|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 67877054488
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.17 |
| Max. Negotiated Rate |
$195.05 |
| Rate for Payer: Aetna Commercial |
$175.54
|
| Rate for Payer: Aetna Medicare |
$72.17
|
| Rate for Payer: ASR ASR |
$189.20
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: BCBS Trust/PPO |
$160.82
|
| Rate for Payer: BCN Commercial |
$160.82
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$183.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$189.20
|
| Rate for Payer: Healthscope Whirlpool |
$195.05
|
| Rate for Payer: Mclaren Commercial |
$175.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$170.90
|
| Rate for Payer: Priority Health Narrow Network |
$136.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.64
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$242.05
|
|
|
Service Code
|
NDC 68180044001
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.54 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$217.84
|
| Rate for Payer: ASR ASR |
$234.79
|
| Rate for Payer: BCBS Trust/PPO |
$198.77
|
| Rate for Payer: BCN Commercial |
$198.77
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$227.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Healthscope Commercial |
$234.79
|
| Rate for Payer: Healthscope Whirlpool |
$242.05
|
| Rate for Payer: Mclaren Commercial |
$217.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.74
|
| Rate for Payer: Nomi Health Commercial |
$198.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.00
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.82
|
|
|
Service Code
|
NDC 9900000408
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: ASR ASR |
$4.67
|
| Rate for Payer: BCBS Complete |
$1.93
|
| Rate for Payer: BCBS Trust/PPO |
$3.97
|
| Rate for Payer: BCN Commercial |
$3.97
|
| 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: MI Amish Medical Board Commercial |
$3.85
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.22
|
| Rate for Payer: Priority Health Narrow Network |
$3.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.24
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$415.95
|
|
|
Service Code
|
NDC 93417573
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$415.95 |
| Rate for Payer: Aetna Commercial |
$374.36
|
| Rate for Payer: Aetna Medicare |
$153.90
|
| Rate for Payer: ASR ASR |
$403.47
|
| Rate for Payer: BCBS Complete |
$166.38
|
| Rate for Payer: BCBS Trust/PPO |
$342.95
|
| Rate for Payer: BCN Commercial |
$342.95
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cofinity Commercial |
$390.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
| Rate for Payer: Healthscope Commercial |
$403.47
|
| Rate for Payer: Healthscope Whirlpool |
$415.95
|
| Rate for Payer: Mclaren Commercial |
$374.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: Nomi Health Commercial |
$341.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$364.46
|
| Rate for Payer: Priority Health Narrow Network |
$291.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.04
|
|
|
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
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$242.05
|
|
|
Service Code
|
NDC 68180044001
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.56 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$217.84
|
| Rate for Payer: Aetna Medicare |
$89.56
|
| Rate for Payer: ASR ASR |
$234.79
|
| Rate for Payer: BCBS Complete |
$96.82
|
| Rate for Payer: BCBS Trust/PPO |
$199.57
|
| Rate for Payer: BCN Commercial |
$199.57
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$227.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Healthscope Commercial |
$234.79
|
| Rate for Payer: Healthscope Whirlpool |
$242.05
|
| Rate for Payer: Mclaren Commercial |
$217.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.74
|
| Rate for Payer: Nomi Health Commercial |
$198.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$212.08
|
| Rate for Payer: Priority Health Narrow Network |
$169.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.00
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 67877054488
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.29 |
| Max. Negotiated Rate |
$195.05 |
| Rate for Payer: Aetna Commercial |
$175.54
|
| Rate for Payer: ASR ASR |
$189.20
|
| Rate for Payer: BCBS Trust/PPO |
$160.18
|
| Rate for Payer: BCN Commercial |
$160.18
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$183.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$189.20
|
| Rate for Payer: Healthscope Whirlpool |
$195.05
|
| Rate for Payer: Mclaren Commercial |
$175.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.64
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
NDC 67877054588
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.34 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Aetna Medicare |
$104.34
|
| Rate for Payer: ASR ASR |
$273.54
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS Trust/PPO |
$232.51
|
| Rate for Payer: BCN Commercial |
$232.51
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$265.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$273.54
|
| Rate for Payer: Healthscope Whirlpool |
$282.00
|
| Rate for Payer: Mclaren Commercial |
$253.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$247.09
|
| Rate for Payer: Priority Health Narrow Network |
$197.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.16
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$354.85
|
|
|
Service Code
|
NDC 68180044101
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.14 |
| Max. Negotiated Rate |
$354.85 |
| Rate for Payer: Aetna Commercial |
$319.37
|
| Rate for Payer: ASR ASR |
$344.20
|
| Rate for Payer: BCBS Trust/PPO |
$291.40
|
| Rate for Payer: BCN Commercial |
$291.40
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Commercial |
$333.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$344.20
|
| Rate for Payer: Healthscope Whirlpool |
$354.85
|
| Rate for Payer: Mclaren Commercial |
$319.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: Nomi Health Commercial |
$290.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.27
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
NDC 67877054588
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: ASR ASR |
$273.54
|
| Rate for Payer: BCBS Trust/PPO |
$231.58
|
| Rate for Payer: BCN Commercial |
$231.58
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$265.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$273.54
|
| Rate for Payer: Healthscope Whirlpool |
$282.00
|
| Rate for Payer: Mclaren Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.16
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$354.85
|
|
|
Service Code
|
NDC 68180044101
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.29 |
| Max. Negotiated Rate |
$354.85 |
| Rate for Payer: Aetna Commercial |
$319.37
|
| Rate for Payer: Aetna Medicare |
$131.29
|
| Rate for Payer: ASR ASR |
$344.20
|
| Rate for Payer: BCBS Complete |
$141.94
|
| Rate for Payer: BCBS Trust/PPO |
$292.57
|
| Rate for Payer: BCN Commercial |
$292.57
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Commercial |
$333.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$344.20
|
| Rate for Payer: Healthscope Whirlpool |
$354.85
|
| Rate for Payer: Mclaren Commercial |
$319.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: Nomi Health Commercial |
$290.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$310.92
|
| Rate for Payer: Priority Health Narrow Network |
$248.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.27
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
NDC 60687015211
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: ASR ASR |
$2.78
|
| Rate for Payer: BCBS Complete |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.78
|
| Rate for Payer: Healthscope Whirlpool |
$2.87
|
| Rate for Payer: Mclaren Commercial |
$2.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.51
|
| Rate for Payer: Priority Health Narrow Network |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.52
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$262.20
|
|
|
Service Code
|
NDC 904733661
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$235.98
|
| Rate for Payer: ASR ASR |
$254.33
|
| Rate for Payer: BCBS Trust/PPO |
$215.32
|
| Rate for Payer: BCN Commercial |
$215.32
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Commercial |
$246.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$254.33
|
| Rate for Payer: Healthscope Whirlpool |
$262.20
|
| Rate for Payer: Mclaren Commercial |
$235.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Nomi Health Commercial |
$215.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.74
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
NDC 50268015111
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: ASR ASR |
$2.80
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCN Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Healthscope Whirlpool |
$2.89
|
| Rate for Payer: Mclaren Commercial |
$2.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.53
|
| Rate for Payer: Priority Health Narrow Network |
$2.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.54
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 50268015111
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: ASR ASR |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Healthscope Whirlpool |
$2.89
|
| Rate for Payer: Mclaren Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.54
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 93314501
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.79 |
| Max. Negotiated Rate |
$289.05 |
| Rate for Payer: Aetna Commercial |
$260.14
|
| Rate for Payer: ASR ASR |
$280.38
|
| Rate for Payer: BCBS Trust/PPO |
$237.37
|
| Rate for Payer: BCN Commercial |
$237.37
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$271.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$280.38
|
| Rate for Payer: Healthscope Whirlpool |
$289.05
|
| Rate for Payer: Mclaren Commercial |
$260.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Nomi Health Commercial |
$237.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.36
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$2.87
|
|
|
Service Code
|
NDC 60687015211
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: ASR ASR |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.78
|
| Rate for Payer: Healthscope Whirlpool |
$2.87
|
| Rate for Payer: Mclaren Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.52
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$144.40
|
|
|
Service Code
|
NDC 50268015115
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.30 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna Commercial |
$129.96
|
| Rate for Payer: ASR ASR |
$140.07
|
| Rate for Payer: BCBS Trust/PPO |
$118.58
|
| Rate for Payer: BCN Commercial |
$118.58
|
| Rate for Payer: Cash Price |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$135.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.52
|
| Rate for Payer: Healthscope Commercial |
$140.07
|
| Rate for Payer: Healthscope Whirlpool |
$144.40
|
| Rate for Payer: Mclaren Commercial |
$129.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.74
|
| Rate for Payer: Nomi Health Commercial |
$118.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.07
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$286.90
|
|
|
Service Code
|
NDC 60687015201
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.15 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Aetna Commercial |
$258.21
|
| Rate for Payer: Aetna Medicare |
$106.15
|
| Rate for Payer: ASR ASR |
$278.29
|
| Rate for Payer: BCBS Complete |
$114.76
|
| Rate for Payer: BCBS Trust/PPO |
$236.55
|
| Rate for Payer: BCN Commercial |
$236.55
|
| Rate for Payer: Cash Price |
$229.52
|
| Rate for Payer: Cofinity Commercial |
$269.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.52
|
| Rate for Payer: Healthscope Commercial |
$278.29
|
| Rate for Payer: Healthscope Whirlpool |
$286.90
|
| Rate for Payer: Mclaren Commercial |
$258.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.87
|
| Rate for Payer: Nomi Health Commercial |
$235.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$251.38
|
| Rate for Payer: Priority Health Narrow Network |
$201.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.47
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$286.90
|
|
|
Service Code
|
NDC 60687015201
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.18 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Aetna Commercial |
$258.21
|
| Rate for Payer: ASR ASR |
$278.29
|
| Rate for Payer: BCBS Trust/PPO |
$235.60
|
| Rate for Payer: BCN Commercial |
$235.60
|
| Rate for Payer: Cash Price |
$229.52
|
| Rate for Payer: Cofinity Commercial |
$269.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.52
|
| Rate for Payer: Healthscope Commercial |
$278.29
|
| Rate for Payer: Healthscope Whirlpool |
$286.90
|
| Rate for Payer: Mclaren Commercial |
$258.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.87
|
| Rate for Payer: Nomi Health Commercial |
$235.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.47
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$262.20
|
|
|
Service Code
|
NDC 904733661
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$235.98
|
| Rate for Payer: Aetna Medicare |
$97.01
|
| Rate for Payer: ASR ASR |
$254.33
|
| Rate for Payer: BCBS Complete |
$104.88
|
| Rate for Payer: BCBS Trust/PPO |
$216.18
|
| Rate for Payer: BCN Commercial |
$216.18
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Commercial |
$246.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$254.33
|
| Rate for Payer: Healthscope Whirlpool |
$262.20
|
| Rate for Payer: Mclaren Commercial |
$235.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Nomi Health Commercial |
$215.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$229.74
|
| Rate for Payer: Priority Health Narrow Network |
$183.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.74
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$144.40
|
|
|
Service Code
|
NDC 50268015115
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna Commercial |
$129.96
|
| Rate for Payer: Aetna Medicare |
$53.43
|
| Rate for Payer: ASR ASR |
$140.07
|
| Rate for Payer: BCBS Complete |
$57.76
|
| Rate for Payer: BCBS Trust/PPO |
$119.06
|
| Rate for Payer: BCN Commercial |
$119.06
|
| Rate for Payer: Cash Price |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$135.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.52
|
| Rate for Payer: Healthscope Commercial |
$140.07
|
| Rate for Payer: Healthscope Whirlpool |
$144.40
|
| Rate for Payer: Mclaren Commercial |
$129.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.74
|
| Rate for Payer: Nomi Health Commercial |
$118.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$126.52
|
| Rate for Payer: Priority Health Narrow Network |
$101.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.07
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$289.05
|
|
|
Service Code
|
NDC 93314501
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$289.05 |
| Rate for Payer: Aetna Commercial |
$260.14
|
| Rate for Payer: Aetna Medicare |
$106.95
|
| Rate for Payer: ASR ASR |
$280.38
|
| Rate for Payer: BCBS Complete |
$115.62
|
| Rate for Payer: BCBS Trust/PPO |
$238.32
|
| Rate for Payer: BCN Commercial |
$238.32
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$271.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$280.38
|
| Rate for Payer: Healthscope Whirlpool |
$289.05
|
| Rate for Payer: Mclaren Commercial |
$260.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Nomi Health Commercial |
$237.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$253.27
|
| Rate for Payer: Priority Health Narrow Network |
$202.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.36
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 67877021901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.04 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$302.44
|
| Rate for Payer: ASR ASR |
$325.97
|
| Rate for Payer: BCBS Trust/PPO |
$275.96
|
| Rate for Payer: BCN Commercial |
$275.96
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$315.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$325.97
|
| Rate for Payer: Healthscope Whirlpool |
$336.05
|
| Rate for Payer: Mclaren Commercial |
$302.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.72
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$129.20
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna Commercial |
$116.28
|
| Rate for Payer: Aetna Medicare |
$47.80
|
| Rate for Payer: ASR ASR |
$125.32
|
| Rate for Payer: BCBS Complete |
$51.68
|
| Rate for Payer: BCBS Trust/PPO |
$106.53
|
| Rate for Payer: BCN Commercial |
$106.53
|
| Rate for Payer: Cash Price |
$103.36
|
| Rate for Payer: Cofinity Commercial |
$121.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.36
|
| Rate for Payer: Healthscope Commercial |
$125.32
|
| Rate for Payer: Healthscope Whirlpool |
$129.20
|
| Rate for Payer: Mclaren Commercial |
$116.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.82
|
| Rate for Payer: Nomi Health Commercial |
$105.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$113.21
|
| Rate for Payer: Priority Health Narrow Network |
$90.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.70
|
|
