|
CEFTRIAXONE 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$16.65
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: ASR ASR |
$16.15
|
| Rate for Payer: ASR Commercial |
$16.15
|
| Rate for Payer: BCBS Trust/PPO |
$13.57
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Whirlpool |
$16.15
|
| Rate for Payer: Mclaren Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.65
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$16.65
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
301709
|
|
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 Medicare |
$8.32
|
| Rate for Payer: ASR ASR |
$16.15
|
| Rate for Payer: ASR Commercial |
$16.15
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Trust/PPO |
$13.63
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Whirlpool |
$16.15
|
| Rate for Payer: Mclaren Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| 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 |
$14.65
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Aetna Commercial |
$6.72
|
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: Aetna Commercial |
$10.77
|
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna Medicare |
$1.54
|
| Rate for Payer: Aetna Medicare |
$5.98
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: Aetna Medicare |
$3.74
|
| Rate for Payer: ASR ASR |
$11.61
|
| Rate for Payer: ASR ASR |
$2.94
|
| Rate for Payer: ASR ASR |
$2.99
|
| Rate for Payer: ASR ASR |
$7.25
|
| Rate for Payer: ASR Commercial |
$11.61
|
| Rate for Payer: ASR Commercial |
$2.99
|
| Rate for Payer: ASR Commercial |
$7.25
|
| Rate for Payer: ASR Commercial |
$2.94
|
| Rate for Payer: BCBS Complete |
$1.23
|
| Rate for Payer: BCBS Complete |
$2.99
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$9.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.52
|
| Rate for Payer: BCN Commercial |
$9.28
|
| Rate for Payer: BCN Commercial |
$5.79
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cash Price |
$9.58
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$9.58
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.58
|
| Rate for Payer: Healthscope Commercial |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Healthscope Commercial |
$11.97
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Healthscope Whirlpool |
$2.94
|
| Rate for Payer: Healthscope Whirlpool |
$11.61
|
| Rate for Payer: Healthscope Whirlpool |
$2.99
|
| Rate for Payer: Healthscope Whirlpool |
$7.25
|
| Rate for Payer: Mclaren Commercial |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$6.72
|
| Rate for Payer: Mclaren Commercial |
$10.77
|
| Rate for Payer: Mclaren Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.35
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: Nomi Health Commercial |
$2.53
|
| Rate for Payer: Nomi Health Commercial |
$6.13
|
| Rate for Payer: Nomi Health Commercial |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| 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: UHC All Payor (Choice/PPO) + Core |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.67
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna Commercial |
$6.72
|
| Rate for Payer: Aetna Commercial |
$10.77
|
| Rate for Payer: ASR ASR |
$11.61
|
| Rate for Payer: ASR ASR |
$2.99
|
| Rate for Payer: ASR ASR |
$2.94
|
| Rate for Payer: ASR ASR |
$7.25
|
| Rate for Payer: ASR Commercial |
$2.99
|
| Rate for Payer: ASR Commercial |
$7.25
|
| Rate for Payer: ASR Commercial |
$2.94
|
| Rate for Payer: ASR Commercial |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$6.09
|
| Rate for Payer: BCBS Trust/PPO |
$9.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$5.79
|
| Rate for Payer: BCN Commercial |
$9.28
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$9.58
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Healthscope Commercial |
$11.97
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$7.47
|
| Rate for Payer: Healthscope Whirlpool |
$7.25
|
| Rate for Payer: Healthscope Whirlpool |
$2.94
|
| Rate for Payer: Healthscope Whirlpool |
$2.99
|
| Rate for Payer: Healthscope Whirlpool |
$11.61
|
| Rate for Payer: Mclaren Commercial |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$6.72
|
| Rate for Payer: Mclaren Commercial |
$2.73
|
| Rate for Payer: Mclaren Commercial |
$10.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.17
|
| Rate for Payer: Nomi Health Commercial |
$9.82
|
| Rate for Payer: Nomi Health Commercial |
$6.13
|
| Rate for Payer: Nomi Health Commercial |
$2.53
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.53
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$145.20
|
|
|
Service Code
|
NDC 50268016815
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.38 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Aetna Commercial |
$130.68
|
| Rate for Payer: ASR ASR |
$140.84
|
| Rate for Payer: ASR Commercial |
$140.84
|
| Rate for Payer: BCBS Trust/PPO |
$118.32
|
| Rate for Payer: BCN Commercial |
$112.57
|
| Rate for Payer: Cash Price |
$116.16
|
| Rate for Payer: Cofinity Commercial |
$136.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.16
|
| Rate for Payer: Healthscope Commercial |
$145.20
|
| Rate for Payer: Healthscope Whirlpool |
$140.84
|
| Rate for Payer: Mclaren Commercial |
$130.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.42
|
| Rate for Payer: Nomi Health Commercial |
$119.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.78
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$3,464.31
|
|
|
Service Code
|
NDC 00025152031
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,385.72 |
| Max. Negotiated Rate |
$3,464.31 |
| Rate for Payer: Aetna Commercial |
$3,117.88
|
| Rate for Payer: Aetna Medicare |
$1,732.16
|
| Rate for Payer: ASR ASR |
$3,360.38
|
| Rate for Payer: ASR Commercial |
$3,360.38
|
| Rate for Payer: BCBS Complete |
$1,385.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,836.92
|
| Rate for Payer: BCN Commercial |
$2,685.88
|
| Rate for Payer: Cash Price |
$2,771.45
|
| Rate for Payer: Cofinity Commercial |
$3,256.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,771.45
|
| Rate for Payer: Healthscope Commercial |
$3,464.31
|
| Rate for Payer: Healthscope Whirlpool |
$3,360.38
|
| Rate for Payer: Mclaren Commercial |
$3,117.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,944.66
|
| Rate for Payer: Nomi Health Commercial |
$2,840.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,251.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,035.43
|
| Rate for Payer: Priority Health Narrow Network |
$2,428.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,048.59
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
NDC 50268016811
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: ASR ASR |
$2.81
|
| Rate for Payer: ASR Commercial |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Healthscope Whirlpool |
$2.81
|
| Rate for Payer: Mclaren Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.54
|
| Rate for Payer: Priority Health Narrow Network |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.55
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
NDC 50268016811
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: ASR ASR |
$2.81
|
| Rate for Payer: ASR Commercial |
$2.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Healthscope Whirlpool |
$2.81
|
| Rate for Payer: Mclaren Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.55
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$3,464.31
|
|
|
Service Code
|
NDC 00025152031
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,251.80 |
| Max. Negotiated Rate |
$3,464.31 |
| Rate for Payer: Aetna Commercial |
$3,117.88
|
| Rate for Payer: ASR ASR |
$3,360.38
|
| Rate for Payer: ASR Commercial |
$3,360.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,823.07
|
| Rate for Payer: BCN Commercial |
$2,685.88
|
| Rate for Payer: Cash Price |
$2,771.45
|
| Rate for Payer: Cofinity Commercial |
$3,256.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,771.45
|
| Rate for Payer: Healthscope Commercial |
$3,464.31
|
| Rate for Payer: Healthscope Whirlpool |
$3,360.38
|
| Rate for Payer: Mclaren Commercial |
$3,117.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,944.66
|
| Rate for Payer: Nomi Health Commercial |
$2,840.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,251.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,048.59
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$145.20
|
|
|
Service Code
|
NDC 50268016815
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Aetna Commercial |
$130.68
|
| Rate for Payer: Aetna Medicare |
$72.60
|
| Rate for Payer: ASR ASR |
$140.84
|
| Rate for Payer: ASR Commercial |
$140.84
|
| Rate for Payer: BCBS Complete |
$58.08
|
| Rate for Payer: BCBS Trust/PPO |
$118.90
|
| Rate for Payer: BCN Commercial |
$112.57
|
| Rate for Payer: Cash Price |
$116.16
|
| Rate for Payer: Cofinity Commercial |
$136.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.16
|
| Rate for Payer: Healthscope Commercial |
$145.20
|
| Rate for Payer: Healthscope Whirlpool |
$140.84
|
| Rate for Payer: Mclaren Commercial |
$130.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.42
|
| Rate for Payer: Nomi Health Commercial |
$119.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.22
|
| Rate for Payer: Priority Health Narrow Network |
$101.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.78
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$365.28
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.11 |
| Max. Negotiated Rate |
$365.28 |
| Rate for Payer: Aetna Commercial |
$328.75
|
| Rate for Payer: Aetna Medicare |
$182.64
|
| Rate for Payer: ASR ASR |
$354.32
|
| Rate for Payer: ASR Commercial |
$354.32
|
| Rate for Payer: BCBS Complete |
$146.11
|
| Rate for Payer: BCBS Trust/PPO |
$299.13
|
| Rate for Payer: BCN Commercial |
$283.20
|
| Rate for Payer: Cash Price |
$292.22
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.22
|
| Rate for Payer: Healthscope Commercial |
$365.28
|
| Rate for Payer: Healthscope Whirlpool |
$354.32
|
| Rate for Payer: Mclaren Commercial |
$328.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: Nomi Health Commercial |
$299.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.06
|
| Rate for Payer: Priority Health Narrow Network |
$256.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.45
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.72 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$247.46
|
| Rate for Payer: ASR ASR |
$266.70
|
| Rate for Payer: ASR Commercial |
$266.70
|
| Rate for Payer: BCBS Trust/PPO |
$224.06
|
| Rate for Payer: BCN Commercial |
$213.17
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$258.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Healthscope Whirlpool |
$266.70
|
| Rate for Payer: Mclaren Commercial |
$247.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.96
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$345.10
|
|
|
Service Code
|
NDC 00025152034
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.32 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: ASR ASR |
$334.75
|
| Rate for Payer: ASR Commercial |
$334.75
|
| Rate for Payer: BCBS Trust/PPO |
$281.22
|
| Rate for Payer: BCN Commercial |
$267.56
|
| Rate for Payer: Cash Price |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$324.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.08
|
| Rate for Payer: Healthscope Commercial |
$345.10
|
| Rate for Payer: Healthscope Whirlpool |
$334.75
|
| Rate for Payer: Mclaren Commercial |
$310.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.34
|
| Rate for Payer: Nomi Health Commercial |
$282.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.69
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$345.10
|
|
|
Service Code
|
NDC 00025152034
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$172.55
|
| Rate for Payer: ASR ASR |
$334.75
|
| Rate for Payer: ASR Commercial |
$334.75
|
| Rate for Payer: BCBS Complete |
$138.04
|
| Rate for Payer: BCBS Trust/PPO |
$282.60
|
| Rate for Payer: BCN Commercial |
$267.56
|
| Rate for Payer: Cash Price |
$276.08
|
| Rate for Payer: Cofinity Commercial |
$324.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.08
|
| Rate for Payer: Healthscope Commercial |
$345.10
|
| Rate for Payer: Healthscope Whirlpool |
$334.75
|
| Rate for Payer: Mclaren Commercial |
$310.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.34
|
| Rate for Payer: Nomi Health Commercial |
$282.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.38
|
| Rate for Payer: Priority Health Narrow Network |
$241.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.69
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 69097042207
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.98 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$247.46
|
| Rate for Payer: Aetna Medicare |
$137.48
|
| Rate for Payer: ASR ASR |
$266.70
|
| Rate for Payer: ASR Commercial |
$266.70
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: BCBS Trust/PPO |
$225.16
|
| Rate for Payer: BCN Commercial |
$213.17
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$258.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Healthscope Whirlpool |
$266.70
|
| Rate for Payer: Mclaren Commercial |
$247.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.91
|
| Rate for Payer: Priority Health Narrow Network |
$192.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.96
|
|
|
CELECOXIB 100 MG CAPSULE
|
Facility
|
IP
|
$365.28
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.43 |
| Max. Negotiated Rate |
$365.28 |
| Rate for Payer: Aetna Commercial |
$328.75
|
| Rate for Payer: ASR ASR |
$354.32
|
| Rate for Payer: ASR Commercial |
$354.32
|
| Rate for Payer: BCBS Trust/PPO |
$297.67
|
| Rate for Payer: BCN Commercial |
$283.20
|
| Rate for Payer: Cash Price |
$292.22
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.22
|
| Rate for Payer: Healthscope Commercial |
$365.28
|
| Rate for Payer: Healthscope Whirlpool |
$354.32
|
| Rate for Payer: Mclaren Commercial |
$328.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.49
|
| Rate for Payer: Nomi Health Commercial |
$299.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.45
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
OP
|
$273.05
|
|
|
Service Code
|
NDC 09900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.22 |
| Max. Negotiated Rate |
$273.05 |
| Rate for Payer: Aetna Commercial |
$245.74
|
| Rate for Payer: Aetna Medicare |
$136.52
|
| Rate for Payer: ASR ASR |
$264.86
|
| Rate for Payer: ASR Commercial |
$264.86
|
| Rate for Payer: BCBS Complete |
$109.22
|
| Rate for Payer: BCBS Trust/PPO |
$223.60
|
| Rate for Payer: BCN Commercial |
$211.70
|
| Rate for Payer: Cash Price |
$218.44
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.44
|
| Rate for Payer: Healthscope Commercial |
$273.05
|
| Rate for Payer: Healthscope Whirlpool |
$264.86
|
| Rate for Payer: Mclaren Commercial |
$245.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.09
|
| Rate for Payer: Nomi Health Commercial |
$223.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.25
|
| Rate for Payer: Priority Health Narrow Network |
$191.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.28
|
|
|
CELLULOSE, OXIDIZED 4" X 8" PADS
|
Facility
|
IP
|
$273.05
|
|
|
Service Code
|
NDC 09900000604
|
| Hospital Charge Code |
169204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$177.48 |
| Max. Negotiated Rate |
$273.05 |
| Rate for Payer: Aetna Commercial |
$245.74
|
| Rate for Payer: ASR ASR |
$264.86
|
| Rate for Payer: ASR Commercial |
$264.86
|
| Rate for Payer: BCBS Trust/PPO |
$222.51
|
| Rate for Payer: BCN Commercial |
$211.70
|
| Rate for Payer: Cash Price |
$218.44
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.44
|
| Rate for Payer: Healthscope Commercial |
$273.05
|
| Rate for Payer: Healthscope Whirlpool |
$264.86
|
| Rate for Payer: Mclaren Commercial |
$245.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.09
|
| Rate for Payer: Nomi Health Commercial |
$223.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.28
|
|
|
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 |
$126.78 |
| Max. Negotiated Rate |
$195.05 |
| Rate for Payer: Aetna Commercial |
$175.54
|
| Rate for Payer: ASR ASR |
$189.20
|
| Rate for Payer: ASR Commercial |
$189.20
|
| Rate for Payer: BCBS Trust/PPO |
$158.95
|
| Rate for Payer: BCN Commercial |
$151.22
|
| 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 |
$195.05
|
| Rate for Payer: Healthscope Whirlpool |
$189.20
|
| 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: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.64
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$415.95
|
|
|
Service Code
|
NDC 00093417573
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.37 |
| Max. Negotiated Rate |
$415.95 |
| Rate for Payer: Aetna Commercial |
$374.36
|
| Rate for Payer: ASR ASR |
$403.47
|
| Rate for Payer: ASR Commercial |
$403.47
|
| Rate for Payer: BCBS Trust/PPO |
$338.96
|
| Rate for Payer: BCN Commercial |
$322.49
|
| 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 |
$415.95
|
| Rate for Payer: Healthscope Whirlpool |
$403.47
|
| Rate for Payer: Mclaren Commercial |
$374.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: Nomi Health Commercial |
$341.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.04
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$446.50
|
|
|
Service Code
|
NDC 68180044001
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.60 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna Commercial |
$401.85
|
| Rate for Payer: Aetna Medicare |
$223.25
|
| Rate for Payer: ASR ASR |
$433.10
|
| Rate for Payer: ASR Commercial |
$433.10
|
| Rate for Payer: BCBS Complete |
$178.60
|
| Rate for Payer: BCBS Trust/PPO |
$365.64
|
| Rate for Payer: BCN Commercial |
$346.17
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$419.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$446.50
|
| Rate for Payer: Healthscope Whirlpool |
$433.10
|
| Rate for Payer: Mclaren Commercial |
$401.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: Nomi Health Commercial |
$366.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.22
|
| Rate for Payer: Priority Health Narrow Network |
$313.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.92
|
|
|
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 |
$78.02 |
| Max. Negotiated Rate |
$195.05 |
| Rate for Payer: Aetna Commercial |
$175.54
|
| Rate for Payer: Aetna Medicare |
$97.52
|
| Rate for Payer: ASR ASR |
$189.20
|
| Rate for Payer: ASR Commercial |
$189.20
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: BCBS Trust/PPO |
$159.73
|
| Rate for Payer: BCN Commercial |
$151.22
|
| 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 |
$195.05
|
| Rate for Payer: Healthscope Whirlpool |
$189.20
|
| 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: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: 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
|
OP
|
$415.95
|
|
|
Service Code
|
NDC 00093417573
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.38 |
| Max. Negotiated Rate |
$415.95 |
| Rate for Payer: Aetna Commercial |
$374.36
|
| Rate for Payer: Aetna Medicare |
$207.98
|
| Rate for Payer: ASR ASR |
$403.47
|
| Rate for Payer: ASR Commercial |
$403.47
|
| Rate for Payer: BCBS Complete |
$166.38
|
| Rate for Payer: BCBS Trust/PPO |
$340.62
|
| Rate for Payer: BCN Commercial |
$322.49
|
| 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 |
$415.95
|
| Rate for Payer: Healthscope Whirlpool |
$403.47
|
| Rate for Payer: Mclaren Commercial |
$374.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: Nomi Health Commercial |
$341.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.37
|
| Rate for Payer: 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
|
OP
|
$4.82
|
|
|
Service Code
|
NDC 09900000408
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna Medicare |
$2.41
|
| Rate for Payer: ASR ASR |
$4.68
|
| Rate for Payer: ASR Commercial |
$4.68
|
| Rate for Payer: BCBS Complete |
$1.93
|
| Rate for Payer: BCBS Trust/PPO |
$3.95
|
| Rate for Payer: BCN Commercial |
$3.74
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cofinity Commercial |
$4.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.86
|
| Rate for Payer: Healthscope Commercial |
$4.82
|
| Rate for Payer: Healthscope Whirlpool |
$4.68
|
| 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: Priority Health Cigna Priority Health |
$3.13
|
| Rate for Payer: 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
|
IP
|
$4.82
|
|
|
Service Code
|
NDC 09900000408
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: ASR ASR |
$4.68
|
| Rate for Payer: ASR Commercial |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$3.93
|
| Rate for Payer: BCN Commercial |
$3.74
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cofinity Commercial |
$4.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.86
|
| Rate for Payer: Healthscope Commercial |
$4.82
|
| Rate for Payer: Healthscope Whirlpool |
$4.68
|
| 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: Priority Health Cigna Priority Health |
$3.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.24
|
|
