
| Rate for Payer: BCN Commercial |
$14.02
|
| Rate for Payer: BCN Commercial |
$13.43
|
| Rate for Payer: BCN Commercial |
$17.79
|
| Rate for Payer: BCN Commercial |
$13.45
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cash Price |
$18.35
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Cofinity Commercial |
$21.56
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Cofinity Commercial |
$16.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$17.35
|
| Rate for Payer: Healthscope Commercial |
$18.08
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Whirlpool |
$17.54
|
| Rate for Payer: Healthscope Whirlpool |
$16.83
|
| Rate for Payer: Healthscope Whirlpool |
$22.25
|
| Rate for Payer: Healthscope Whirlpool |
$16.80
|
| Rate for Payer: Mclaren Commercial |
$20.65
|
| Rate for Payer: Mclaren Commercial |
$15.62
|
| Rate for Payer: Mclaren Commercial |
$16.27
|
| Rate for Payer: Mclaren Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.19
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$19.58
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna Commercial |
$29.18
|
| Rate for Payer: ASR ASR |
$31.45
|
| Rate for Payer: ASR ASR |
$18.99
|
| Rate for Payer: BCBS Trust/PPO |
$25.14
|
| Rate for Payer: BCBS Trust/PPO |
$15.18
|
| Rate for Payer: BCN Commercial |
$15.18
|
| Rate for Payer: BCN Commercial |
$25.14
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cofinity Commercial |
$30.47
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$32.42
|
| Rate for Payer: Healthscope Whirlpool |
$31.45
|
| Rate for Payer: Healthscope Whirlpool |
$18.99
|
| Rate for Payer: Mclaren Commercial |
$17.62
|
| Rate for Payer: Mclaren Commercial |
$29.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.23
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION
|
Facility
IP
|
$24.12
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
150848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$24.12 |
| Rate for Payer: Aetna Commercial |
$21.71
|
| Rate for Payer: ASR ASR |
$23.40
|
| Rate for Payer: BCBS Trust/PPO |
$18.70
|
| Rate for Payer: BCN Commercial |
$18.70
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Healthscope Whirlpool |
$23.40
|
| Rate for Payer: Mclaren Commercial |
$21.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.23
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$13.27
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$13.27 |
| Rate for Payer: Aetna Commercial |
$11.94
|
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna Commercial |
$26.30
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$23.29
|
| Rate for Payer: Aetna Commercial |
$13.35
|
| Rate for Payer: Aetna Commercial |
$21.71
|
| Rate for Payer: ASR ASR |
$23.40
|
| Rate for Payer: ASR ASR |
$12.87
|
| Rate for Payer: ASR ASR |
$14.39
|
| Rate for Payer: ASR ASR |
$18.31
|
| Rate for Payer: ASR ASR |
$25.10
|
| Rate for Payer: ASR ASR |
$28.34
|
| Rate for Payer: ASR ASR |
$25.38
|
| Rate for Payer: BCBS Trust/PPO |
$22.65
|
| Rate for Payer: BCBS Trust/PPO |
$18.70
|
| Rate for Payer: BCBS Trust/PPO |
$10.29
|
| Rate for Payer: BCBS Trust/PPO |
$14.64
|
| Rate for Payer: BCBS Trust/PPO |
$20.06
|
| Rate for Payer: BCBS Trust/PPO |
$20.28
|
| Rate for Payer: BCBS Trust/PPO |
$11.50
|
| Rate for Payer: BCN Commercial |
$20.28
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: BCN Commercial |
$10.29
|
| Rate for Payer: BCN Commercial |
$18.70
|
| Rate for Payer: BCN Commercial |
$20.06
|
| Rate for Payer: BCN Commercial |
$11.50
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cofinity Commercial |
$24.33
|
| Rate for Payer: Cofinity Commercial |
$27.47
|
| Rate for Payer: Cofinity Commercial |
$24.59
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$12.47
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Healthscope Commercial |
$25.88
|
| Rate for Payer: Healthscope Commercial |
$29.22
|
| Rate for Payer: Healthscope Whirlpool |
$25.38
|
| Rate for Payer: Healthscope Whirlpool |
$28.34
|
| Rate for Payer: Healthscope Whirlpool |
$23.40
|
| Rate for Payer: Healthscope Whirlpool |
$12.87
|
| Rate for Payer: Healthscope Whirlpool |
$14.39
|
| Rate for Payer: Healthscope Whirlpool |
$18.31
|
| Rate for Payer: Healthscope Whirlpool |
$25.10
|
| Rate for Payer: Mclaren Commercial |
$26.30
|
| Rate for Payer: Mclaren Commercial |
$23.29
|
| Rate for Payer: Mclaren Commercial |
$11.94
|
| Rate for Payer: Mclaren Commercial |
$21.71
|
| Rate for Payer: Mclaren Commercial |
$13.35
|
| Rate for Payer: Mclaren Commercial |
$23.54
|
| Rate for Payer: Mclaren Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.02
|
|
