|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 904630161
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Medicare |
$69.56
|
| Rate for Payer: ASR ASR |
$182.36
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS Trust/PPO |
$155.01
|
| Rate for Payer: BCN Commercial |
$155.01
|
| 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 |
$182.36
|
| Rate for Payer: Healthscope Whirlpool |
$188.00
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$164.73
|
| Rate for Payer: Priority Health Narrow Network |
$131.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.44
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
NDC 51079093001
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna Commercial |
$1.93
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: ASR ASR |
$2.07
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$1.76
|
| Rate for Payer: BCN Commercial |
$1.76
|
| 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 |
$2.07
|
| Rate for Payer: Healthscope Whirlpool |
$2.14
|
| Rate for Payer: Mclaren Commercial |
$1.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Nomi Health Commercial |
$1.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.87
|
| Rate for Payer: Priority Health Narrow Network |
$1.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.88
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$61.10
|
|
|
Service Code
|
NDC 68382009301
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.83 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Aetna Commercial |
$54.99
|
| Rate for Payer: ASR ASR |
$59.27
|
| Rate for Payer: BCBS Trust/PPO |
$50.18
|
| Rate for Payer: BCN Commercial |
$50.18
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$57.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$59.27
|
| Rate for Payer: Healthscope Whirlpool |
$61.10
|
| Rate for Payer: Mclaren Commercial |
$54.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Nomi Health Commercial |
$50.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.77
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 904730661
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Aetna Medicare |
$68.69
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS Trust/PPO |
$153.07
|
| Rate for Payer: BCN Commercial |
$153.07
|
| 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 |
$180.08
|
| Rate for Payer: Healthscope Whirlpool |
$185.65
|
| Rate for Payer: Mclaren Commercial |
$167.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.67
|
| Rate for Payer: Priority Health Narrow Network |
$130.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.37
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$220.90
|
|
|
Service Code
|
NDC 43547025510
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.68 |
| 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 |
$181.40
|
| Rate for Payer: BCN Commercial |
$181.40
|
| 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 |
$214.27
|
| Rate for Payer: Healthscope Whirlpool |
$220.90
|
| Rate for Payer: Mclaren Commercial |
$198.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Nomi Health Commercial |
$181.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.39
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 904630161
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.00 |
| 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 |
$154.39
|
| Rate for Payer: BCN Commercial |
$154.39
|
| 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 |
$182.36
|
| Rate for Payer: Healthscope Whirlpool |
$188.00
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.44
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$61.10
|
|
|
Service Code
|
NDC 68382009301
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Aetna Commercial |
$54.99
|
| Rate for Payer: Aetna Medicare |
$22.61
|
| Rate for Payer: ASR ASR |
$59.27
|
| Rate for Payer: BCBS Complete |
$24.44
|
| Rate for Payer: BCBS Trust/PPO |
$50.38
|
| Rate for Payer: BCN Commercial |
$50.38
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$57.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$59.27
|
| Rate for Payer: Healthscope Whirlpool |
$61.10
|
| Rate for Payer: Mclaren Commercial |
$54.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Nomi Health Commercial |
$50.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$53.54
|
| Rate for Payer: Priority Health Narrow Network |
$42.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.77
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 904730661
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.24 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: BCBS Trust/PPO |
$152.46
|
| Rate for Payer: BCN Commercial |
$152.46
|
| 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 |
$180.08
|
| Rate for Payer: Healthscope Whirlpool |
$185.65
|
| Rate for Payer: Mclaren Commercial |
$167.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.37
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
NDC 51079093001
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna Commercial |
$1.93
|
| Rate for Payer: ASR ASR |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$1.76
|
| Rate for Payer: BCN Commercial |
$1.76
|
| 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 |
$2.07
|
| Rate for Payer: Healthscope Whirlpool |
$2.14
|
| Rate for Payer: Mclaren Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Nomi Health Commercial |
$1.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.88
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$220.90
|
|
|
Service Code
|
NDC 43547025510
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.73 |
| Max. Negotiated Rate |
$220.90 |
| Rate for Payer: Aetna Commercial |
$198.81
|
| Rate for Payer: Aetna Medicare |
$81.73
|
| Rate for Payer: ASR ASR |
$214.27
|
| Rate for Payer: BCBS Complete |
$88.36
|
| Rate for Payer: BCBS Trust/PPO |
$182.13
|
| Rate for Payer: BCN Commercial |
$182.13
|
| 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 |
$214.27
|
| Rate for Payer: Healthscope Whirlpool |
$220.90
|
| Rate for Payer: Mclaren Commercial |
$198.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Nomi Health Commercial |
$181.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$193.55
|
| Rate for Payer: Priority Health Narrow Network |
$154.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.39
|
|
|
CEFAZOLIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.10
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
27297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna Commercial |
$14.49
|
| Rate for Payer: Aetna Medicare |
$5.96
|
| Rate for Payer: ASR ASR |
$15.62
|
| Rate for Payer: BCBS Complete |
$6.44
|
| Rate for Payer: BCBS Trust/PPO |
$13.28
|
| Rate for Payer: BCN Commercial |
$13.28
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cofinity Commercial |
$15.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$15.62
|
| Rate for Payer: Healthscope Whirlpool |
$16.10
|
| Rate for Payer: Mclaren Commercial |
$14.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.69
|
| Rate for Payer: Nomi Health Commercial |
$13.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.86
|
| Rate for Payer: Priority Health Narrow Network |
$0.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.17
|
|
|
CEFAZOLIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.10
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
27297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.08 |
| 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 |
$13.22
|
| Rate for Payer: BCN Commercial |
$13.22
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cofinity Commercial |
$15.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$15.62
|
| Rate for Payer: Healthscope Whirlpool |
$16.10
|
| Rate for Payer: Mclaren Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.69
|
| Rate for Payer: Nomi Health Commercial |
$13.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.17
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$14.43 |
| Rate for Payer: Aetna Commercial |
$12.98
|
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: ASR ASR |
$18.85
|
| Rate for Payer: ASR ASR |
$13.99
|
| Rate for Payer: ASR ASR |
$13.80
|
| Rate for Payer: ASR ASR |
$12.36
|
| Rate for Payer: BCBS Trust/PPO |
$11.85
|
| Rate for Payer: BCBS Trust/PPO |
$10.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.96
|
| Rate for Payer: BCN Commercial |
$10.47
|
| Rate for Payer: BCN Commercial |
$15.96
|
| Rate for Payer: BCN Commercial |
$11.68
|
| Rate for Payer: BCN Commercial |
$11.85
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$11.98
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.20
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$12.36
|
| Rate for Payer: Healthscope Commercial |
$13.80
|
| Rate for Payer: Healthscope Commercial |
$18.85
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Healthscope Whirlpool |
$19.43
|
| Rate for Payer: Healthscope Whirlpool |
$12.75
|
| Rate for Payer: Healthscope Whirlpool |
$14.22
|
| Rate for Payer: Mclaren Commercial |
$11.47
|
| Rate for Payer: Mclaren Commercial |
$17.49
|
| Rate for Payer: Mclaren Commercial |
$12.80
|
| Rate for Payer: Mclaren Commercial |
$12.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.83
|
| Rate for Payer: Nomi Health Commercial |
$11.66
|
| Rate for Payer: Nomi Health Commercial |
$15.93
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Nomi Health Commercial |
$10.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.10
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$19.43
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna Commercial |
$12.98
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Medicare |
$4.72
|
| Rate for Payer: Aetna Medicare |
$7.19
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: ASR ASR |
$13.99
|
| Rate for Payer: ASR ASR |
$13.80
|
| Rate for Payer: ASR ASR |
$12.36
|
| Rate for Payer: ASR ASR |
$18.85
|
| Rate for Payer: BCBS Complete |
$5.77
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS Complete |
$7.77
|
| Rate for Payer: BCBS Complete |
$5.69
|
| Rate for Payer: BCBS Trust/PPO |
$11.73
|
| Rate for Payer: BCBS Trust/PPO |
$16.02
|
| Rate for Payer: BCBS Trust/PPO |
$11.89
|
| Rate for Payer: BCBS Trust/PPO |
$10.51
|
| Rate for Payer: BCN Commercial |
$16.02
|
| Rate for Payer: BCN Commercial |
$11.89
|
| Rate for Payer: BCN Commercial |
$10.51
|
| Rate for Payer: BCN Commercial |
$11.73
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$11.98
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$18.85
|
| Rate for Payer: Healthscope Commercial |
$12.36
|
| Rate for Payer: Healthscope Commercial |
$13.80
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Whirlpool |
$12.75
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Healthscope Whirlpool |
$19.43
|
| Rate for Payer: Healthscope Whirlpool |
$14.22
|
| Rate for Payer: Mclaren Commercial |
$12.98
|
| Rate for Payer: Mclaren Commercial |
$12.80
|
| Rate for Payer: Mclaren Commercial |
$11.47
|
| Rate for Payer: Mclaren Commercial |
$17.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Nomi Health Commercial |
$10.45
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Nomi Health Commercial |
$15.93
|
| Rate for Payer: Nomi Health Commercial |
$11.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.86
|
| Rate for Payer: Priority Health Narrow Network |
$0.69
|
| Rate for Payer: Priority Health Narrow Network |
$0.69
|
| Rate for Payer: Priority Health Narrow Network |
$0.69
|
| Rate for Payer: Priority Health Narrow Network |
$0.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.52
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
OP
|
$14.23
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: ASR ASR |
$13.80
|
| Rate for Payer: BCBS Complete |
$5.69
|
| Rate for Payer: BCBS Trust/PPO |
$11.73
|
| Rate for Payer: BCN Commercial |
$11.73
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.38
|
| Rate for Payer: Healthscope Commercial |
$13.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.22
|
| Rate for Payer: Mclaren Commercial |
$12.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.09
|
| Rate for Payer: Nomi Health Commercial |
$11.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.86
|
| Rate for Payer: Priority Health Narrow Network |
$0.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.52
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
IP
|
$14.23
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: ASR ASR |
$13.80
|
| Rate for Payer: BCBS Trust/PPO |
$11.68
|
| Rate for Payer: BCN Commercial |
$11.68
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.38
|
| Rate for Payer: Healthscope Commercial |
$13.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.22
|
| Rate for Payer: Mclaren Commercial |
$12.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.09
|
| Rate for Payer: Nomi Health Commercial |
$11.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.52
|
|
|
CEFAZOLIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.48
|
|
|
Service Code
|
HCPCS J0688
|
| Hospital Charge Code |
203261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: ASR ASR |
$20.83
|
| Rate for Payer: BCBS Trust/PPO |
$17.64
|
| Rate for Payer: BCN Commercial |
$17.64
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Whirlpool |
$21.48
|
| Rate for Payer: Mclaren Commercial |
$19.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.90
|
|
|
CEFAZOLIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.48
|
|
|
Service Code
|
HCPCS J0688
|
| Hospital Charge Code |
203261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: ASR ASR |
$20.83
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.71
|
| Rate for Payer: BCN Commercial |
$17.71
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Whirlpool |
$21.48
|
| Rate for Payer: Mclaren Commercial |
$19.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.91
|
| Rate for Payer: Priority Health Narrow Network |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.90
|
|
|
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 |
$13.97 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: ASR ASR |
$18.07
|
| Rate for Payer: BCBS Trust/PPO |
$15.29
|
| Rate for Payer: BCN Commercial |
$15.29
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$17.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$18.07
|
| Rate for Payer: Healthscope Whirlpool |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.83
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.39
|
|
|
CEFAZOLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$18.62
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
199467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna Medicare |
$6.89
|
| Rate for Payer: ASR ASR |
$18.07
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$15.36
|
| Rate for Payer: BCN Commercial |
$15.36
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$17.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$18.07
|
| Rate for Payer: Healthscope Whirlpool |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$16.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.83
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.86
|
| Rate for Payer: Priority Health Narrow Network |
$0.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.39
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 68180072205
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.01 |
| 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 |
$181.77
|
| Rate for Payer: BCN Commercial |
$181.77
|
| 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 |
$214.71
|
| Rate for Payer: Healthscope Whirlpool |
$221.35
|
| Rate for Payer: Mclaren Commercial |
$199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.79
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$176.70
|
|
|
Service Code
|
NDC 68180072204
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.53 |
| 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 |
$145.11
|
| Rate for Payer: BCN Commercial |
$145.11
|
| 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 |
$171.40
|
| Rate for Payer: Healthscope Whirlpool |
$176.70
|
| Rate for Payer: Mclaren Commercial |
$159.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.19
|
| Rate for Payer: Nomi Health Commercial |
$144.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.50
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$221.37
|
|
|
Service Code
|
NDC 67877054798
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.03 |
| Max. Negotiated Rate |
$221.37 |
| Rate for Payer: Aetna Commercial |
$199.23
|
| Rate for Payer: ASR ASR |
$214.73
|
| Rate for Payer: BCBS Trust/PPO |
$181.79
|
| Rate for Payer: BCN Commercial |
$181.79
|
| Rate for Payer: Cash Price |
$177.10
|
| Rate for Payer: Cofinity Commercial |
$208.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.10
|
| Rate for Payer: Healthscope Commercial |
$214.73
|
| Rate for Payer: Healthscope Whirlpool |
$221.37
|
| Rate for Payer: Mclaren Commercial |
$199.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.16
|
| Rate for Payer: Nomi Health Commercial |
$181.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.81
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$221.37
|
|
|
Service Code
|
NDC 67877054798
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.91 |
| Max. Negotiated Rate |
$221.37 |
| Rate for Payer: Aetna Commercial |
$199.23
|
| Rate for Payer: Aetna Medicare |
$81.91
|
| Rate for Payer: ASR ASR |
$214.73
|
| Rate for Payer: BCBS Complete |
$88.55
|
| Rate for Payer: BCBS Trust/PPO |
$182.52
|
| Rate for Payer: BCN Commercial |
$182.52
|
| Rate for Payer: Cash Price |
$177.10
|
| Rate for Payer: Cofinity Commercial |
$208.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.10
|
| Rate for Payer: Healthscope Commercial |
$214.73
|
| Rate for Payer: Healthscope Whirlpool |
$221.37
|
| Rate for Payer: Mclaren Commercial |
$199.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.16
|
| Rate for Payer: Nomi Health Commercial |
$181.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$193.96
|
| Rate for Payer: Priority Health Narrow Network |
$155.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.81
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$291.40
|
|
|
Service Code
|
NDC 67877054788
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.82 |
| Max. Negotiated Rate |
$291.40 |
| Rate for Payer: Aetna Commercial |
$262.26
|
| Rate for Payer: Aetna Medicare |
$107.82
|
| Rate for Payer: ASR ASR |
$282.66
|
| Rate for Payer: BCBS Complete |
$116.56
|
| Rate for Payer: BCBS Trust/PPO |
$240.26
|
| Rate for Payer: BCN Commercial |
$240.26
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$273.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$282.66
|
| Rate for Payer: Healthscope Whirlpool |
$291.40
|
| Rate for Payer: Mclaren Commercial |
$262.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$238.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$255.32
|
| Rate for Payer: Priority Health Narrow Network |
$204.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.43
|
|
