|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$53.57
|
|
|
Service Code
|
NDC 42571016242
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$48.21 |
| Rate for Payer: Aetna Commercial |
$45.53
|
| Rate for Payer: Aetna Medicare |
$26.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.82
|
| Rate for Payer: BCBS Complete |
$21.43
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Advantage |
$37.50
|
| Rate for Payer: Cofinity Commercial |
$46.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$48.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.18
|
| Rate for Payer: PHP Commercial |
$45.53
|
| Rate for Payer: Priority Health SBD |
$33.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.82
|
| Rate for Payer: UHC Core |
$27.91
|
| Rate for Payer: UHC Exchange |
$21.05
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$101.86
|
|
|
Service Code
|
NDC 66685100100
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.17 |
| Max. Negotiated Rate |
$91.67 |
| Rate for Payer: Aetna Commercial |
$86.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.21
|
| Rate for Payer: Cash Price |
$81.49
|
| Rate for Payer: Cofinity Advantage |
$71.30
|
| Rate for Payer: Cofinity Commercial |
$87.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.49
|
| Rate for Payer: Healthscope Commercial |
$91.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.39
|
| Rate for Payer: PHP Commercial |
$86.58
|
| Rate for Payer: Priority Health SBD |
$64.17
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$63.27
|
|
|
Service Code
|
NDC 00093227534
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$56.94 |
| Rate for Payer: Aetna Commercial |
$53.78
|
| Rate for Payer: Aetna Medicare |
$31.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.13
|
| Rate for Payer: BCBS Complete |
$25.31
|
| Rate for Payer: Cash Price |
$50.62
|
| Rate for Payer: Cofinity Advantage |
$44.29
|
| Rate for Payer: Cofinity Commercial |
$54.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.62
|
| Rate for Payer: Healthscope Commercial |
$56.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.45
|
| Rate for Payer: PHP Commercial |
$53.78
|
| Rate for Payer: Priority Health SBD |
$39.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.13
|
| Rate for Payer: UHC Core |
$32.96
|
| Rate for Payer: UHC Exchange |
$24.87
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$63.27
|
|
|
Service Code
|
NDC 00093227534
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$56.94 |
| Rate for Payer: Aetna Commercial |
$53.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.13
|
| Rate for Payer: Cash Price |
$50.62
|
| Rate for Payer: Cofinity Advantage |
$44.29
|
| Rate for Payer: Cofinity Commercial |
$54.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.62
|
| Rate for Payer: Healthscope Commercial |
$56.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.45
|
| Rate for Payer: PHP Commercial |
$53.78
|
| Rate for Payer: Priority Health SBD |
$39.86
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION
|
Facility
|
IP
|
$351.42
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
21900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$221.39 |
| Max. Negotiated Rate |
$316.28 |
| Rate for Payer: Aetna Commercial |
$298.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.42
|
| Rate for Payer: Cash Price |
$281.14
|
| Rate for Payer: Cofinity Advantage |
$245.99
|
| Rate for Payer: Cofinity Commercial |
$302.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.14
|
| Rate for Payer: Healthscope Commercial |
$316.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.56
|
| Rate for Payer: PHP Commercial |
$298.71
|
| Rate for Payer: Priority Health SBD |
$221.39
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$351.42
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
21900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$316.28 |
| Rate for Payer: Aetna Commercial |
$298.71
|
| Rate for Payer: Aetna Medicare |
$23.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.51
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS MAPPO |
$22.81
|
| Rate for Payer: BCBS Trust/PPO |
$51.98
|
| Rate for Payer: BCN Commercial |
$51.98
|
| Rate for Payer: BCN Medicare Advantage |
$22.81
|
| Rate for Payer: Cash Price |
$281.14
|
| Rate for Payer: Cash Price |
$281.14
|
| Rate for Payer: Cofinity Advantage |
$245.99
|
| Rate for Payer: Cofinity Commercial |
$302.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.81
|
| Rate for Payer: Healthscope Commercial |
$316.28
|
| Rate for Payer: Mclaren Medicaid |
$11.93
|
| Rate for Payer: Mclaren Medicare |
$22.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.95
|
| Rate for Payer: Meridian Medicaid |
$23.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.71
|
| Rate for Payer: Nomi Health Commercial |
$68.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.56
|
| Rate for Payer: PACE Medicare |
$21.67
|
| Rate for Payer: PACE SWMI |
$22.81
|
| Rate for Payer: PHP Commercial |
$298.71
|
| Rate for Payer: PHP Medicare Advantage |
$22.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$67.76
|
| Rate for Payer: Priority Health Medicare |
$22.81
|
| Rate for Payer: Priority Health SBD |
$221.39
|
| Rate for Payer: Priority Health Tiered Network |
$54.21
|
| Rate for Payer: Railroad Medicare Medicare |
$22.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.19
|
| Rate for Payer: UHC Core |
$34.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.81
|
| Rate for Payer: UHC Exchange |
$34.19
|
| Rate for Payer: UHC Medicaid |
$11.93
|
| Rate for Payer: UHCCP Medicaid |
$11.93
|
| Rate for Payer: VA VA |
$22.81
|
|
|
AMPICILLIN 1 GRAM CUSTOM SOLUTION FOR INJECTION (CHARGE IN INCREMENTS)
|
Facility
|
OP
|
$23.55
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Medicare |
$11.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Advantage |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
|
|
AMPICILLIN 1 GRAM CUSTOM SOLUTION FOR INJECTION (CHARGE IN INCREMENTS)
|
Facility
|
IP
|
$23.55
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Advantage |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health SBD |
$14.84
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$22.39
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.29
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cofinity Advantage |
$15.67
|
| Rate for Payer: Cofinity Advantage |
$10.01
|
| Rate for Payer: Cofinity Advantage |
$20.01
|
| Rate for Payer: Cofinity Advantage |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$24.59
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Commercial |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$18.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.37
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: PHP Commercial |
$12.15
|
| Rate for Payer: PHP Commercial |
$24.30
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: Priority Health SBD |
$18.01
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: Priority Health SBD |
$9.01
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$20.49
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: Aetna Medicare |
$10.24
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: Aetna Medicare |
$7.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: BCBS Complete |
$11.44
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS Complete |
$5.72
|
| Rate for Payer: BCBS Complete |
$8.96
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cofinity Advantage |
$20.01
|
| Rate for Payer: Cofinity Advantage |
$10.01
|
| Rate for Payer: Cofinity Advantage |
$15.67
|
| Rate for Payer: Cofinity Advantage |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$24.59
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Commercial |
$18.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.44
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: PHP Commercial |
$24.30
|
| Rate for Payer: PHP Commercial |
$12.15
|
| Rate for Payer: Priority Health SBD |
$9.01
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: Priority Health SBD |
$18.01
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
|
|
AMPICILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$20.49
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cofinity Advantage |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$18.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.37
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: Priority Health SBD |
$12.91
|
|
|
AMPICILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$20.49
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna Medicare |
$10.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cofinity Advantage |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$18.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.37
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
|
|
AMPICILLIN 250 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$14.95
|
|
|
Service Code
|
NDC 00781340295
|
| Hospital Charge Code |
473
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$13.46 |
| Rate for Payer: Aetna Commercial |
$12.71
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.72
|
| Rate for Payer: BCBS Complete |
$5.98
|
| Rate for Payer: Cash Price |
$11.96
|
| Rate for Payer: Cofinity Advantage |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$12.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.96
|
| Rate for Payer: Healthscope Commercial |
$13.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.21
|
| Rate for Payer: PHP Commercial |
$12.71
|
| Rate for Payer: Priority Health SBD |
$9.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.72
|
| Rate for Payer: UHC Core |
$7.79
|
| Rate for Payer: UHC Exchange |
$5.88
|
|
|
AMPICILLIN 250 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$14.95
|
|
|
Service Code
|
NDC 00781340295
|
| Hospital Charge Code |
473
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$13.46 |
| Rate for Payer: Aetna Commercial |
$12.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.72
|
| Rate for Payer: Cash Price |
$11.96
|
| Rate for Payer: Cofinity Advantage |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$12.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.96
|
| Rate for Payer: Healthscope Commercial |
$13.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.21
|
| Rate for Payer: PHP Commercial |
$12.71
|
| Rate for Payer: Priority Health SBD |
$9.42
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$17.42
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$15.68 |
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Commercial |
$13.34
|
| Rate for Payer: Aetna Commercial |
$23.51
|
| Rate for Payer: Aetna Commercial |
$25.02
|
| Rate for Payer: Aetna Commercial |
$47.49
|
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Commercial |
$15.51
|
| Rate for Payer: Aetna Medicare |
$12.03
|
| Rate for Payer: Aetna Medicare |
$10.22
|
| Rate for Payer: Aetna Medicare |
$7.84
|
| Rate for Payer: Aetna Medicare |
$8.71
|
| Rate for Payer: Aetna Medicare |
$9.12
|
| Rate for Payer: Aetna Medicare |
$27.93
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna Medicare |
$13.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.98
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Complete |
$11.77
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS Complete |
$7.30
|
| Rate for Payer: BCBS Complete |
$11.06
|
| Rate for Payer: BCBS Complete |
$6.28
|
| Rate for Payer: BCBS Complete |
$22.35
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cash Price |
$44.70
|
| Rate for Payer: Cash Price |
$44.70
|
| Rate for Payer: Cofinity Advantage |
$10.98
|
| Rate for Payer: Cofinity Advantage |
$19.36
|
| Rate for Payer: Cofinity Advantage |
$12.78
|
| Rate for Payer: Cofinity Advantage |
$39.11
|
| Rate for Payer: Cofinity Advantage |
$12.19
|
| Rate for Payer: Cofinity Advantage |
$14.31
|
| Rate for Payer: Cofinity Advantage |
$16.84
|
| Rate for Payer: Cofinity Advantage |
$20.60
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$48.05
|
| Rate for Payer: Cofinity Commercial |
$23.79
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Cofinity Commercial |
$15.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.13
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$50.28
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.33
|
| Rate for Payer: PHP Commercial |
$15.51
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: PHP Commercial |
$13.34
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: PHP Commercial |
$25.02
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: PHP Commercial |
$47.49
|
| Rate for Payer: PHP Commercial |
$23.51
|
| Rate for Payer: Priority Health SBD |
$10.97
|
| Rate for Payer: Priority Health SBD |
$35.20
|
| Rate for Payer: Priority Health SBD |
$17.43
|
| Rate for Payer: Priority Health SBD |
$11.50
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: Priority Health SBD |
$18.54
|
| Rate for Payer: Priority Health SBD |
$9.88
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$27.66
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$23.51
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Commercial |
$47.49
|
| Rate for Payer: Aetna Commercial |
$25.02
|
| Rate for Payer: Aetna Commercial |
$13.34
|
| Rate for Payer: Aetna Commercial |
$15.51
|
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Cash Price |
$44.70
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cofinity Advantage |
$20.60
|
| Rate for Payer: Cofinity Advantage |
$39.11
|
| Rate for Payer: Cofinity Advantage |
$16.84
|
| Rate for Payer: Cofinity Advantage |
$12.19
|
| Rate for Payer: Cofinity Advantage |
$19.36
|
| Rate for Payer: Cofinity Advantage |
$10.98
|
| Rate for Payer: Cofinity Advantage |
$14.31
|
| Rate for Payer: Cofinity Advantage |
$12.78
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Cofinity Commercial |
$15.70
|
| Rate for Payer: Cofinity Commercial |
$23.79
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Cofinity Commercial |
$48.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.35
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$50.28
|
| Rate for Payer: Healthscope Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$16.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.69
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: PHP Commercial |
$47.49
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: PHP Commercial |
$25.02
|
| Rate for Payer: PHP Commercial |
$13.34
|
| Rate for Payer: PHP Commercial |
$23.51
|
| Rate for Payer: PHP Commercial |
$15.51
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: Priority Health SBD |
$9.88
|
| Rate for Payer: Priority Health SBD |
$17.43
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: Priority Health SBD |
$11.50
|
| Rate for Payer: Priority Health SBD |
$18.54
|
| Rate for Payer: Priority Health SBD |
$35.20
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: Priority Health SBD |
$10.97
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$15.69
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Aetna Commercial |
$13.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cofinity Advantage |
$10.98
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.77
|
| Rate for Payer: PHP Commercial |
$13.34
|
| Rate for Payer: Priority Health SBD |
$9.88
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$15.69
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Aetna Commercial |
$13.34
|
| Rate for Payer: Aetna Medicare |
$7.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: BCBS Complete |
$6.28
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cofinity Advantage |
$10.98
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.77
|
| Rate for Payer: PHP Commercial |
$13.34
|
| Rate for Payer: Priority Health SBD |
$9.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
|
|
AMPICILLIN 500 MG IM
|
Facility
|
OP
|
$10.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: BCBS Complete |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cofinity Advantage |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$9.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.01
|
| Rate for Payer: PHP Commercial |
$9.08
|
| Rate for Payer: Priority Health SBD |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
|
|
AMPICILLIN 500 MG IM
|
Facility
|
IP
|
$10.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cofinity Advantage |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$9.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.01
|
| Rate for Payer: PHP Commercial |
$9.08
|
| Rate for Payer: Priority Health SBD |
$6.73
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$10.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: BCBS Complete |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cofinity Advantage |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$9.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.01
|
| Rate for Payer: PHP Commercial |
$9.08
|
| Rate for Payer: Priority Health SBD |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$10.68
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna Commercial |
$9.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: Cash Price |
$8.54
|
| Rate for Payer: Cofinity Advantage |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$9.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$9.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.01
|
| Rate for Payer: PHP Commercial |
$9.08
|
| Rate for Payer: Priority Health SBD |
$6.73
|
|
|
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 Advantage |
$0.44
|
| Rate for Payer: Cofinity Commercial |
$0.54
|
| 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: Opus (Opus Packaging Group) HMA |
$0.47
|
| Rate for Payer: PHP Commercial |
$0.54
|
| 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 |
$1.48 |
| 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: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cofinity Advantage |
$0.44
|
| Rate for Payer: Cofinity Commercial |
$0.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.50
|
| Rate for Payer: Healthscope Commercial |
$0.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.47
|
| Rate for Payer: PHP Commercial |
$0.54
|
| Rate for Payer: Priority Health SBD |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$28.32
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$25.49 |
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Advantage |
$18.85
|
| Rate for Payer: Cofinity Advantage |
$20.20
|
| Rate for Payer: Cofinity Advantage |
$21.95
|
| Rate for Payer: Cofinity Advantage |
$13.97
|
| Rate for Payer: Cofinity Advantage |
$19.82
|
| Rate for Payer: Cofinity Advantage |
$14.94
|
| Rate for Payer: Cofinity Advantage |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| 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 |
$25.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$19.21
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Commercial |
$28.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: PHP Commercial |
$24.07
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$26.65
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$18.14
|
| Rate for Payer: Priority Health SBD |
$17.84
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: Priority Health SBD |
$13.44
|
| Rate for Payer: Priority Health SBD |
$19.75
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$11.23
|
|
