|
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
|
$2.74
|
|
|
Service Code
|
NDC 50268015111
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: ASR ASR |
$2.66
|
| Rate for Payer: ASR Commercial |
$2.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.23
|
| 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: UHC All Payor (Choice/PPO) + Core |
$2.41
|
|
|
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
|
IP
|
$258.40
|
|
|
Service Code
|
NDC 00904733661
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.96 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: ASR ASR |
$250.65
|
| Rate for Payer: ASR Commercial |
$250.65
|
| Rate for Payer: BCBS Trust/PPO |
$210.57
|
| 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: UHC All Payor (Choice/PPO) + Core |
$227.39
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$324.30
|
|
|
Service Code
|
NDC 67877021901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.79 |
| Max. Negotiated Rate |
$324.30 |
| Rate for Payer: Aetna Commercial |
$291.87
|
| Rate for Payer: ASR ASR |
$314.57
|
| Rate for Payer: ASR Commercial |
$314.57
|
| Rate for Payer: BCBS Trust/PPO |
$264.27
|
| Rate for Payer: BCN Commercial |
$251.43
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$304.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$324.30
|
| Rate for Payer: Healthscope Whirlpool |
$314.57
|
| Rate for Payer: Mclaren Commercial |
$291.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.38
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 50268015211
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: ASR ASR |
$2.48
|
| Rate for Payer: ASR Commercial |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$2.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Healthscope Whirlpool |
$2.48
|
| Rate for Payer: Mclaren Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.25
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 00904733735
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$1.17
|
| Rate for Payer: ASR ASR |
$2.26
|
| Rate for Payer: ASR Commercial |
$2.26
|
| Rate for Payer: BCBS Complete |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Healthscope Whirlpool |
$2.26
|
| Rate for Payer: Mclaren Commercial |
$2.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$1.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.04
|
| Rate for Payer: Priority Health Narrow Network |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.05
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$254.60
|
|
|
Service Code
|
NDC 68180012201
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.84 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: ASR ASR |
$246.96
|
| Rate for Payer: ASR Commercial |
$246.96
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: BCBS Trust/PPO |
$208.49
|
| Rate for Payer: BCN Commercial |
$197.39
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$239.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$254.60
|
| Rate for Payer: Healthscope Whirlpool |
$246.96
|
| Rate for Payer: Mclaren Commercial |
$229.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.41
|
| Rate for Payer: Nomi Health Commercial |
$208.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.08
|
| Rate for Payer: Priority Health Narrow Network |
$178.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.05
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 00093314701
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.35 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Aetna Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$187.06
|
| Rate for Payer: ASR Commercial |
$187.06
|
| Rate for Payer: BCBS Trust/PPO |
$157.15
|
| Rate for Payer: BCN Commercial |
$149.52
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$181.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$192.85
|
| Rate for Payer: Healthscope Whirlpool |
$187.06
|
| Rate for Payer: Mclaren Commercial |
$173.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.71
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$116.38
|
|
|
Service Code
|
NDC 00904733706
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$116.38 |
| Rate for Payer: Aetna Commercial |
$104.74
|
| Rate for Payer: ASR ASR |
$112.89
|
| Rate for Payer: ASR Commercial |
$112.89
|
| Rate for Payer: BCBS Trust/PPO |
$94.84
|
| Rate for Payer: BCN Commercial |
$90.23
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: Cofinity Commercial |
$109.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.10
|
| Rate for Payer: Healthscope Commercial |
$116.38
|
| Rate for Payer: Healthscope Whirlpool |
$112.89
|
| Rate for Payer: Mclaren Commercial |
$104.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.92
|
| Rate for Payer: Nomi Health Commercial |
$95.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.41
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.36 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna Commercial |
$115.42
|
| Rate for Payer: ASR ASR |
$124.40
|
| Rate for Payer: ASR Commercial |
$124.40
|
| Rate for Payer: BCBS Trust/PPO |
$104.51
|
| Rate for Payer: BCN Commercial |
$99.43
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$120.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$128.25
|
| Rate for Payer: Healthscope Whirlpool |
$124.40
|
| Rate for Payer: Mclaren Commercial |
$115.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: Nomi Health Commercial |
$105.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.86
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 00904733735
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: ASR ASR |
$2.26
|
| Rate for Payer: ASR Commercial |
$2.26
|
| Rate for Payer: BCBS Trust/PPO |
$1.90
|
| Rate for Payer: BCN Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Healthscope Whirlpool |
$2.26
|
| Rate for Payer: Mclaren Commercial |
$2.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$1.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.05
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 50268015211
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: ASR ASR |
$2.48
|
| Rate for Payer: ASR Commercial |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$2.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Healthscope Whirlpool |
$2.48
|
| Rate for Payer: Mclaren Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.24
|
| Rate for Payer: Priority Health Narrow Network |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.25
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$254.60
|
|
|
Service Code
|
NDC 68180012201
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: ASR ASR |
$246.96
|
| Rate for Payer: ASR Commercial |
$246.96
|
| Rate for Payer: BCBS Trust/PPO |
$207.47
|
| Rate for Payer: BCN Commercial |
$197.39
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$239.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$254.60
|
| Rate for Payer: Healthscope Whirlpool |
$246.96
|
| Rate for Payer: Mclaren Commercial |
$229.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.41
|
| Rate for Payer: Nomi Health Commercial |
$208.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.05
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$116.38
|
|
|
Service Code
|
NDC 00904733706
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.55 |
| Max. Negotiated Rate |
$116.38 |
| Rate for Payer: Aetna Commercial |
$104.74
|
| Rate for Payer: Aetna Medicare |
$58.19
|
| Rate for Payer: ASR ASR |
$112.89
|
| Rate for Payer: ASR Commercial |
$112.89
|
| Rate for Payer: BCBS Complete |
$46.55
|
| Rate for Payer: BCBS Trust/PPO |
$95.30
|
| Rate for Payer: BCN Commercial |
$90.23
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: Cofinity Commercial |
$109.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.10
|
| Rate for Payer: Healthscope Commercial |
$116.38
|
| Rate for Payer: Healthscope Whirlpool |
$112.89
|
| Rate for Payer: Mclaren Commercial |
$104.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.92
|
| Rate for Payer: Nomi Health Commercial |
$95.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.97
|
| Rate for Payer: Priority Health Narrow Network |
$81.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.41
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 00093314701
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Aetna Commercial |
$173.56
|
| Rate for Payer: Aetna Medicare |
$96.42
|
| Rate for Payer: ASR ASR |
$187.06
|
| Rate for Payer: ASR Commercial |
$187.06
|
| Rate for Payer: BCBS Complete |
$77.14
|
| Rate for Payer: BCBS Trust/PPO |
$157.92
|
| Rate for Payer: BCN Commercial |
$149.52
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$181.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$192.85
|
| Rate for Payer: Healthscope Whirlpool |
$187.06
|
| Rate for Payer: Mclaren Commercial |
$173.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.98
|
| Rate for Payer: Priority Health Narrow Network |
$135.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.71
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$128.25
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna Commercial |
$115.42
|
| Rate for Payer: Aetna Medicare |
$64.12
|
| Rate for Payer: ASR ASR |
$124.40
|
| Rate for Payer: ASR Commercial |
$124.40
|
| Rate for Payer: BCBS Complete |
$51.30
|
| Rate for Payer: BCBS Trust/PPO |
$105.02
|
| Rate for Payer: BCN Commercial |
$99.43
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$120.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$128.25
|
| Rate for Payer: Healthscope Whirlpool |
$124.40
|
| Rate for Payer: Mclaren Commercial |
$115.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: Nomi Health Commercial |
$105.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.37
|
| Rate for Payer: Priority Health Narrow Network |
$89.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.86
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$324.30
|
|
|
Service Code
|
NDC 67877021901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$324.30 |
| Rate for Payer: Aetna Commercial |
$291.87
|
| Rate for Payer: Aetna Medicare |
$162.15
|
| Rate for Payer: ASR ASR |
$314.57
|
| Rate for Payer: ASR Commercial |
$314.57
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS Trust/PPO |
$265.57
|
| Rate for Payer: BCN Commercial |
$251.43
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$304.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$324.30
|
| Rate for Payer: Healthscope Whirlpool |
$314.57
|
| Rate for Payer: Mclaren Commercial |
$291.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.15
|
| Rate for Payer: Priority Health Narrow Network |
$227.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.38
|
|
|
CHEMICAL PEELS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 00172
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
Both
|
$1,748.00
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$444.32 |
| Max. Negotiated Rate |
$1,136.20 |
| Rate for Payer: Aetna Commercial |
$595.39
|
| Rate for Payer: Aetna Commercial |
$595.39
|
| Rate for Payer: Aetna Medicare |
$444.32
|
| Rate for Payer: Aetna Medicare |
$444.32
|
| Rate for Payer: BCBS Complete |
$549.20
|
| Rate for Payer: BCBS Complete |
$699.20
|
| Rate for Payer: BCBS MAPPO |
$444.32
|
| Rate for Payer: BCBS MAPPO |
$444.32
|
| Rate for Payer: BCN Medicare Advantage |
$444.32
|
| Rate for Payer: BCN Medicare Advantage |
$444.32
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,398.40
|
| Rate for Payer: Cofinity Commercial |
$595.39
|
| Rate for Payer: Cofinity Commercial |
$639.82
|
| Rate for Payer: Cofinity Commercial |
$595.39
|
| Rate for Payer: Cofinity Commercial |
$639.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.32
|
| Rate for Payer: Healthscope Commercial |
$533.18
|
| Rate for Payer: Healthscope Commercial |
$533.18
|
| Rate for Payer: Healthscope Whirlpool |
$533.18
|
| Rate for Payer: Healthscope Whirlpool |
$533.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.54
|
| Rate for Payer: Nomi Health Commercial |
$533.18
|
| Rate for Payer: Nomi Health Commercial |
$533.18
|
| Rate for Payer: PACE SWMI |
$444.32
|
| Rate for Payer: PACE SWMI |
$444.32
|
| Rate for Payer: PHP Medicare Advantage |
$444.32
|
| Rate for Payer: PHP Medicare Advantage |
$444.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.20
|
| Rate for Payer: Priority Health Medicare |
$444.32
|
| Rate for Payer: Priority Health Medicare |
$444.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.32
|
| Rate for Payer: UHC Medicare Advantage |
$444.32
|
| Rate for Payer: UHC Medicare Advantage |
$444.32
|
| Rate for Payer: UHCCP DNSP |
$444.32
|
| Rate for Payer: UHCCP DNSP |
$444.32
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$97.71
|
| Rate for Payer: Aetna Medicare |
$72.92
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$72.92
|
| Rate for Payer: BCN Medicare Advantage |
$72.92
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$97.71
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.92
|
| Rate for Payer: Healthscope Commercial |
$87.50
|
| Rate for Payer: Healthscope Whirlpool |
$87.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.57
|
| Rate for Payer: Nomi Health Commercial |
$87.50
|
| Rate for Payer: PACE SWMI |
$72.92
|
| Rate for Payer: PHP Medicare Advantage |
$72.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health Medicare |
$72.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.92
|
| Rate for Payer: UHC Medicare Advantage |
$72.92
|
| Rate for Payer: UHCCP DNSP |
$72.92
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Aetna Commercial |
$31.41
|
| Rate for Payer: Aetna Commercial |
$31.41
|
| Rate for Payer: Aetna Medicare |
$23.44
|
| Rate for Payer: Aetna Medicare |
$23.44
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$23.44
|
| Rate for Payer: BCBS MAPPO |
$23.44
|
| Rate for Payer: BCN Medicare Advantage |
$23.44
|
| Rate for Payer: BCN Medicare Advantage |
$23.44
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$33.75
|
| Rate for Payer: Cofinity Commercial |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$33.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.44
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.61
|
| Rate for Payer: Nomi Health Commercial |
$28.13
|
| Rate for Payer: Nomi Health Commercial |
$28.13
|
| Rate for Payer: PACE SWMI |
$23.44
|
| Rate for Payer: PACE SWMI |
$23.44
|
| Rate for Payer: PHP Medicare Advantage |
$23.44
|
| Rate for Payer: PHP Medicare Advantage |
$23.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Medicare |
$23.44
|
| Rate for Payer: Priority Health Medicare |
$23.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.44
|
| Rate for Payer: UHC Medicare Advantage |
$23.44
|
| Rate for Payer: UHC Medicare Advantage |
$23.44
|
| Rate for Payer: UHCCP DNSP |
$23.44
|
| Rate for Payer: UHCCP DNSP |
$23.44
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 78278
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$445.90 |
| Rate for Payer: Aetna Commercial |
$374.82
|
| Rate for Payer: Aetna Medicare |
$279.72
|
| Rate for Payer: BCBS Complete |
$274.40
|
| Rate for Payer: BCBS MAPPO |
$279.72
|
| Rate for Payer: BCN Medicare Advantage |
$279.72
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$402.80
|
| Rate for Payer: Cofinity Commercial |
$374.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.72
|
| Rate for Payer: Healthscope Commercial |
$335.66
|
| Rate for Payer: Healthscope Whirlpool |
$335.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.71
|
| Rate for Payer: Nomi Health Commercial |
$335.66
|
| Rate for Payer: PACE SWMI |
$279.72
|
| Rate for Payer: PHP Medicare Advantage |
$279.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health Medicare |
$279.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.72
|
| Rate for Payer: UHC Medicare Advantage |
$279.72
|
| Rate for Payer: UHCCP DNSP |
$279.72
|
|
|
CHG ANGIO ARCH ANGIOGRAM W CATH
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 75650
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.55
|
|
|
CHG ANGIO AV SHUNT COMPLETE EVAL
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 75791
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: Aetna Medicare |
$253.50
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS Complete |
$202.80
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
|
