|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC
|
Facility
|
IP
|
$33,404.03
|
|
|
Service Code
|
MS-DRG 734
|
| Min. Negotiated Rate |
$15,339.21 |
| Max. Negotiated Rate |
$33,404.03 |
| Rate for Payer: Aetna Medicare |
$16,792.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,183.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,183.18
|
| Rate for Payer: BCBS MAPPO |
$16,146.54
|
| Rate for Payer: BCBS Trust/PPO |
$33,404.03
|
| Rate for Payer: BCN Medicare Advantage |
$16,146.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,146.54
|
| Rate for Payer: Mclaren Medicare |
$16,146.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,953.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,568.52
|
| Rate for Payer: PACE Medicare |
$15,339.21
|
| Rate for Payer: PACE SWMI |
$16,146.54
|
| Rate for Payer: PHP Medicare Advantage |
$16,146.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,190.99
|
| Rate for Payer: Priority Health Medicare |
$16,146.54
|
| Rate for Payer: Priority Health Narrow Network |
$24,952.79
|
| Rate for Payer: Railroad Medicare Medicare |
$16,146.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,156.09
|
| Rate for Payer: UHC Core |
$20,344.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,146.54
|
| Rate for Payer: UHC Exchange |
$21,790.34
|
| Rate for Payer: UHC Medicare Advantage |
$16,630.94
|
| Rate for Payer: VA VA |
$16,146.54
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$26,664.81
|
|
|
Service Code
|
MS-DRG 735
|
| Min. Negotiated Rate |
$9,090.01 |
| Max. Negotiated Rate |
$26,664.81 |
| Rate for Payer: Aetna Medicare |
$9,951.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,960.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,960.54
|
| Rate for Payer: BCBS MAPPO |
$9,568.43
|
| Rate for Payer: BCBS Trust/PPO |
$26,664.81
|
| Rate for Payer: BCN Medicare Advantage |
$9,568.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,568.43
|
| Rate for Payer: Mclaren Medicare |
$9,568.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,046.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,003.69
|
| Rate for Payer: PACE Medicare |
$9,090.01
|
| Rate for Payer: PACE SWMI |
$9,568.43
|
| Rate for Payer: PHP Medicare Advantage |
$9,568.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,083.77
|
| Rate for Payer: Priority Health Medicare |
$9,568.43
|
| Rate for Payer: Priority Health Narrow Network |
$14,467.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9,568.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,223.09
|
| Rate for Payer: UHC Core |
$11,795.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,568.43
|
| Rate for Payer: UHC Exchange |
$12,633.51
|
| Rate for Payer: UHC Medicare Advantage |
$9,855.48
|
| Rate for Payer: VA VA |
$9,568.43
|
|
|
PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 57410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,574.13
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.90
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$104.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,953.27
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$22,457.94 |
| Rate for Payer: Aetna Commercial |
$21,210.28
|
| Rate for Payer: Aetna Medicare |
$57.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,219.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.66
|
| Rate for Payer: BCBS Complete |
$32.01
|
| Rate for Payer: BCBS MAPPO |
$55.73
|
| Rate for Payer: BCBS Trust/PPO |
$164.99
|
| Rate for Payer: BCN Medicare Advantage |
$55.73
|
| Rate for Payer: Cash Price |
$19,962.62
|
| Rate for Payer: Cash Price |
$19,962.62
|
| Rate for Payer: Cofinity Commercial |
$21,459.81
|
| Rate for Payer: Cofinity Commercial |
$17,467.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.73
|
| Rate for Payer: Healthscope Commercial |
$22,457.94
|
| Rate for Payer: Mclaren Medicaid |
$30.48
|
| Rate for Payer: Mclaren Medicare |
$55.73
|
| Rate for Payer: Meridian Medicaid |
$32.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,210.28
|
| Rate for Payer: PACE Medicare |
$52.94
|
| Rate for Payer: PACE SWMI |
$55.73
|
| Rate for Payer: PHP Commercial |
$21,210.28
|
| Rate for Payer: PHP Medicare Advantage |
$55.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,467.29
|
| Rate for Payer: Priority Health Medicare |
$55.73
|
| Rate for Payer: Priority Health SBD |
$15,720.56
|
| Rate for Payer: Railroad Medicare Medicare |
$55.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.73
|
| Rate for Payer: UHC Medicare Advantage |
$57.40
|
| Rate for Payer: VA VA |
$55.73
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,953.27
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15,720.56 |
| Max. Negotiated Rate |
$22,457.94 |
| Rate for Payer: Aetna Commercial |
$21,210.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,219.63
|
| Rate for Payer: Cash Price |
$19,962.62
|
| Rate for Payer: Cofinity Commercial |
$17,467.29
|
| Rate for Payer: Cofinity Commercial |
$21,459.81
|
| Rate for Payer: Healthscope Commercial |
$22,457.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,210.28
|
| Rate for Payer: PHP Commercial |
$21,210.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,467.29
|
| Rate for Payer: Priority Health SBD |
$15,720.56
|
|
|
PEMETREXED DISODIUM 1,000 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$703.75
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
200483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$633.38 |
| Rate for Payer: Aetna Commercial |
$598.19
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS Trust/PPO |
$12.93
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cofinity Commercial |
$605.22
|
| Rate for Payer: Cofinity Commercial |
$492.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$633.38
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$598.19
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PHP Commercial |
$598.19
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.62
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health SBD |
$443.36
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: VA VA |
$4.37
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$2,522.85
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$2,270.56 |
| Rate for Payer: Aetna Commercial |
$2,144.42
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,639.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS Trust/PPO |
$12.93
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: Cash Price |
$2,018.28
|
| Rate for Payer: Cash Price |
$2,018.28
|
| Rate for Payer: Cofinity Commercial |
$1,766.00
|
| Rate for Payer: Cofinity Commercial |
$2,169.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$2,270.56
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,144.42
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PHP Commercial |
$2,144.42
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,766.00
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health SBD |
$1,589.40
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: VA VA |
$4.37
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$17,699.27
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
37894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,150.54 |
| Max. Negotiated Rate |
$15,929.34 |
| Rate for Payer: Aetna Commercial |
$15,044.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,504.53
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cofinity Commercial |
$15,221.37
|
| Rate for Payer: Cofinity Commercial |
$12,389.49
|
| Rate for Payer: Healthscope Commercial |
$15,929.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,044.38
|
| Rate for Payer: PHP Commercial |
$15,044.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,389.49
|
| Rate for Payer: Priority Health SBD |
$11,150.54
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$17,699.27
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
37894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$15,929.34 |
| Rate for Payer: Aetna Commercial |
$15,044.38
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,504.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS Trust/PPO |
$12.93
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cofinity Commercial |
$12,389.49
|
| Rate for Payer: Cofinity Commercial |
$15,221.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$15,929.34
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicare |
$4.37
|
| Rate for Payer: Meridian Medicaid |
$2.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,044.38
|
| Rate for Payer: PACE Medicare |
$4.15
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PHP Commercial |
$15,044.38
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,389.49
|
| Rate for Payer: Priority Health Medicare |
$4.37
|
| Rate for Payer: Priority Health SBD |
$11,150.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: VA VA |
$4.37
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$915.30
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$576.64 |
| Max. Negotiated Rate |
$823.77 |
| Rate for Payer: Aetna Commercial |
$778.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$594.94
|
| Rate for Payer: Cash Price |
$732.24
|
| Rate for Payer: Cofinity Commercial |
$640.71
|
| Rate for Payer: Cofinity Commercial |
$787.16
|
| Rate for Payer: Healthscope Commercial |
$823.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$778.00
|
| Rate for Payer: PHP Commercial |
$778.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.71
|
| Rate for Payer: Priority Health SBD |
$576.64
|
|
|
PENICILLIN G IV 16,000 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$162.50
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna Commercial |
$138.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.62
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cofinity Commercial |
$113.75
|
| Rate for Payer: Cofinity Commercial |
$139.75
|
| Rate for Payer: Healthscope Commercial |
$146.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.12
|
| Rate for Payer: PHP Commercial |
$138.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health SBD |
$102.38
|
|
|
PENICILLIN G IV 1,600 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$18.75
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.19
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.94
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.12
|
| Rate for Payer: Priority Health SBD |
$11.81
|
|
|
PENICILLIN G IV 160 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$6.25
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.31
|
| Rate for Payer: PHP Commercial |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.38
|
| Rate for Payer: Priority Health SBD |
$3.94
|
|
|
PENICILLIN G IV 3 MILLION UNITS IVPB 100 ML (IV PREMIX)
|
Facility
|
IP
|
$82.80
|
|
|
Service Code
|
NDC 9900-0001-60
|
| Hospital Charge Code |
500537
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.82
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Commercial |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.38
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.96
|
| Rate for Payer: Priority Health SBD |
$52.16
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$99.82
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.89 |
| Max. Negotiated Rate |
$89.84 |
| Rate for Payer: Aetna Commercial |
$84.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.88
|
| Rate for Payer: Cash Price |
$79.86
|
| Rate for Payer: Cofinity Commercial |
$69.87
|
| Rate for Payer: Cofinity Commercial |
$85.85
|
| Rate for Payer: Healthscope Commercial |
$89.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.85
|
| Rate for Payer: PHP Commercial |
$84.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.87
|
| Rate for Payer: Priority Health SBD |
$62.89
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$18.34
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.92
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Healthscope Commercial |
$16.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.59
|
| Rate for Payer: PHP Commercial |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health SBD |
$11.55
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 0093-4127-73
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.31 |
| Max. Negotiated Rate |
$129.02 |
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Healthscope Commercial |
$129.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.85
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.34
|
| Rate for Payer: Priority Health SBD |
$90.31
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
IP
|
$244.32
|
|
|
Service Code
|
NDC 0781-1205-01
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.92 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.81
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Commercial |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$210.12
|
| Rate for Payer: Healthscope Commercial |
$219.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.67
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.02
|
| Rate for Payer: Priority Health SBD |
$153.92
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 65862-175-01
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.64
|
| Rate for Payer: Priority Health SBD |
$93.27
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 57237-040-01
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.04 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.81
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.38
|
| Rate for Payer: Priority Health SBD |
$111.04
|
|
|
PENIS PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$34,155.03
|
|
|
Service Code
|
MS-DRG 709
|
| Min. Negotiated Rate |
$15,320.06 |
| Max. Negotiated Rate |
$34,155.03 |
| Rate for Payer: Aetna Medicare |
$16,771.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,157.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,157.98
|
| Rate for Payer: BCBS MAPPO |
$16,126.38
|
| Rate for Payer: BCBS Trust/PPO |
$34,155.03
|
| Rate for Payer: BCN Medicare Advantage |
$16,126.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,126.38
|
| Rate for Payer: Mclaren Medicare |
$16,126.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,932.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,545.34
|
| Rate for Payer: PACE Medicare |
$15,320.06
|
| Rate for Payer: PACE SWMI |
$16,126.38
|
| Rate for Payer: PHP Medicare Advantage |
$16,126.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,421.83
|
| Rate for Payer: Priority Health Medicare |
$16,126.38
|
| Rate for Payer: Priority Health Narrow Network |
$24,337.46
|
| Rate for Payer: Railroad Medicare Medicare |
$16,126.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,338.48
|
| Rate for Payer: UHC Core |
$19,843.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,126.38
|
| Rate for Payer: UHC Exchange |
$21,253.00
|
| Rate for Payer: UHC Medicare Advantage |
$16,610.17
|
| Rate for Payer: VA VA |
$16,126.38
|
|
|
PENIS PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,828.01
|
|
|
Service Code
|
MS-DRG 710
|
| Min. Negotiated Rate |
$9,343.82 |
| Max. Negotiated Rate |
$18,828.01 |
| Rate for Payer: Aetna Medicare |
$10,229.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,294.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,294.50
|
| Rate for Payer: BCBS MAPPO |
$9,835.60
|
| Rate for Payer: BCBS Trust/PPO |
$11,273.75
|
| Rate for Payer: BCN Medicare Advantage |
$9,835.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,835.60
|
| Rate for Payer: Mclaren Medicare |
$9,835.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,327.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,310.94
|
| Rate for Payer: PACE Medicare |
$9,343.82
|
| Rate for Payer: PACE SWMI |
$9,835.60
|
| Rate for Payer: PHP Medicare Advantage |
$9,835.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,712.11
|
| Rate for Payer: Priority Health Medicare |
$9,835.60
|
| Rate for Payer: Priority Health Narrow Network |
$14,169.69
|
| Rate for Payer: Railroad Medicare Medicare |
$9,835.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,828.01
|
| Rate for Payer: UHC Core |
$11,553.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,835.60
|
| Rate for Payer: UHC Exchange |
$12,373.86
|
| Rate for Payer: UHC Medicare Advantage |
$10,130.67
|
| Rate for Payer: VA VA |
$9,835.60
|
|
|
PENTAMIDINE 300 MG IM INJECTION
|
Facility
|
IP
|
$168.58
|
|
|
Service Code
|
NDC 63323-113-10
|
| Hospital Charge Code |
299999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$106.21 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.01
|
| Rate for Payer: Priority Health SBD |
$106.21
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$574.28
|
|
|
Service Code
|
NDC 63323-877-15
|
| Hospital Charge Code |
28235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$361.80 |
| Max. Negotiated Rate |
$516.85 |
| Rate for Payer: Aetna Commercial |
$488.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.28
|
| Rate for Payer: Cash Price |
$459.42
|
| Rate for Payer: Cofinity Commercial |
$402.00
|
| Rate for Payer: Cofinity Commercial |
$493.88
|
| Rate for Payer: Healthscope Commercial |
$516.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$488.14
|
| Rate for Payer: PHP Commercial |
$488.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.00
|
| Rate for Payer: Priority Health SBD |
$361.80
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$347.95
|
|
|
Service Code
|
NDC 13925-522-01
|
| Hospital Charge Code |
28235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$219.21 |
| Max. Negotiated Rate |
$313.16 |
| Rate for Payer: Aetna Commercial |
$295.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.17
|
| Rate for Payer: Cash Price |
$278.36
|
| Rate for Payer: Cofinity Commercial |
$243.56
|
| Rate for Payer: Cofinity Commercial |
$299.24
|
| Rate for Payer: Healthscope Commercial |
$313.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$295.76
|
| Rate for Payer: PHP Commercial |
$295.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.56
|
| Rate for Payer: Priority Health SBD |
$219.21
|
|
