|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
NDC 51079093001
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna Commercial |
$1.93
|
| Rate for Payer: ASR ASR |
$2.08
|
| Rate for Payer: ASR Commercial |
$2.08
|
| Rate for Payer: BCBS Trust/PPO |
$1.74
|
| Rate for Payer: BCN Commercial |
$1.66
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cofinity Commercial |
$2.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$2.14
|
| Rate for Payer: Healthscope Whirlpool |
$2.08
|
| Rate for Payer: Mclaren Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Nomi Health Commercial |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.88
|
|
|
CEFADROXIL 500 MG CAPSULE
|
Facility
|
OP
|
$224.43
|
|
|
Service Code
|
NDC 68180018008
|
| Hospital Charge Code |
9436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.77 |
| Max. Negotiated Rate |
$224.43 |
| Rate for Payer: Aetna Commercial |
$201.99
|
| Rate for Payer: Aetna Medicare |
$112.22
|
| Rate for Payer: ASR ASR |
$217.70
|
| Rate for Payer: ASR Commercial |
$217.70
|
| Rate for Payer: BCBS Complete |
$89.77
|
| Rate for Payer: BCBS Trust/PPO |
$183.79
|
| Rate for Payer: BCN Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$179.54
|
| Rate for Payer: Cofinity Commercial |
$210.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.54
|
| Rate for Payer: Healthscope Commercial |
$224.43
|
| Rate for Payer: Healthscope Whirlpool |
$217.70
|
| Rate for Payer: Mclaren Commercial |
$201.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.77
|
| Rate for Payer: Nomi Health Commercial |
$184.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.65
|
| Rate for Payer: Priority Health Narrow Network |
$157.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.50
|
|
|
CEFADROXIL 500 MG CAPSULE
|
Facility
|
IP
|
$224.43
|
|
|
Service Code
|
NDC 68180018008
|
| Hospital Charge Code |
9436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.88 |
| Max. Negotiated Rate |
$224.43 |
| Rate for Payer: Aetna Commercial |
$201.99
|
| Rate for Payer: ASR ASR |
$217.70
|
| Rate for Payer: ASR Commercial |
$217.70
|
| Rate for Payer: BCBS Trust/PPO |
$182.89
|
| Rate for Payer: BCN Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$179.54
|
| Rate for Payer: Cofinity Commercial |
$210.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.54
|
| Rate for Payer: Healthscope Commercial |
$224.43
|
| Rate for Payer: Healthscope Whirlpool |
$217.70
|
| Rate for Payer: Mclaren Commercial |
$201.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.77
|
| Rate for Payer: Nomi Health Commercial |
$184.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.50
|
|
|
CEFAZOLIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.10
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
27297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna Commercial |
$14.49
|
| Rate for Payer: ASR ASR |
$15.62
|
| Rate for Payer: ASR Commercial |
$15.62
|
| Rate for Payer: BCBS Trust/PPO |
$13.12
|
| Rate for Payer: BCN Commercial |
$12.48
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Healthscope Whirlpool |
$15.62
|
| Rate for Payer: Mclaren Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.69
|
| Rate for Payer: Nomi Health Commercial |
$13.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.17
|
|
|
CEFAZOLIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.10
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
27297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna Commercial |
$14.49
|
| Rate for Payer: Aetna Medicare |
$8.05
|
| Rate for Payer: ASR ASR |
$15.62
|
| Rate for Payer: ASR Commercial |
$15.62
|
| Rate for Payer: BCBS Complete |
$6.44
|
| Rate for Payer: BCBS Trust/PPO |
$13.18
|
| Rate for Payer: BCN Commercial |
$12.48
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Healthscope Whirlpool |
$15.62
|
| Rate for Payer: Mclaren Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.69
|
| Rate for Payer: Nomi Health Commercial |
$13.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.11
|
| Rate for Payer: Priority Health Narrow Network |
$11.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.17
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$18.88
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna Commercial |
$15.13
|
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: ASR ASR |
$13.79
|
| Rate for Payer: ASR ASR |
$18.31
|
| Rate for Payer: ASR ASR |
$16.31
|
| Rate for Payer: ASR ASR |
$18.85
|
| Rate for Payer: ASR Commercial |
$18.31
|
| Rate for Payer: ASR Commercial |
$18.85
|
| Rate for Payer: ASR Commercial |
$16.31
|
| Rate for Payer: ASR Commercial |
$13.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.83
|
| Rate for Payer: BCBS Trust/PPO |
$11.59
|
| Rate for Payer: BCBS Trust/PPO |
$13.70
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$15.06
|
| Rate for Payer: BCN Commercial |
$11.02
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: BCN Commercial |
$13.03
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$15.80
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| 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 |
$13.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$16.81
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Healthscope Whirlpool |
$18.85
|
| Rate for Payer: Healthscope Whirlpool |
$16.31
|
| Rate for Payer: Healthscope Whirlpool |
$18.31
|
| Rate for Payer: Healthscope Whirlpool |
$13.79
|
| Rate for Payer: Mclaren Commercial |
$16.99
|
| Rate for Payer: Mclaren Commercial |
$17.49
|
| Rate for Payer: Mclaren Commercial |
$15.13
|
| Rate for Payer: Mclaren Commercial |
$12.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.09
|
| Rate for Payer: Nomi Health Commercial |
$11.66
|
| Rate for Payer: Nomi Health Commercial |
$15.93
|
| Rate for Payer: Nomi Health Commercial |
$15.48
|
| Rate for Payer: Nomi Health Commercial |
$13.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.51
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$16.81
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$16.81 |
| Rate for Payer: Aetna Commercial |
$15.13
|
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna Medicare |
$9.71
|
| Rate for Payer: Aetna Medicare |
$8.40
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: Aetna Medicare |
$7.11
|
| Rate for Payer: ASR ASR |
$18.31
|
| Rate for Payer: ASR ASR |
$13.79
|
| Rate for Payer: ASR ASR |
$18.85
|
| Rate for Payer: ASR ASR |
$16.31
|
| Rate for Payer: ASR Commercial |
$16.31
|
| Rate for Payer: ASR Commercial |
$18.31
|
| Rate for Payer: ASR Commercial |
$18.85
|
| Rate for Payer: ASR Commercial |
$13.79
|
| Rate for Payer: BCBS Complete |
$5.69
|
| Rate for Payer: BCBS Complete |
$7.77
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS Complete |
$6.72
|
| Rate for Payer: BCBS Trust/PPO |
$13.77
|
| Rate for Payer: BCBS Trust/PPO |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$11.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.46
|
| Rate for Payer: BCN Commercial |
$15.06
|
| Rate for Payer: BCN Commercial |
$13.03
|
| Rate for Payer: BCN Commercial |
$11.02
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$15.80
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| 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 |
$15.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.45
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$16.81
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Healthscope Whirlpool |
$18.85
|
| Rate for Payer: Healthscope Whirlpool |
$18.31
|
| Rate for Payer: Healthscope Whirlpool |
$16.31
|
| Rate for Payer: Healthscope Whirlpool |
$13.79
|
| Rate for Payer: Mclaren Commercial |
$12.80
|
| Rate for Payer: Mclaren Commercial |
$15.13
|
| Rate for Payer: Mclaren Commercial |
$16.99
|
| Rate for Payer: Mclaren Commercial |
$17.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.05
|
| Rate for Payer: Nomi Health Commercial |
$15.48
|
| Rate for Payer: Nomi Health Commercial |
$13.78
|
| Rate for Payer: Nomi Health Commercial |
$15.93
|
| Rate for Payer: Nomi Health Commercial |
$11.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.46
|
| Rate for Payer: Priority Health Narrow Network |
$13.23
|
| Rate for Payer: Priority Health Narrow Network |
$11.78
|
| Rate for Payer: Priority Health Narrow Network |
$13.62
|
| Rate for Payer: Priority Health Narrow Network |
$9.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.79
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
OP
|
$14.22
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna Medicare |
$7.11
|
| Rate for Payer: ASR ASR |
$13.79
|
| Rate for Payer: ASR Commercial |
$13.79
|
| Rate for Payer: BCBS Complete |
$5.69
|
| Rate for Payer: BCBS Trust/PPO |
$11.64
|
| Rate for Payer: BCN Commercial |
$11.02
|
| 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 |
$14.22
|
| Rate for Payer: Healthscope Whirlpool |
$13.79
|
| 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: Priority Health Cigna Priority Health |
$9.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.46
|
| Rate for Payer: Priority Health Narrow Network |
$9.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.51
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
IP
|
$14.22
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: ASR ASR |
$13.79
|
| Rate for Payer: ASR Commercial |
$13.79
|
| Rate for Payer: BCBS Trust/PPO |
$11.59
|
| Rate for Payer: BCN Commercial |
$11.02
|
| 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 |
$14.22
|
| Rate for Payer: Healthscope Whirlpool |
$13.79
|
| 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: Priority Health Cigna Priority Health |
$9.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.51
|
|
|
CEFAZOLIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.78
|
|
|
Service Code
|
HCPCS J0688
|
| Hospital Charge Code |
203261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna Commercial |
$22.30
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.16
|
| Rate for Payer: ASR ASR |
$24.04
|
| Rate for Payer: ASR Commercial |
$24.04
|
| Rate for Payer: BCBS Complete |
$0.52
|
| Rate for Payer: BCBS MAPPO |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$20.29
|
| Rate for Payer: BCN Commercial |
$19.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.93
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$23.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.93
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Whirlpool |
$24.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.93
|
| Rate for Payer: Mclaren Commercial |
$22.30
|
| Rate for Payer: Mclaren Medicaid |
$0.50
|
| Rate for Payer: Mclaren Medicare |
$0.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.98
|
| Rate for Payer: Meridian Medicaid |
$0.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.06
|
| Rate for Payer: Nomi Health Commercial |
$20.32
|
| Rate for Payer: PACE Medicare |
$0.88
|
| Rate for Payer: PACE SWMI |
$0.93
|
| Rate for Payer: PHP Commercial |
$1.02
|
| Rate for Payer: PHP Medicaid |
$0.50
|
| Rate for Payer: PHP Medicare Advantage |
$0.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.71
|
| Rate for Payer: Priority Health Medicare |
$0.93
|
| Rate for Payer: Priority Health Narrow Network |
$17.37
|
| Rate for Payer: Railroad Medicare Medicare |
$0.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.93
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Medicare Advantage |
$0.93
|
| Rate for Payer: UHCCP DNSP |
$0.93
|
| Rate for Payer: UHCCP Medicaid |
$0.50
|
| Rate for Payer: VA VA |
$0.93
|
|
|
CEFAZOLIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.78
|
|
|
Service Code
|
HCPCS J0688
|
| Hospital Charge Code |
203261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna Commercial |
$22.30
|
| Rate for Payer: ASR ASR |
$24.04
|
| Rate for Payer: ASR Commercial |
$24.04
|
| Rate for Payer: BCBS Trust/PPO |
$20.19
|
| Rate for Payer: BCN Commercial |
$19.21
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$23.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Whirlpool |
$24.04
|
| Rate for Payer: Mclaren Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.06
|
| Rate for Payer: Nomi Health Commercial |
$20.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.81
|
|
|
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 |
$7.45 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna Medicare |
$9.31
|
| Rate for Payer: ASR ASR |
$18.06
|
| Rate for Payer: ASR Commercial |
$18.06
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$15.25
|
| Rate for Payer: BCN Commercial |
$14.44
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$18.62
|
| Rate for Payer: Healthscope Whirlpool |
$18.06
|
| Rate for Payer: Mclaren Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.83
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.31
|
| Rate for Payer: Priority Health Narrow Network |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.39
|
|
|
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 |
$12.10 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: ASR ASR |
$18.06
|
| Rate for Payer: ASR Commercial |
$18.06
|
| Rate for Payer: BCBS Trust/PPO |
$15.17
|
| Rate for Payer: BCN Commercial |
$14.44
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$18.62
|
| Rate for Payer: Healthscope Whirlpool |
$18.06
|
| Rate for Payer: Mclaren Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.83
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.39
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$218.55
|
|
|
Service Code
|
NDC 67877054798
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$218.55 |
| Rate for Payer: Aetna Commercial |
$196.69
|
| Rate for Payer: Aetna Medicare |
$109.28
|
| Rate for Payer: ASR ASR |
$211.99
|
| Rate for Payer: ASR Commercial |
$211.99
|
| Rate for Payer: BCBS Complete |
$87.42
|
| Rate for Payer: BCBS Trust/PPO |
$178.97
|
| Rate for Payer: BCN Commercial |
$169.44
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$205.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$218.55
|
| Rate for Payer: Healthscope Whirlpool |
$211.99
|
| Rate for Payer: Mclaren Commercial |
$196.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Nomi Health Commercial |
$179.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.49
|
| Rate for Payer: Priority Health Narrow Network |
$153.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.32
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 67877054798
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.06 |
| Max. Negotiated Rate |
$218.55 |
| Rate for Payer: Aetna Commercial |
$196.69
|
| Rate for Payer: ASR ASR |
$211.99
|
| Rate for Payer: ASR Commercial |
$211.99
|
| Rate for Payer: BCBS Trust/PPO |
$178.10
|
| Rate for Payer: BCN Commercial |
$169.44
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$205.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$218.55
|
| Rate for Payer: Healthscope Whirlpool |
$211.99
|
| Rate for Payer: Mclaren Commercial |
$196.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Nomi Health Commercial |
$179.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.32
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 67877054788
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.66 |
| Max. Negotiated Rate |
$326.65 |
| Rate for Payer: Aetna Commercial |
$293.99
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: ASR ASR |
$316.85
|
| Rate for Payer: ASR Commercial |
$316.85
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: BCBS Trust/PPO |
$267.49
|
| Rate for Payer: BCN Commercial |
$253.25
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$307.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$326.65
|
| Rate for Payer: Healthscope Whirlpool |
$316.85
|
| Rate for Payer: Mclaren Commercial |
$293.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.21
|
| Rate for Payer: Priority Health Narrow Network |
$228.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.45
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$176.70
|
|
|
Service Code
|
NDC 68180072204
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.68 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$159.03
|
| Rate for Payer: Aetna Medicare |
$88.35
|
| Rate for Payer: ASR ASR |
$171.40
|
| Rate for Payer: ASR Commercial |
$171.40
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS Trust/PPO |
$144.70
|
| Rate for Payer: BCN Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$141.36
|
| Rate for Payer: Cofinity Commercial |
$166.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.36
|
| Rate for Payer: Healthscope Commercial |
$176.70
|
| Rate for Payer: Healthscope Whirlpool |
$171.40
|
| Rate for Payer: Mclaren Commercial |
$159.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.19
|
| Rate for Payer: Nomi Health Commercial |
$144.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.82
|
| Rate for Payer: Priority Health Narrow Network |
$123.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.50
|
|
|
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 |
$114.86 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$159.03
|
| Rate for Payer: ASR ASR |
$171.40
|
| Rate for Payer: ASR Commercial |
$171.40
|
| Rate for Payer: BCBS Trust/PPO |
$143.99
|
| Rate for Payer: BCN Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$141.36
|
| Rate for Payer: Cofinity Commercial |
$166.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.36
|
| Rate for Payer: Healthscope Commercial |
$176.70
|
| Rate for Payer: Healthscope Whirlpool |
$171.40
|
| Rate for Payer: Mclaren Commercial |
$159.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.19
|
| Rate for Payer: Nomi Health Commercial |
$144.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.50
|
|
|
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 |
$143.88 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna Commercial |
$199.22
|
| Rate for Payer: ASR ASR |
$214.71
|
| Rate for Payer: ASR Commercial |
$214.71
|
| Rate for Payer: BCBS Trust/PPO |
$180.38
|
| Rate for Payer: BCN Commercial |
$171.61
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$208.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$221.35
|
| Rate for Payer: Healthscope Whirlpool |
$214.71
|
| Rate for Payer: Mclaren Commercial |
$199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.79
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 67877054788
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.32 |
| Max. Negotiated Rate |
$326.65 |
| Rate for Payer: Aetna Commercial |
$293.99
|
| Rate for Payer: ASR ASR |
$316.85
|
| Rate for Payer: ASR Commercial |
$316.85
|
| Rate for Payer: BCBS Trust/PPO |
$266.19
|
| Rate for Payer: BCN Commercial |
$253.25
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$307.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$326.65
|
| Rate for Payer: Healthscope Whirlpool |
$316.85
|
| Rate for Payer: Mclaren Commercial |
$293.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.45
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$221.35
|
|
|
Service Code
|
NDC 68180072205
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.54 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna Commercial |
$199.22
|
| Rate for Payer: Aetna Medicare |
$110.67
|
| Rate for Payer: ASR ASR |
$214.71
|
| Rate for Payer: ASR Commercial |
$214.71
|
| Rate for Payer: BCBS Complete |
$88.54
|
| Rate for Payer: BCBS Trust/PPO |
$181.26
|
| Rate for Payer: BCN Commercial |
$171.61
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$208.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$221.35
|
| Rate for Payer: Healthscope Whirlpool |
$214.71
|
| Rate for Payer: Mclaren Commercial |
$199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.95
|
| Rate for Payer: Priority Health Narrow Network |
$155.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.79
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$348.21
|
|
|
Service Code
|
NDC 60687069921
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.34 |
| Max. Negotiated Rate |
$348.21 |
| Rate for Payer: Aetna Commercial |
$313.39
|
| Rate for Payer: ASR ASR |
$337.76
|
| Rate for Payer: ASR Commercial |
$337.76
|
| Rate for Payer: BCBS Trust/PPO |
$283.76
|
| Rate for Payer: BCN Commercial |
$269.97
|
| Rate for Payer: Cash Price |
$278.57
|
| Rate for Payer: Cofinity Commercial |
$327.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.57
|
| Rate for Payer: Healthscope Commercial |
$348.21
|
| Rate for Payer: Healthscope Whirlpool |
$337.76
|
| Rate for Payer: Mclaren Commercial |
$313.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.98
|
| Rate for Payer: Nomi Health Commercial |
$285.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.42
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
IP
|
$11.61
|
|
|
Service Code
|
NDC 60687069911
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Aetna Commercial |
$10.45
|
| Rate for Payer: ASR ASR |
$11.26
|
| Rate for Payer: ASR Commercial |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$9.46
|
| Rate for Payer: BCN Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$10.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$11.61
|
| Rate for Payer: Healthscope Whirlpool |
$11.26
|
| Rate for Payer: Mclaren Commercial |
$10.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.87
|
| Rate for Payer: Nomi Health Commercial |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.22
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
OP
|
$348.21
|
|
|
Service Code
|
NDC 60687069921
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.28 |
| Max. Negotiated Rate |
$348.21 |
| Rate for Payer: Aetna Commercial |
$313.39
|
| Rate for Payer: Aetna Medicare |
$174.10
|
| Rate for Payer: ASR ASR |
$337.76
|
| Rate for Payer: ASR Commercial |
$337.76
|
| Rate for Payer: BCBS Complete |
$139.28
|
| Rate for Payer: BCBS Trust/PPO |
$285.15
|
| Rate for Payer: BCN Commercial |
$269.97
|
| Rate for Payer: Cash Price |
$278.57
|
| Rate for Payer: Cofinity Commercial |
$327.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.57
|
| Rate for Payer: Healthscope Commercial |
$348.21
|
| Rate for Payer: Healthscope Whirlpool |
$337.76
|
| Rate for Payer: Mclaren Commercial |
$313.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.98
|
| Rate for Payer: Nomi Health Commercial |
$285.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$244.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.42
|
|
|
CEFDINIR 300 MG CAPSULE
|
Facility
|
OP
|
$11.61
|
|
|
Service Code
|
NDC 60687069911
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Aetna Commercial |
$10.45
|
| Rate for Payer: Aetna Medicare |
$5.80
|
| Rate for Payer: ASR ASR |
$11.26
|
| Rate for Payer: ASR Commercial |
$11.26
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: BCBS Trust/PPO |
$9.51
|
| Rate for Payer: BCN Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$10.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$11.61
|
| Rate for Payer: Healthscope Whirlpool |
$11.26
|
| Rate for Payer: Mclaren Commercial |
$10.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.87
|
| Rate for Payer: Nomi Health Commercial |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.17
|
| Rate for Payer: Priority Health Narrow Network |
$8.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.22
|
|
