|
CEFTRIAXONE 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$25.45
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$25.45 |
| Rate for Payer: Aetna Commercial |
$22.90
|
| Rate for Payer: ASR ASR |
$24.68
|
| Rate for Payer: BCBS Trust/PPO |
$20.90
|
| Rate for Payer: BCN Commercial |
$20.90
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$23.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$24.68
|
| Rate for Payer: Healthscope Whirlpool |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$22.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.63
|
| Rate for Payer: Nomi Health Commercial |
$20.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.39
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$25.45
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$25.45 |
| Rate for Payer: Aetna Commercial |
$22.90
|
| Rate for Payer: Aetna Medicare |
$9.42
|
| Rate for Payer: ASR ASR |
$24.68
|
| Rate for Payer: BCBS Complete |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$20.98
|
| Rate for Payer: BCN Commercial |
$20.98
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$23.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$24.68
|
| Rate for Payer: Healthscope Whirlpool |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$22.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.63
|
| Rate for Payer: Nomi Health Commercial |
$20.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.48
|
| Rate for Payer: Priority Health Narrow Network |
$0.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.39
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$4.74
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$4.74 |
| Rate for Payer: Aetna Commercial |
$4.27
|
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: Aetna Commercial |
$10.77
|
| Rate for Payer: Aetna Medicare |
$4.43
|
| Rate for Payer: Aetna Medicare |
$1.75
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: ASR ASR |
$2.99
|
| Rate for Payer: ASR ASR |
$2.94
|
| Rate for Payer: ASR ASR |
$11.61
|
| Rate for Payer: ASR ASR |
$4.60
|
| Rate for Payer: BCBS Complete |
$1.23
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.54
|
| Rate for Payer: BCBS Trust/PPO |
$9.87
|
| Rate for Payer: BCN Commercial |
$3.91
|
| Rate for Payer: BCN Commercial |
$2.54
|
| Rate for Payer: BCN Commercial |
$9.87
|
| Rate for Payer: BCN Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$9.58
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$9.58
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.47
|
| Rate for Payer: Healthscope Commercial |
$4.60
|
| Rate for Payer: Healthscope Commercial |
$11.61
|
| Rate for Payer: Healthscope Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Healthscope Whirlpool |
$11.97
|
| Rate for Payer: Healthscope Whirlpool |
$3.08
|
| Rate for Payer: Healthscope Whirlpool |
$4.74
|
| Rate for Payer: Healthscope Whirlpool |
$3.03
|
| Rate for Payer: Mclaren Commercial |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$2.73
|
| Rate for Payer: Mclaren Commercial |
$10.77
|
| Rate for Payer: Mclaren Commercial |
$4.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.03
|
| Rate for Payer: Nomi Health Commercial |
$9.82
|
| Rate for Payer: Nomi Health Commercial |
$2.53
|
| Rate for Payer: Nomi Health Commercial |
$3.89
|
| Rate for Payer: Nomi Health Commercial |
$2.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.48
|
| Rate for Payer: Priority Health Narrow Network |
$0.38
|
| Rate for Payer: Priority Health Narrow Network |
$0.38
|
| Rate for Payer: Priority Health Narrow Network |
$0.38
|
| Rate for Payer: Priority Health Narrow Network |
$0.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.67
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna Commercial |
$4.27
|
| Rate for Payer: Aetna Commercial |
$10.77
|
| Rate for Payer: ASR ASR |
$4.60
|
| Rate for Payer: ASR ASR |
$2.99
|
| Rate for Payer: ASR ASR |
$2.94
|
| Rate for Payer: ASR ASR |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.83
|
| Rate for Payer: BCBS Trust/PPO |
$2.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$9.83
|
| Rate for Payer: BCN Commercial |
$3.89
|
| Rate for Payer: BCN Commercial |
$2.49
|
| Rate for Payer: BCN Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cash Price |
$9.58
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.58
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$11.61
|
| Rate for Payer: Healthscope Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$4.60
|
| Rate for Payer: Healthscope Whirlpool |
$3.08
|
| Rate for Payer: Healthscope Whirlpool |
$4.74
|
| Rate for Payer: Healthscope Whirlpool |
$11.97
|
| Rate for Payer: Healthscope Whirlpool |
$3.03
|
| Rate for Payer: Mclaren Commercial |
$10.77
|
| Rate for Payer: Mclaren Commercial |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$2.73
|
| Rate for Payer: Mclaren Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.17
|
| Rate for Payer: Nomi Health Commercial |
$2.49
|
| Rate for Payer: Nomi Health Commercial |
$3.89
|
| Rate for Payer: Nomi Health Commercial |
$2.53
|
| Rate for Payer: Nomi Health Commercial |
$9.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.17
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$3,464.31
|
|
|
Service Code
|
NDC 25152031
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,598.23 |
| Max. Negotiated Rate |
$3,464.31 |
| Rate for Payer: Aetna Commercial |
$3,117.88
|
| Rate for Payer: ASR ASR |
$3,360.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,844.89
|
| Rate for Payer: BCN Commercial |
$2,844.89
|
| Rate for Payer: Cash Price |
$2,771.45
|
| Rate for Payer: Cofinity Commercial |
$3,256.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,771.45
|
| Rate for Payer: Healthscope Commercial |
$3,360.38
|
| Rate for Payer: Healthscope Whirlpool |
$3,464.31
|
| Rate for Payer: Mclaren Commercial |
$3,117.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,944.66
|
| Rate for Payer: Nomi Health Commercial |
$2,840.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,598.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,048.59
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$345.10
|
|
|
Service Code
|
NDC 25152034
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.82 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: ASR ASR |
$334.75
|
| Rate for Payer: BCBS Trust/PPO |
$283.40
|
| Rate for Payer: BCN Commercial |
$283.40
|
| Rate for Payer: Cash Price |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$324.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.08
|
| Rate for Payer: Healthscope Commercial |
$334.75
|
| Rate for Payer: Healthscope Whirlpool |
$345.10
|
| Rate for Payer: Mclaren Commercial |
$310.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.33
|
| Rate for Payer: Nomi Health Commercial |
$282.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.69
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$3.13
|
|
|
Service Code
|
NDC 50268016811
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna Medicare |
$1.16
|
| Rate for Payer: ASR ASR |
$3.04
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.58
|
| Rate for Payer: BCN Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Healthscope Whirlpool |
$3.13
|
| Rate for Payer: Mclaren Commercial |
$2.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: Nomi Health Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.74
|
| Rate for Payer: Priority Health Narrow Network |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.75
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$156.48
|
|
|
Service Code
|
NDC 50268016815
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.36 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$140.83
|
| Rate for Payer: ASR ASR |
$151.79
|
| Rate for Payer: BCBS Trust/PPO |
$128.50
|
| Rate for Payer: BCN Commercial |
$128.50
|
| Rate for Payer: Cash Price |
$125.18
|
| Rate for Payer: Cofinity Commercial |
$147.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.18
|
| Rate for Payer: Healthscope Commercial |
$151.79
|
| Rate for Payer: Healthscope Whirlpool |
$156.48
|
| Rate for Payer: Mclaren Commercial |
$140.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.01
|
| Rate for Payer: Nomi Health Commercial |
$128.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.70
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$345.10
|
|
|
Service Code
|
NDC 25152034
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.69 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$127.69
|
| Rate for Payer: ASR ASR |
$334.75
|
| Rate for Payer: BCBS Complete |
$138.04
|
| Rate for Payer: BCBS Trust/PPO |
$284.53
|
| Rate for Payer: BCN Commercial |
$284.53
|
| Rate for Payer: Cash Price |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$324.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.08
|
| Rate for Payer: Healthscope Commercial |
$334.75
|
| Rate for Payer: Healthscope Whirlpool |
$345.10
|
| Rate for Payer: Mclaren Commercial |
$310.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.33
|
| Rate for Payer: Nomi Health Commercial |
$282.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$302.38
|
| Rate for Payer: Priority Health Narrow Network |
$241.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.69
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.60 |
| Max. Negotiated Rate |
$277.30 |
| Rate for Payer: Aetna Commercial |
$249.57
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: ASR ASR |
$268.98
|
| Rate for Payer: BCBS Complete |
$110.92
|
| Rate for Payer: BCBS Trust/PPO |
$228.63
|
| Rate for Payer: BCN Commercial |
$228.63
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$260.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$268.98
|
| Rate for Payer: Healthscope Whirlpool |
$277.30
|
| Rate for Payer: Mclaren Commercial |
$249.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$242.97
|
| Rate for Payer: Priority Health Narrow Network |
$194.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.02
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$365.28
|
|
|
Service Code
|
NDC 904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$365.28 |
| Rate for Payer: Aetna Commercial |
$328.75
|
| Rate for Payer: Aetna Medicare |
$135.15
|
| Rate for Payer: ASR ASR |
$354.32
|
| Rate for Payer: BCBS Complete |
$146.11
|
| Rate for Payer: BCBS Trust/PPO |
$301.17
|
| Rate for Payer: BCN Commercial |
$301.17
|
| Rate for Payer: Cash Price |
$292.22
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.22
|
| Rate for Payer: Healthscope Commercial |
$354.32
|
| Rate for Payer: Healthscope Whirlpool |
$365.28
|
| Rate for Payer: Mclaren Commercial |
$328.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$292.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: Nomi Health Commercial |
$299.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$320.06
|
| Rate for Payer: Priority Health Narrow Network |
$256.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.45
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$3,464.31
|
|
|
Service Code
|
NDC 25152031
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,281.79 |
| Max. Negotiated Rate |
$3,464.31 |
| Rate for Payer: Aetna Commercial |
$3,117.88
|
| Rate for Payer: Aetna Medicare |
$1,281.79
|
| Rate for Payer: ASR ASR |
$3,360.38
|
| Rate for Payer: BCBS Complete |
$1,385.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,856.32
|
| Rate for Payer: BCN Commercial |
$2,856.32
|
| Rate for Payer: Cash Price |
$2,771.45
|
| Rate for Payer: Cofinity Commercial |
$3,256.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,771.45
|
| Rate for Payer: Healthscope Commercial |
$3,360.38
|
| Rate for Payer: Healthscope Whirlpool |
$3,464.31
|
| Rate for Payer: Mclaren Commercial |
$3,117.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,771.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,944.66
|
| Rate for Payer: Nomi Health Commercial |
$2,840.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,598.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,035.43
|
| Rate for Payer: Priority Health Narrow Network |
$2,428.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,048.59
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.97 |
| Max. Negotiated Rate |
$277.30 |
| Rate for Payer: Aetna Commercial |
$249.57
|
| Rate for Payer: ASR ASR |
$268.98
|
| Rate for Payer: BCBS Trust/PPO |
$227.72
|
| Rate for Payer: BCN Commercial |
$227.72
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$260.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$268.98
|
| Rate for Payer: Healthscope Whirlpool |
$277.30
|
| Rate for Payer: Mclaren Commercial |
$249.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.02
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$156.48
|
|
|
Service Code
|
NDC 50268016815
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$140.83
|
| Rate for Payer: Aetna Medicare |
$57.90
|
| Rate for Payer: ASR ASR |
$151.79
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS Trust/PPO |
$129.02
|
| Rate for Payer: BCN Commercial |
$129.02
|
| Rate for Payer: Cash Price |
$125.18
|
| Rate for Payer: Cofinity Commercial |
$147.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.18
|
| Rate for Payer: Healthscope Commercial |
$151.79
|
| Rate for Payer: Healthscope Whirlpool |
$156.48
|
| Rate for Payer: Mclaren Commercial |
$140.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.01
|
| Rate for Payer: Nomi Health Commercial |
$128.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$137.11
|
| Rate for Payer: Priority Health Narrow Network |
$109.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.70
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$365.28
|
|
|
Service Code
|
NDC 904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.96 |
| Max. Negotiated Rate |
$365.28 |
| Rate for Payer: Aetna Commercial |
$328.75
|
| Rate for Payer: ASR ASR |
$354.32
|
| Rate for Payer: BCBS Trust/PPO |
$299.97
|
| Rate for Payer: BCN Commercial |
$299.97
|
| Rate for Payer: Cash Price |
$292.22
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.22
|
| Rate for Payer: Healthscope Commercial |
$354.32
|
| Rate for Payer: Healthscope Whirlpool |
$365.28
|
| Rate for Payer: Mclaren Commercial |
$328.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: Nomi Health Commercial |
$299.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.45
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$3.13
|
|
|
Service Code
|
NDC 50268016811
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: ASR ASR |
$3.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.57
|
| Rate for Payer: BCN Commercial |
$2.57
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Healthscope Whirlpool |
$3.13
|
| Rate for Payer: Mclaren Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: Nomi Health Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.75
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$9,059.79
|
|
|
Service Code
|
APR-DRG 3834
|
| Min. Negotiated Rate |
$8,191.14 |
| Max. Negotiated Rate |
$9,059.79 |
| Rate for Payer: BCBS Complete |
$9,059.79
|
| Rate for Payer: Mclaren Medicaid |
$8,628.38
|
| Rate for Payer: Meridian Medicaid |
$9,059.79
|
| Rate for Payer: PHP Medicaid |
$8,191.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,628.38
|
| Rate for Payer: UHC Medicaid |
$8,628.38
|
| Rate for Payer: UHCCP Medicaid |
$8,628.38
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$5,978.10
|
|
|
Service Code
|
APR-DRG 3833
|
| Min. Negotiated Rate |
$5,404.92 |
| Max. Negotiated Rate |
$5,978.10 |
| Rate for Payer: BCBS Complete |
$5,978.10
|
| Rate for Payer: Mclaren Medicaid |
$5,693.43
|
| Rate for Payer: Meridian Medicaid |
$5,978.10
|
| Rate for Payer: PHP Medicaid |
$5,404.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,693.43
|
| Rate for Payer: UHC Medicaid |
$5,693.43
|
| Rate for Payer: UHCCP Medicaid |
$5,693.43
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$3,100.22
|
|
|
Service Code
|
APR-DRG 3831
|
| Min. Negotiated Rate |
$2,802.97 |
| Max. Negotiated Rate |
$3,100.22 |
| Rate for Payer: BCBS Complete |
$3,100.22
|
| Rate for Payer: Mclaren Medicaid |
$2,952.59
|
| Rate for Payer: Meridian Medicaid |
$3,100.22
|
| Rate for Payer: PHP Medicaid |
$2,802.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,952.59
|
| Rate for Payer: UHC Medicaid |
$2,952.59
|
| Rate for Payer: UHCCP Medicaid |
$2,952.59
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$4,005.38
|
|
|
Service Code
|
APR-DRG 3832
|
| Min. Negotiated Rate |
$3,621.34 |
| Max. Negotiated Rate |
$4,005.38 |
| Rate for Payer: BCBS Complete |
$4,005.38
|
| Rate for Payer: Mclaren Medicaid |
$3,814.65
|
| Rate for Payer: Meridian Medicaid |
$4,005.38
|
| Rate for Payer: PHP Medicaid |
$3,621.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,814.65
|
| Rate for Payer: UHC Medicaid |
$3,814.65
|
| Rate for Payer: UHCCP Medicaid |
$3,814.65
|
|
|
CELLULITIS WITH MCC
|
Facility
|
IP
|
$19,526.96
|
|
|
Service Code
|
MSDRG 602
|
| Min. Negotiated Rate |
$11,390.11 |
| Max. Negotiated Rate |
$19,526.96 |
| Rate for Payer: Aetna Medicare |
$11,989.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,986.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,986.99
|
| Rate for Payer: BCBS MAPPO |
$11,989.59
|
| Rate for Payer: BCN Medicare Advantage |
$11,989.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,989.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,989.59
|
| Rate for Payer: Mclaren Medicare |
$11,989.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,589.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,788.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,188.55
|
| Rate for Payer: PACE Medicare |
$11,390.11
|
| Rate for Payer: PACE SWMI |
$11,989.59
|
| Rate for Payer: PHP Commercial |
$13,188.55
|
| Rate for Payer: PHP Medicare Advantage |
$11,989.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19,526.96
|
| Rate for Payer: Priority Health Medicare |
$11,989.59
|
| Rate for Payer: Priority Health Narrow Network |
$15,621.57
|
| Rate for Payer: Railroad Medicare Medicare |
$11,989.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,989.59
|
| Rate for Payer: UHC Exchange |
$18,583.86
|
| Rate for Payer: UHCCP DNSP |
$11,989.59
|
| Rate for Payer: VA VA |
$11,989.59
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
|
IP
|
$12,440.33
|
|
|
Service Code
|
MSDRG 603
|
| Min. Negotiated Rate |
$7,624.72 |
| Max. Negotiated Rate |
$12,440.33 |
| Rate for Payer: Aetna Medicare |
$8,026.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,032.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,032.52
|
| Rate for Payer: BCBS MAPPO |
$8,026.02
|
| Rate for Payer: BCN Medicare Advantage |
$8,026.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,026.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,026.02
|
| Rate for Payer: Mclaren Medicare |
$8,026.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,427.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,229.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,828.62
|
| Rate for Payer: PACE Medicare |
$7,624.72
|
| Rate for Payer: PACE SWMI |
$8,026.02
|
| Rate for Payer: PHP Commercial |
$8,828.62
|
| Rate for Payer: PHP Medicare Advantage |
$8,026.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,965.12
|
| Rate for Payer: Priority Health Medicare |
$8,026.02
|
| Rate for Payer: Priority Health Narrow Network |
$9,572.10
|
| Rate for Payer: Railroad Medicare Medicare |
$8,026.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,026.02
|
| Rate for Payer: UHC Exchange |
$12,440.33
|
| Rate for Payer: UHCCP DNSP |
$8,026.02
|
| Rate for Payer: VA VA |
$8,026.02
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
OP
|
$273.05
|
|
|
Service Code
|
NDC 9900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.03 |
| Max. Negotiated Rate |
$273.05 |
| Rate for Payer: Aetna Commercial |
$245.75
|
| Rate for Payer: Aetna Medicare |
$101.03
|
| Rate for Payer: ASR ASR |
$264.86
|
| Rate for Payer: BCBS Complete |
$109.22
|
| Rate for Payer: BCBS Trust/PPO |
$225.13
|
| Rate for Payer: BCN Commercial |
$225.13
|
| Rate for Payer: Cash Price |
$218.44
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.44
|
| Rate for Payer: Healthscope Commercial |
$264.86
|
| Rate for Payer: Healthscope Whirlpool |
$273.05
|
| Rate for Payer: Mclaren Commercial |
$245.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.10
|
| Rate for Payer: Nomi Health Commercial |
$223.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$239.25
|
| Rate for Payer: Priority Health Narrow Network |
$191.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.29
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
IP
|
$273.05
|
|
|
Service Code
|
NDC 9900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$204.79 |
| Max. Negotiated Rate |
$273.05 |
| Rate for Payer: Aetna Commercial |
$245.75
|
| Rate for Payer: ASR ASR |
$264.86
|
| Rate for Payer: BCBS Trust/PPO |
$224.23
|
| Rate for Payer: BCN Commercial |
$224.23
|
| Rate for Payer: Cash Price |
$218.44
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.44
|
| Rate for Payer: Healthscope Commercial |
$264.86
|
| Rate for Payer: Healthscope Whirlpool |
$273.05
|
| Rate for Payer: Mclaren Commercial |
$245.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.10
|
| Rate for Payer: Nomi Health Commercial |
$223.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.29
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.82
|
|
|
Service Code
|
NDC 9900000408
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: ASR ASR |
$4.67
|
| Rate for Payer: BCBS Trust/PPO |
$3.96
|
| Rate for Payer: BCN Commercial |
$3.96
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cofinity Commercial |
$4.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.85
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Healthscope Whirlpool |
$4.82
|
| Rate for Payer: Mclaren Commercial |
$4.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.10
|
| Rate for Payer: Nomi Health Commercial |
$3.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.24
|
|
