|
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 |
$196.70
|
| 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 |
$196.70
|
| 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
|
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 |
$150.20
|
| 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
|
$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 |
$196.70
|
| 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 |
$196.70
|
| 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 |
$293.98
|
| 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 |
$293.98
|
| 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
|
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 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
|
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
|
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
|
|
|
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
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$18.08
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Commercial |
$15.62
|
| Rate for Payer: Aetna Commercial |
$20.65
|
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: ASR ASR |
$17.54
|
| Rate for Payer: ASR ASR |
$16.83
|
| Rate for Payer: ASR ASR |
$22.25
|
| Rate for Payer: ASR Commercial |
$17.54
|
| Rate for Payer: ASR Commercial |
$22.25
|
| Rate for Payer: ASR Commercial |
$16.83
|
| Rate for Payer: ASR Commercial |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$18.69
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.14
|
| Rate for Payer: BCBS Trust/PPO |
$14.73
|
| Rate for Payer: BCN Commercial |
$17.79
|
| Rate for Payer: BCN Commercial |
$13.43
|
| Rate for Payer: BCN Commercial |
$14.02
|
| Rate for Payer: BCN Commercial |
$13.45
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cash Price |
$18.35
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Cofinity Commercial |
$16.31
|
| Rate for Payer: Cofinity Commercial |
$21.56
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$17.35
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$18.08
|
| Rate for Payer: Healthscope Commercial |
$22.94
|
| Rate for Payer: Healthscope Whirlpool |
$22.25
|
| Rate for Payer: Healthscope Whirlpool |
$16.83
|
| Rate for Payer: Healthscope Whirlpool |
$17.54
|
| Rate for Payer: Healthscope Whirlpool |
$16.80
|
| Rate for Payer: Mclaren Commercial |
$16.27
|
| Rate for Payer: Mclaren Commercial |
$20.65
|
| Rate for Payer: Mclaren Commercial |
$15.62
|
| Rate for Payer: Mclaren Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Nomi Health Commercial |
$14.20
|
| Rate for Payer: Nomi Health Commercial |
$18.81
|
| Rate for Payer: Nomi Health Commercial |
$14.83
|
| Rate for Payer: Nomi Health Commercial |
$14.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.24
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$22.94
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$22.94 |
| Rate for Payer: Aetna Commercial |
$20.65
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna Commercial |
$15.62
|
| Rate for Payer: Aetna Medicare |
$9.04
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: Aetna Medicare |
$8.68
|
| Rate for Payer: Aetna Medicare |
$11.47
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: ASR ASR |
$16.83
|
| Rate for Payer: ASR ASR |
$17.54
|
| Rate for Payer: ASR ASR |
$22.25
|
| Rate for Payer: ASR Commercial |
$16.80
|
| Rate for Payer: ASR Commercial |
$17.54
|
| Rate for Payer: ASR Commercial |
$22.25
|
| Rate for Payer: ASR Commercial |
$16.83
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS Complete |
$9.18
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS Complete |
$6.94
|
| Rate for Payer: BCBS Trust/PPO |
$18.79
|
| Rate for Payer: BCBS Trust/PPO |
$14.21
|
| Rate for Payer: BCBS Trust/PPO |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$14.81
|
| Rate for Payer: BCN Commercial |
$13.43
|
| Rate for Payer: BCN Commercial |
$17.79
|
| Rate for Payer: BCN Commercial |
$13.45
|
| Rate for Payer: BCN Commercial |
$14.02
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$18.35
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$16.31
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Cofinity Commercial |
$21.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$17.35
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$18.08
|
| Rate for Payer: Healthscope Whirlpool |
$16.83
|
| Rate for Payer: Healthscope Whirlpool |
$16.80
|
| Rate for Payer: Healthscope Whirlpool |
$17.54
|
| Rate for Payer: Healthscope Whirlpool |
$22.25
|
| Rate for Payer: Mclaren Commercial |
$16.27
|
| Rate for Payer: Mclaren Commercial |
$20.65
|
| Rate for Payer: Mclaren Commercial |
$15.59
|
| Rate for Payer: Mclaren Commercial |
$15.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.50
|
| Rate for Payer: Nomi Health Commercial |
$14.23
|
| Rate for Payer: Nomi Health Commercial |
$14.83
|
| Rate for Payer: Nomi Health Commercial |
$18.81
|
| Rate for Payer: Nomi Health Commercial |
$14.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.25
|
| Rate for Payer: Priority Health Narrow Network |
$1.00
|
| Rate for Payer: Priority Health Narrow Network |
$1.00
|
| Rate for Payer: Priority Health Narrow Network |
$1.00
|
| Rate for Payer: Priority Health Narrow Network |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.27
|
|
|
CEFEPIME 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$18.08
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$9.04
|
| Rate for Payer: ASR ASR |
$17.54
|
| Rate for Payer: ASR Commercial |
$17.54
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS Trust/PPO |
$14.81
|
| Rate for Payer: BCN Commercial |
$14.02
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$18.08
|
| Rate for Payer: Healthscope Whirlpool |
$17.54
|
| Rate for Payer: Mclaren Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: Nomi Health Commercial |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.25
|
| Rate for Payer: Priority Health Narrow Network |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.91
|
|
|
CEFEPIME 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$18.08
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: ASR ASR |
$17.54
|
| Rate for Payer: ASR Commercial |
$17.54
|
| Rate for Payer: BCBS Trust/PPO |
$14.73
|
| Rate for Payer: BCN Commercial |
$14.02
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$18.08
|
| Rate for Payer: Healthscope Whirlpool |
$17.54
|
| Rate for Payer: Mclaren Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.37
|
| Rate for Payer: Nomi Health Commercial |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.91
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$32.42
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.07 |
| Max. Negotiated Rate |
$32.42 |
| Rate for Payer: Aetna Commercial |
$29.18
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: ASR ASR |
$31.45
|
| Rate for Payer: ASR ASR |
$18.99
|
| Rate for Payer: ASR Commercial |
$18.99
|
| Rate for Payer: ASR Commercial |
$31.45
|
| Rate for Payer: BCBS Trust/PPO |
$15.96
|
| Rate for Payer: BCBS Trust/PPO |
$26.42
|
| Rate for Payer: BCN Commercial |
$25.14
|
| Rate for Payer: BCN Commercial |
$15.18
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$30.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.94
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$32.42
|
| Rate for Payer: Healthscope Whirlpool |
$18.99
|
| Rate for Payer: Healthscope Whirlpool |
$31.45
|
| Rate for Payer: Mclaren Commercial |
$17.62
|
| Rate for Payer: Mclaren Commercial |
$29.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.56
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Nomi Health Commercial |
$26.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.53
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$32.42
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$32.42 |
| Rate for Payer: Aetna Commercial |
$29.18
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna Medicare |
$9.79
|
| Rate for Payer: Aetna Medicare |
$16.21
|
| Rate for Payer: ASR ASR |
$31.45
|
| Rate for Payer: ASR ASR |
$18.99
|
| Rate for Payer: ASR Commercial |
$18.99
|
| Rate for Payer: ASR Commercial |
$31.45
|
| Rate for Payer: BCBS Complete |
$12.97
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Trust/PPO |
$26.55
|
| Rate for Payer: BCBS Trust/PPO |
$16.03
|
| Rate for Payer: BCN Commercial |
$15.18
|
| Rate for Payer: BCN Commercial |
$25.14
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$30.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$32.42
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Whirlpool |
$31.45
|
| Rate for Payer: Healthscope Whirlpool |
$18.99
|
| Rate for Payer: Mclaren Commercial |
$17.62
|
| Rate for Payer: Mclaren Commercial |
$29.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$26.58
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.25
|
| Rate for Payer: Priority Health Narrow Network |
$1.00
|
| Rate for Payer: Priority Health Narrow Network |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.53
|
|
|
CEFEPIME 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$19.58
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: ASR ASR |
$18.99
|
| Rate for Payer: ASR Commercial |
$18.99
|
| Rate for Payer: BCBS Trust/PPO |
$15.96
|
| Rate for Payer: BCN Commercial |
$15.18
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Whirlpool |
$18.99
|
| Rate for Payer: Mclaren Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.23
|
|
|
CEFEPIME 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$19.58
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
301707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna Medicare |
$9.79
|
| Rate for Payer: ASR ASR |
$18.99
|
| Rate for Payer: ASR Commercial |
$18.99
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Trust/PPO |
$16.03
|
| Rate for Payer: BCN Commercial |
$15.18
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Whirlpool |
$18.99
|
| Rate for Payer: Mclaren Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.25
|
| Rate for Payer: Priority Health Narrow Network |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.23
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION
|
Facility
|
IP
|
$24.12
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
150848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$24.12 |
| Rate for Payer: Aetna Commercial |
$21.71
|
| Rate for Payer: ASR ASR |
$23.40
|
| Rate for Payer: ASR Commercial |
$23.40
|
| Rate for Payer: BCBS Trust/PPO |
$19.66
|
| Rate for Payer: BCN Commercial |
$18.70
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Healthscope Whirlpool |
$23.40
|
| Rate for Payer: Mclaren Commercial |
$21.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.50
|
| Rate for Payer: Nomi Health Commercial |
$19.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.23
|
|
|
CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION
|
Facility
|
OP
|
$24.12
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
150848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$24.12 |
| Rate for Payer: Aetna Commercial |
$21.71
|
| Rate for Payer: Aetna Medicare |
$12.06
|
| Rate for Payer: ASR ASR |
$23.40
|
| Rate for Payer: ASR Commercial |
$23.40
|
| Rate for Payer: BCBS Complete |
$9.65
|
| Rate for Payer: BCBS Trust/PPO |
$19.75
|
| Rate for Payer: BCN Commercial |
$18.70
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Healthscope Whirlpool |
$23.40
|
| Rate for Payer: Mclaren Commercial |
$21.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.50
|
| Rate for Payer: Nomi Health Commercial |
$19.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.23
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$13.62
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: Aetna Commercial |
$21.71
|
| Rate for Payer: Aetna Commercial |
$13.35
|
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Commercial |
$26.30
|
| Rate for Payer: Aetna Commercial |
$11.94
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: ASR ASR |
$23.40
|
| Rate for Payer: ASR ASR |
$14.39
|
| Rate for Payer: ASR ASR |
$28.34
|
| Rate for Payer: ASR ASR |
$25.11
|
| Rate for Payer: ASR ASR |
$13.21
|
| Rate for Payer: ASR ASR |
$12.87
|
| Rate for Payer: ASR ASR |
$25.38
|
| Rate for Payer: ASR Commercial |
$28.34
|
| Rate for Payer: ASR Commercial |
$25.38
|
| Rate for Payer: ASR Commercial |
$14.39
|
| Rate for Payer: ASR Commercial |
$25.11
|
| Rate for Payer: ASR Commercial |
$23.40
|
| Rate for Payer: ASR Commercial |
$13.21
|
| Rate for Payer: ASR Commercial |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$21.32
|
| Rate for Payer: BCBS Trust/PPO |
$21.10
|
| Rate for Payer: BCBS Trust/PPO |
$10.81
|
| Rate for Payer: BCBS Trust/PPO |
$11.10
|
| Rate for Payer: BCBS Trust/PPO |
$19.66
|
| Rate for Payer: BCBS Trust/PPO |
$12.08
|
| Rate for Payer: BCBS Trust/PPO |
$23.81
|
| Rate for Payer: BCN Commercial |
$11.50
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: BCN Commercial |
$20.07
|
| Rate for Payer: BCN Commercial |
$10.29
|
| Rate for Payer: BCN Commercial |
$10.56
|
| Rate for Payer: BCN Commercial |
$20.28
|
| Rate for Payer: BCN Commercial |
$18.70
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$24.34
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$12.47
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$24.59
|
| Rate for Payer: Cofinity Commercial |
$27.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Healthscope Commercial |
$29.22
|
| Rate for Payer: Healthscope Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$13.62
|
| Rate for Payer: Healthscope Commercial |
$13.27
|
| Rate for Payer: Healthscope Whirlpool |
$25.38
|
| Rate for Payer: Healthscope Whirlpool |
$25.11
|
| Rate for Payer: Healthscope Whirlpool |
$23.40
|
| Rate for Payer: Healthscope Whirlpool |
$13.21
|
| Rate for Payer: Healthscope Whirlpool |
$14.39
|
| Rate for Payer: Healthscope Whirlpool |
$12.87
|
| Rate for Payer: Healthscope Whirlpool |
$28.34
|
| Rate for Payer: Mclaren Commercial |
$23.30
|
| Rate for Payer: Mclaren Commercial |
$26.30
|
| Rate for Payer: Mclaren Commercial |
$11.94
|
| Rate for Payer: Mclaren Commercial |
$23.54
|
| Rate for Payer: Mclaren Commercial |
$13.35
|
| Rate for Payer: Mclaren Commercial |
$12.26
|
| Rate for Payer: Mclaren Commercial |
$21.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Nomi Health Commercial |
$10.88
|
| Rate for Payer: Nomi Health Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$23.96
|
| Rate for Payer: Nomi Health Commercial |
$19.78
|
| Rate for Payer: Nomi Health Commercial |
$12.16
|
| Rate for Payer: Nomi Health Commercial |
$11.17
|
| Rate for Payer: Nomi Health Commercial |
$21.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.05
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$29.22
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Aetna Commercial |
$26.30
|
| Rate for Payer: Aetna Commercial |
$13.35
|
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: Aetna Commercial |
$21.71
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$11.94
|
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: Aetna Medicare |
$12.94
|
| Rate for Payer: Aetna Medicare |
$14.61
|
| Rate for Payer: Aetna Medicare |
$12.06
|
| Rate for Payer: Aetna Medicare |
$6.81
|
| Rate for Payer: Aetna Medicare |
$6.64
|
| Rate for Payer: ASR ASR |
$25.38
|
| Rate for Payer: ASR ASR |
$23.40
|
| Rate for Payer: ASR ASR |
$14.39
|
| Rate for Payer: ASR ASR |
$12.87
|
| Rate for Payer: ASR ASR |
$13.21
|
| Rate for Payer: ASR ASR |
$28.34
|
| Rate for Payer: ASR ASR |
$25.11
|
| Rate for Payer: ASR Commercial |
$12.87
|
| Rate for Payer: ASR Commercial |
$23.40
|
| Rate for Payer: ASR Commercial |
$13.21
|
| Rate for Payer: ASR Commercial |
$14.39
|
| Rate for Payer: ASR Commercial |
$28.34
|
| Rate for Payer: ASR Commercial |
$25.38
|
| Rate for Payer: ASR Commercial |
$25.11
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS Complete |
$5.45
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS Complete |
$11.69
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS Complete |
$9.65
|
| Rate for Payer: BCBS Trust/PPO |
$12.14
|
| Rate for Payer: BCBS Trust/PPO |
$10.87
|
| Rate for Payer: BCBS Trust/PPO |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCBS Trust/PPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$19.75
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: BCN Commercial |
$10.56
|
| Rate for Payer: BCN Commercial |
$20.07
|
| Rate for Payer: BCN Commercial |
$10.29
|
| Rate for Payer: BCN Commercial |
$11.50
|
| Rate for Payer: BCN Commercial |
$18.70
|
| Rate for Payer: BCN Commercial |
$20.28
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$27.47
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$24.59
|
| Rate for Payer: Cofinity Commercial |
$12.47
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$24.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Healthscope Commercial |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$13.62
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Healthscope Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$29.22
|
| Rate for Payer: Healthscope Whirlpool |
$23.40
|
| Rate for Payer: Healthscope Whirlpool |
$14.39
|
| Rate for Payer: Healthscope Whirlpool |
$13.21
|
| Rate for Payer: Healthscope Whirlpool |
$25.11
|
| Rate for Payer: Healthscope Whirlpool |
$25.38
|
| Rate for Payer: Healthscope Whirlpool |
$28.34
|
| Rate for Payer: Healthscope Whirlpool |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$23.54
|
| Rate for Payer: Mclaren Commercial |
$21.71
|
| Rate for Payer: Mclaren Commercial |
$13.35
|
| Rate for Payer: Mclaren Commercial |
$26.30
|
| Rate for Payer: Mclaren Commercial |
$23.30
|
| Rate for Payer: Mclaren Commercial |
$12.26
|
| Rate for Payer: Mclaren Commercial |
$11.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Nomi Health Commercial |
$10.88
|
| Rate for Payer: Nomi Health Commercial |
$19.78
|
| Rate for Payer: Nomi Health Commercial |
$12.16
|
| Rate for Payer: Nomi Health Commercial |
$11.17
|
| Rate for Payer: Nomi Health Commercial |
$21.23
|
| Rate for Payer: Nomi Health Commercial |
$23.96
|
| Rate for Payer: Nomi Health Commercial |
$21.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.99
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$29.22
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Aetna Commercial |
$26.30
|
| Rate for Payer: ASR ASR |
$28.34
|
| Rate for Payer: ASR Commercial |
$28.34
|
| Rate for Payer: BCBS Trust/PPO |
$23.81
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$27.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.38
|
| Rate for Payer: Healthscope Commercial |
$29.22
|
| Rate for Payer: Healthscope Whirlpool |
$28.34
|
| Rate for Payer: Mclaren Commercial |
$26.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.84
|
| Rate for Payer: Nomi Health Commercial |
$23.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.71
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$29.22
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Aetna Commercial |
$26.30
|
| Rate for Payer: Aetna Medicare |
$14.61
|
| Rate for Payer: ASR ASR |
$28.34
|
| Rate for Payer: ASR Commercial |
$28.34
|
| Rate for Payer: BCBS Complete |
$11.69
|
| Rate for Payer: BCBS Trust/PPO |
$23.93
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$27.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.38
|
| Rate for Payer: Healthscope Commercial |
$29.22
|
| Rate for Payer: Healthscope Whirlpool |
$28.34
|
| Rate for Payer: Mclaren Commercial |
$26.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.84
|
| Rate for Payer: Nomi Health Commercial |
$23.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.71
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$16.65
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Commercial |
$41.32
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Medicare |
$22.96
|
| Rate for Payer: Aetna Medicare |
$8.32
|
| Rate for Payer: Aetna Medicare |
$10.70
|
| Rate for Payer: ASR ASR |
$20.75
|
| Rate for Payer: ASR ASR |
$16.15
|
| Rate for Payer: ASR ASR |
$44.53
|
| Rate for Payer: ASR Commercial |
$20.75
|
| Rate for Payer: ASR Commercial |
$16.15
|
| Rate for Payer: ASR Commercial |
$44.53
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Complete |
$8.56
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$13.63
|
| Rate for Payer: BCBS Trust/PPO |
$17.52
|
| Rate for Payer: BCN Commercial |
$16.58
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$17.12
|
| Rate for Payer: Cash Price |
$17.12
|
| Rate for Payer: Cash Price |
$36.73
|
| Rate for Payer: Cash Price |
$36.73
|
| Rate for Payer: Cofinity Commercial |
$43.16
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Cofinity Commercial |
$20.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.11
|
| Rate for Payer: Healthscope Commercial |
$45.91
|
| Rate for Payer: Healthscope Commercial |
$21.39
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Whirlpool |
$44.53
|
| Rate for Payer: Healthscope Whirlpool |
$20.75
|
| Rate for Payer: Healthscope Whirlpool |
$16.15
|
| Rate for Payer: Mclaren Commercial |
$19.25
|
| Rate for Payer: Mclaren Commercial |
$41.32
|
| Rate for Payer: Mclaren Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Nomi Health Commercial |
$37.65
|
| Rate for Payer: Nomi Health Commercial |
$17.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.40
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$21.39
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$21.39 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Commercial |
$41.32
|
| Rate for Payer: ASR ASR |
$16.15
|
| Rate for Payer: ASR ASR |
$20.75
|
| Rate for Payer: ASR ASR |
$44.53
|
| Rate for Payer: ASR Commercial |
$20.75
|
| Rate for Payer: ASR Commercial |
$16.15
|
| Rate for Payer: ASR Commercial |
$44.53
|
| Rate for Payer: BCBS Trust/PPO |
$37.41
|
| Rate for Payer: BCBS Trust/PPO |
$13.57
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: BCN Commercial |
$16.58
|
| Rate for Payer: Cash Price |
$17.12
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$36.73
|
| Rate for Payer: Cofinity Commercial |
$43.16
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Cofinity Commercial |
$20.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.73
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$21.39
|
| Rate for Payer: Healthscope Commercial |
$45.91
|
| Rate for Payer: Healthscope Whirlpool |
$20.75
|
| Rate for Payer: Healthscope Whirlpool |
$16.15
|
| Rate for Payer: Healthscope Whirlpool |
$44.53
|
| Rate for Payer: Mclaren Commercial |
$19.25
|
| Rate for Payer: Mclaren Commercial |
$14.98
|
| Rate for Payer: Mclaren Commercial |
$41.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$17.54
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Nomi Health Commercial |
$37.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.65
|
|
