|
AMPICILLIN 250 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$14.65
|
|
|
Service Code
|
NDC 00781340295
|
| Hospital Charge Code |
473
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$13.19 |
| Rate for Payer: Aetna Commercial |
$12.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.52
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$10.26
|
| Rate for Payer: Cofinity Commercial |
$12.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.72
|
| Rate for Payer: Healthscope Commercial |
$13.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.45
|
| Rate for Payer: PHP Commercial |
$12.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.52
|
| Rate for Payer: Priority Health SBD |
$9.23
|
|
|
AMPICILLIN 250 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$14.65
|
|
|
Service Code
|
NDC 00781340295
|
| Hospital Charge Code |
473
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$13.19 |
| Rate for Payer: Aetna Commercial |
$12.45
|
| Rate for Payer: Aetna Medicare |
$7.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.52
|
| Rate for Payer: BCBS Complete |
$5.86
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$10.26
|
| Rate for Payer: Cofinity Commercial |
$12.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.72
|
| Rate for Payer: Healthscope Commercial |
$13.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.45
|
| Rate for Payer: PHP Commercial |
$12.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.52
|
| Rate for Payer: Priority Health SBD |
$9.23
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$47.49
|
| Rate for Payer: Aetna Commercial |
$20.36
|
| Rate for Payer: Aetna Commercial |
$25.02
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna Medicare |
$8.89
|
| Rate for Payer: Aetna Medicare |
$27.93
|
| Rate for Payer: Aetna Medicare |
$11.97
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.75
|
| Rate for Payer: BCBS Complete |
$11.77
|
| Rate for Payer: BCBS Complete |
$6.81
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$7.11
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: BCBS Complete |
$22.35
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$44.70
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$19.16
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cofinity Commercial |
$12.45
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$48.05
|
| Rate for Payer: Cofinity Commercial |
$39.11
|
| Rate for Payer: Cofinity Commercial |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$20.60
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$16.77
|
| Rate for Payer: Cofinity Commercial |
$20.60
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$11.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Healthscope Commercial |
$21.55
|
| Rate for Payer: Healthscope Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$50.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: PHP Commercial |
$20.36
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: PHP Commercial |
$25.02
|
| Rate for Payer: PHP Commercial |
$47.49
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.57
|
| Rate for Payer: Priority Health SBD |
$18.54
|
| Rate for Payer: Priority Health SBD |
$11.20
|
| Rate for Payer: Priority Health SBD |
$35.20
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$10.73
|
| Rate for Payer: Priority Health SBD |
$9.45
|
| Rate for Payer: Priority Health SBD |
$15.09
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$29.43
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Aetna Commercial |
$25.02
|
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$20.36
|
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Commercial |
$47.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.57
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$19.16
|
| Rate for Payer: Cash Price |
$44.70
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$39.11
|
| Rate for Payer: Cofinity Commercial |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$12.45
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$16.77
|
| Rate for Payer: Cofinity Commercial |
$20.60
|
| Rate for Payer: Cofinity Commercial |
$20.60
|
| Rate for Payer: Cofinity Commercial |
$48.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Healthscope Commercial |
$21.55
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$50.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.49
|
| Rate for Payer: PHP Commercial |
$25.02
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: PHP Commercial |
$20.36
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: PHP Commercial |
$47.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.07
|
| Rate for Payer: Priority Health SBD |
$15.09
|
| Rate for Payer: Priority Health SBD |
$10.73
|
| Rate for Payer: Priority Health SBD |
$35.20
|
| Rate for Payer: Priority Health SBD |
$9.45
|
| Rate for Payer: Priority Health SBD |
$11.20
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$18.54
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$17.03
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cofinity Commercial |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.48
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.07
|
| Rate for Payer: Priority Health SBD |
$10.73
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$17.03
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: BCBS Complete |
$6.81
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cofinity Commercial |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.62
|
| Rate for Payer: Healthscope Commercial |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.48
|
| Rate for Payer: PHP Commercial |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.07
|
| Rate for Payer: Priority Health SBD |
$10.73
|
|
|
AMPICILLIN 500 MG/5 ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.59
|
|
|
AMPICILLIN 500 MG/5 ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.59
|
|
|
AMPICILLIN 500 MG IM
|
Facility
|
OP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.59
|
|
|
AMPICILLIN 500 MG IM
|
Facility
|
IP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.59
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$10.44
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Aetna Commercial |
$8.87
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Cofinity Commercial |
$8.98
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.35
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Healthscope Commercial |
$9.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.87
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.58
|
| Rate for Payer: Priority Health SBD |
$6.59
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$10.44
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Aetna Commercial |
$8.87
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Commercial |
$8.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.87
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.79
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: Priority Health SBD |
$6.58
|
|
|
AMPICILLIN IV 0.0004 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
IP
|
$0.63
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna Commercial |
$0.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.41
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cofinity Commercial |
$0.44
|
| Rate for Payer: Cofinity Commercial |
$0.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.50
|
| Rate for Payer: Healthscope Commercial |
$0.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.54
|
| Rate for Payer: PHP Commercial |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.41
|
| Rate for Payer: Priority Health SBD |
$0.40
|
|
|
AMPICILLIN IV 0.0004 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna Commercial |
$0.54
|
| Rate for Payer: Aetna Medicare |
$0.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.41
|
| Rate for Payer: BCBS Complete |
$0.25
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cofinity Commercial |
$0.44
|
| Rate for Payer: Cofinity Commercial |
$0.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.50
|
| Rate for Payer: Healthscope Commercial |
$0.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.54
|
| Rate for Payer: PHP Commercial |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.41
|
| Rate for Payer: Priority Health SBD |
$0.40
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$28.86
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Commercial |
$16.75
|
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Cofinity Commercial |
$18.85
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$24.07
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Commercial |
$16.75
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health SBD |
$17.84
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$18.18
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$17.83
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$16.75
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Aetna Medicare |
$14.53
|
| Rate for Payer: Aetna Medicare |
$14.16
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna Medicare |
$8.91
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: BCBS Complete |
$10.77
|
| Rate for Payer: BCBS Complete |
$7.13
|
| Rate for Payer: BCBS Complete |
$11.33
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cofinity Commercial |
$18.85
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$24.07
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: PHP Commercial |
$16.75
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.41
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: Priority Health SBD |
$17.84
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$28.86
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health SBD |
$18.18
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$28.86
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health SBD |
$18.18
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$26.96
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$24.26 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$30.96
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cofinity Commercial |
$25.45
|
| Rate for Payer: Cofinity Commercial |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$20.48
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Cofinity Commercial |
$22.46
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Cofinity Commercial |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$28.88
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: PHP Commercial |
$30.96
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$16.36
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: Priority Health SBD |
$18.43
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health SBD |
$16.98
|
| Rate for Payer: Priority Health SBD |
$15.86
|
| Rate for Payer: Priority Health SBD |
$12.13
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$22.91
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$32.09
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.84 |
| Max. Negotiated Rate |
$28.88 |
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Aetna Commercial |
$30.96
|
| Rate for Payer: Aetna Medicare |
$9.62
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna Medicare |
$14.63
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna Medicare |
$18.21
|
| Rate for Payer: Aetna Medicare |
$18.33
|
| Rate for Payer: Aetna Medicare |
$16.05
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: BCBS Complete |
$12.84
|
| Rate for Payer: BCBS Complete |
$14.57
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS Complete |
$11.70
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: BCBS Complete |
$14.54
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$20.48
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Cofinity Commercial |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$22.46
|
| Rate for Payer: Cofinity Commercial |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$25.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Healthscope Commercial |
$28.88
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: PHP Commercial |
$30.96
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$16.36
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.63
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: Priority Health SBD |
$18.43
|
| Rate for Payer: Priority Health SBD |
$22.91
|
| Rate for Payer: Priority Health SBD |
$12.13
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$16.98
|
| Rate for Payer: Priority Health SBD |
$15.86
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health SBD |
$22.94
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$25.17
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health SBD |
$15.86
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$25.17
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health SBD |
$15.86
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
IP
|
$28.86
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health SBD |
$18.18
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
OP
|
$28.86
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health SBD |
$18.18
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH DIRECT CLOSURE
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,781.56
|
| Rate for Payer: VA VA |
$3,164.40
|
|
