|
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 |
$1.89
|
| 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
|
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 |
$137.47
|
| 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
|
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 |
$293.33
|
| Rate for Payer: Nomi Health Commercial |
$282.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.31
|
| 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
|
$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
|
$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
|
IP
|
$345.10
|
|
|
Service Code
|
NDC 00025152034
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.31 |
| 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 |
$293.33
|
| Rate for Payer: Nomi Health Commercial |
$282.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.69
|
|
|
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 |
$1,732.15
|
| 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
|
|
|
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 |
$245.75
|
| 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 |
$245.75
|
| 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
|
|
|
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 |
$245.75
|
| Rate for Payer: Aetna Medicare |
$136.53
|
| 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 |
$245.75
|
| 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
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$446.50
|
|
|
Service Code
|
NDC 68180044001
|
| Hospital Charge Code |
9501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$290.23 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna Commercial |
$401.85
|
| Rate for Payer: ASR ASR |
$433.11
|
| Rate for Payer: ASR Commercial |
$433.11
|
| Rate for Payer: BCBS Trust/PPO |
$363.85
|
| 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 |
$433.11
|
| 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 |
$290.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.92
|
|
|
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 |
$207.97
|
| 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
|
$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 |
$433.11
|
| Rate for Payer: ASR Commercial |
$433.11
|
| 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 |
$433.11
|
| 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 |
$290.23
|
| 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
|
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
|
|
|
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 |
$97.53
|
| 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
|
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 250 MG CAPSULE
|
Facility
|
OP
|
$258.40
|
|
|
Service Code
|
NDC 00904733661
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.36 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$129.20
|
| Rate for Payer: ASR ASR |
$250.65
|
| Rate for Payer: ASR Commercial |
$250.65
|
| Rate for Payer: BCBS Complete |
$103.36
|
| Rate for Payer: BCBS Trust/PPO |
$211.60
|
| Rate for Payer: BCN Commercial |
$200.34
|
| Rate for Payer: Cash Price |
$206.72
|
| Rate for Payer: Cofinity Commercial |
$242.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.72
|
| Rate for Payer: Healthscope Commercial |
$258.40
|
| Rate for Payer: Healthscope Whirlpool |
$250.65
|
| Rate for Payer: Mclaren Commercial |
$232.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.64
|
| Rate for Payer: Nomi Health Commercial |
$211.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.41
|
| Rate for Payer: Priority Health Narrow Network |
$181.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.39
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
NDC 60687015211
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Aetna Medicare |
$1.42
|
| Rate for Payer: ASR ASR |
$2.75
|
| Rate for Payer: ASR Commercial |
$2.75
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Healthscope Whirlpool |
$2.75
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.49
|
| Rate for Payer: Priority Health Narrow Network |
$1.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.50
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 50268015111
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: ASR ASR |
$2.66
|
| Rate for Payer: ASR Commercial |
$2.66
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Healthscope Whirlpool |
$2.66
|
| Rate for Payer: Mclaren Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Nomi Health Commercial |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.40
|
| Rate for Payer: Priority Health Narrow Network |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.41
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 00093314501
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$289.05 |
| Rate for Payer: Aetna Commercial |
$260.14
|
| Rate for Payer: ASR ASR |
$280.38
|
| Rate for Payer: ASR Commercial |
$280.38
|
| Rate for Payer: BCBS Trust/PPO |
$235.55
|
| Rate for Payer: BCN Commercial |
$224.10
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$271.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$289.05
|
| Rate for Payer: Healthscope Whirlpool |
$280.38
|
| Rate for Payer: Mclaren Commercial |
$260.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Nomi Health Commercial |
$237.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.36
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$136.80
|
|
|
Service Code
|
NDC 50268015115
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: ASR ASR |
$132.70
|
| Rate for Payer: ASR Commercial |
$132.70
|
| Rate for Payer: BCBS Trust/PPO |
$111.48
|
| Rate for Payer: BCN Commercial |
$106.06
|
| Rate for Payer: Cash Price |
$109.44
|
| Rate for Payer: Cofinity Commercial |
$128.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.44
|
| Rate for Payer: Healthscope Commercial |
$136.80
|
| Rate for Payer: Healthscope Whirlpool |
$132.70
|
| Rate for Payer: Mclaren Commercial |
$123.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.28
|
| Rate for Payer: Nomi Health Commercial |
$112.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.38
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
IP
|
$284.05
|
|
|
Service Code
|
NDC 60687015201
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.63 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Aetna Commercial |
$255.65
|
| Rate for Payer: ASR ASR |
$275.53
|
| Rate for Payer: ASR Commercial |
$275.53
|
| Rate for Payer: BCBS Trust/PPO |
$231.47
|
| Rate for Payer: BCN Commercial |
$220.22
|
| Rate for Payer: Cash Price |
$227.24
|
| Rate for Payer: Cofinity Commercial |
$267.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.24
|
| Rate for Payer: Healthscope Commercial |
$284.05
|
| Rate for Payer: Healthscope Whirlpool |
$275.53
|
| Rate for Payer: Mclaren Commercial |
$255.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.44
|
| Rate for Payer: Nomi Health Commercial |
$232.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.96
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$136.80
|
|
|
Service Code
|
NDC 50268015115
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.72 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna Medicare |
$68.40
|
| Rate for Payer: ASR ASR |
$132.70
|
| Rate for Payer: ASR Commercial |
$132.70
|
| Rate for Payer: BCBS Complete |
$54.72
|
| Rate for Payer: BCBS Trust/PPO |
$112.03
|
| Rate for Payer: BCN Commercial |
$106.06
|
| Rate for Payer: Cash Price |
$109.44
|
| Rate for Payer: Cofinity Commercial |
$128.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.44
|
| Rate for Payer: Healthscope Commercial |
$136.80
|
| Rate for Payer: Healthscope Whirlpool |
$132.70
|
| Rate for Payer: Mclaren Commercial |
$123.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.28
|
| Rate for Payer: Nomi Health Commercial |
$112.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.86
|
| Rate for Payer: Priority Health Narrow Network |
$95.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.38
|
|
|
CEPHALEXIN 250 MG CAPSULE
|
Facility
|
OP
|
$284.05
|
|
|
Service Code
|
NDC 60687015201
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Aetna Commercial |
$255.65
|
| Rate for Payer: Aetna Medicare |
$142.03
|
| Rate for Payer: ASR ASR |
$275.53
|
| Rate for Payer: ASR Commercial |
$275.53
|
| Rate for Payer: BCBS Complete |
$113.62
|
| Rate for Payer: BCBS Trust/PPO |
$232.61
|
| Rate for Payer: BCN Commercial |
$220.22
|
| Rate for Payer: Cash Price |
$227.24
|
| Rate for Payer: Cofinity Commercial |
$267.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.24
|
| Rate for Payer: Healthscope Commercial |
$284.05
|
| Rate for Payer: Healthscope Whirlpool |
$275.53
|
| Rate for Payer: Mclaren Commercial |
$255.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.44
|
| Rate for Payer: Nomi Health Commercial |
$232.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.88
|
| Rate for Payer: Priority Health Narrow Network |
$199.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.96
|
|
