|
PHYTONADIONE (VITAMIN K1) 1,000 MCG CAPSULE
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 510501050
|
| Hospital Charge Code |
196288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.78 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.14
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.53
|
| Rate for Payer: Priority Health SBD |
$168.78
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$95.39
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$85.85 |
| Rate for Payer: Aetna Commercial |
$81.08
|
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.82
|
| Rate for Payer: Cash Price |
$76.31
|
| Rate for Payer: Cash Price |
$84.79
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Commercial |
$91.15
|
| Rate for Payer: Cofinity Commercial |
$66.77
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Cofinity Commercial |
$74.19
|
| Rate for Payer: Cofinity Commercial |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Healthscope Commercial |
$95.39
|
| Rate for Payer: Healthscope Commercial |
$85.85
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.09
|
| Rate for Payer: PHP Commercial |
$90.09
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: PHP Commercial |
$81.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.19
|
| Rate for Payer: Priority Health SBD |
$52.16
|
| Rate for Payer: Priority Health SBD |
$66.77
|
| Rate for Payer: Priority Health SBD |
$60.10
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
108266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Commercial |
$23.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.12
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$23.98
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$25.09
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.60
|
| Rate for Payer: PHP Commercial |
$23.70
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.49
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$17.56
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
IP
|
$4,014.87
|
|
|
Service Code
|
NDC 69238-1051-3
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,529.37 |
| Max. Negotiated Rate |
$3,613.38 |
| Rate for Payer: Aetna Commercial |
$3,412.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,609.67
|
| Rate for Payer: Cash Price |
$3,211.90
|
| Rate for Payer: Cofinity Commercial |
$2,810.41
|
| Rate for Payer: Cofinity Commercial |
$3,452.79
|
| Rate for Payer: Healthscope Commercial |
$3,613.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,412.64
|
| Rate for Payer: PHP Commercial |
$3,412.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,810.41
|
| Rate for Payer: Priority Health SBD |
$2,529.37
|
|
|
PILOCARPINE 1 % EYE DROPS
|
Facility
|
IP
|
$134.35
|
|
|
Service Code
|
NDC 61314-203-15
|
| Hospital Charge Code |
6279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.64 |
| Max. Negotiated Rate |
$120.92 |
| Rate for Payer: Aetna Commercial |
$114.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.33
|
| Rate for Payer: Cash Price |
$107.48
|
| Rate for Payer: Cofinity Commercial |
$115.54
|
| Rate for Payer: Cofinity Commercial |
$94.04
|
| Rate for Payer: Healthscope Commercial |
$120.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.20
|
| Rate for Payer: PHP Commercial |
$114.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.04
|
| Rate for Payer: Priority Health SBD |
$84.64
|
|
|
PILOCARPINE 1 % EYE DROPS
|
Facility
|
IP
|
$304.61
|
|
|
Service Code
|
NDC 0998-0203-15
|
| Hospital Charge Code |
6279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.90 |
| Max. Negotiated Rate |
$274.15 |
| Rate for Payer: Aetna Commercial |
$258.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.00
|
| Rate for Payer: Cash Price |
$243.69
|
| Rate for Payer: Cofinity Commercial |
$213.23
|
| Rate for Payer: Cofinity Commercial |
$261.96
|
| Rate for Payer: Healthscope Commercial |
$274.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.92
|
| Rate for Payer: PHP Commercial |
$258.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.23
|
| Rate for Payer: Priority Health SBD |
$191.90
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
IP
|
$133.25
|
|
|
Service Code
|
NDC 61314-204-15
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.95 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.61
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$114.60
|
| Rate for Payer: Cofinity Commercial |
$93.28
|
| Rate for Payer: Healthscope Commercial |
$119.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.26
|
| Rate for Payer: PHP Commercial |
$113.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.28
|
| Rate for Payer: Priority Health SBD |
$83.95
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
IP
|
$209.95
|
|
|
Service Code
|
NDC 69238-1746-8
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.27 |
| Max. Negotiated Rate |
$188.96 |
| Rate for Payer: Aetna Commercial |
$178.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.47
|
| Rate for Payer: Cash Price |
$167.96
|
| Rate for Payer: Cofinity Commercial |
$146.96
|
| Rate for Payer: Cofinity Commercial |
$180.56
|
| Rate for Payer: Healthscope Commercial |
$188.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.46
|
| Rate for Payer: PHP Commercial |
$178.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.96
|
| Rate for Payer: Priority Health SBD |
$132.27
|
|
|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
IP
|
$311.54
|
|
|
Service Code
|
NDC 0998-0204-15
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.27 |
| Max. Negotiated Rate |
$280.39 |
| Rate for Payer: Aetna Commercial |
$264.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.50
|
| Rate for Payer: Cash Price |
$249.23
|
| Rate for Payer: Cofinity Commercial |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$267.92
|
| Rate for Payer: Healthscope Commercial |
$280.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$264.81
|
| Rate for Payer: PHP Commercial |
$264.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.08
|
| Rate for Payer: Priority Health SBD |
$196.27
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$1,337.11
|
|
|
Service Code
|
NDC 64764-151-04
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$842.38 |
| Max. Negotiated Rate |
$1,203.40 |
| Rate for Payer: Aetna Commercial |
$1,136.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.12
|
| Rate for Payer: Cash Price |
$1,069.69
|
| Rate for Payer: Cofinity Commercial |
$1,149.91
|
| Rate for Payer: Cofinity Commercial |
$935.98
|
| Rate for Payer: Healthscope Commercial |
$1,203.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,136.54
|
| Rate for Payer: PHP Commercial |
$1,136.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$935.98
|
| Rate for Payer: Priority Health SBD |
$842.38
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$264.38
|
|
|
Service Code
|
NDC 16729-020-15
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.56 |
| Max. Negotiated Rate |
$237.94 |
| Rate for Payer: Aetna Commercial |
$224.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.85
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cofinity Commercial |
$185.07
|
| Rate for Payer: Cofinity Commercial |
$227.37
|
| Rate for Payer: Healthscope Commercial |
$237.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.72
|
| Rate for Payer: PHP Commercial |
$224.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.07
|
| Rate for Payer: Priority Health SBD |
$166.56
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$58.52
|
|
|
Service Code
|
NDC 16729-020-10
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.87 |
| Max. Negotiated Rate |
$52.67 |
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.04
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Cofinity Commercial |
$40.96
|
| Rate for Payer: Cofinity Commercial |
$50.33
|
| Rate for Payer: Healthscope Commercial |
$52.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.74
|
| Rate for Payer: PHP Commercial |
$49.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.96
|
| Rate for Payer: Priority Health SBD |
$36.87
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$542.88
|
|
|
Service Code
|
NDC 51079-513-20
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$342.01 |
| Max. Negotiated Rate |
$488.59 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.87
|
| Rate for Payer: Cash Price |
$434.30
|
| Rate for Payer: Cofinity Commercial |
$380.02
|
| Rate for Payer: Cofinity Commercial |
$466.88
|
| Rate for Payer: Healthscope Commercial |
$488.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$461.45
|
| Rate for Payer: PHP Commercial |
$461.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.02
|
| Rate for Payer: Priority Health SBD |
$342.01
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$459.84
|
|
|
Service Code
|
NDC 60687-391-01
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.70 |
| Max. Negotiated Rate |
$413.86 |
| Rate for Payer: Aetna Commercial |
$390.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.90
|
| Rate for Payer: Cash Price |
$367.87
|
| Rate for Payer: Cofinity Commercial |
$321.89
|
| Rate for Payer: Cofinity Commercial |
$395.46
|
| Rate for Payer: Healthscope Commercial |
$413.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$390.86
|
| Rate for Payer: PHP Commercial |
$390.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.89
|
| Rate for Payer: Priority Health SBD |
$289.70
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$74.39
|
|
|
Service Code
|
NDC 0093-7271-56
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.87 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Aetna Commercial |
$63.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.35
|
| Rate for Payer: Cash Price |
$59.51
|
| Rate for Payer: Cofinity Commercial |
$52.07
|
| Rate for Payer: Cofinity Commercial |
$63.98
|
| Rate for Payer: Healthscope Commercial |
$66.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.23
|
| Rate for Payer: PHP Commercial |
$63.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.07
|
| Rate for Payer: Priority Health SBD |
$46.87
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$5.43
|
|
|
Service Code
|
NDC 51079-513-01
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$4.89 |
| Rate for Payer: Aetna Commercial |
$4.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.53
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.67
|
| Rate for Payer: Healthscope Commercial |
$4.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.62
|
| Rate for Payer: PHP Commercial |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.80
|
| Rate for Payer: Priority Health SBD |
$3.42
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 60687-391-11
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.99
|
| Rate for Payer: Cash Price |
$3.68
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$4.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.91
|
| Rate for Payer: PHP Commercial |
$3.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health SBD |
$2.90
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.46
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Aetna Commercial |
$14.84
|
| Rate for Payer: Aetna Commercial |
$15.42
|
| Rate for Payer: Aetna Commercial |
$21.19
|
| Rate for Payer: Aetna Commercial |
$21.13
|
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.16
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cash Price |
$14.51
|
| Rate for Payer: Cash Price |
$14.91
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$12.70
|
| Rate for Payer: Cofinity Commercial |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$21.44
|
| Rate for Payer: Cofinity Commercial |
$12.22
|
| Rate for Payer: Cofinity Commercial |
$13.05
|
| Rate for Payer: Cofinity Commercial |
$16.03
|
| Rate for Payer: Cofinity Commercial |
$17.45
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Healthscope Commercial |
$22.44
|
| Rate for Payer: Healthscope Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$22.37
|
| Rate for Payer: Healthscope Commercial |
$14.87
|
| Rate for Payer: Healthscope Commercial |
$16.33
|
| Rate for Payer: Healthscope Commercial |
$16.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.04
|
| Rate for Payer: PHP Commercial |
$14.84
|
| Rate for Payer: PHP Commercial |
$15.42
|
| Rate for Payer: PHP Commercial |
$14.04
|
| Rate for Payer: PHP Commercial |
$21.19
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: PHP Commercial |
$21.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.40
|
| Rate for Payer: Priority Health SBD |
$10.41
|
| Rate for Payer: Priority Health SBD |
$15.66
|
| Rate for Payer: Priority Health SBD |
$11.43
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: Priority Health SBD |
$15.71
|
| Rate for Payer: Priority Health SBD |
$11.00
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.23
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Commercial |
$15.56
|
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Commercial |
$30.08
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.00
|
| Rate for Payer: Cash Price |
$28.31
|
| Rate for Payer: Cash Price |
$20.87
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Cofinity Commercial |
$14.08
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Cofinity Commercial |
$12.81
|
| Rate for Payer: Cofinity Commercial |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$13.65
|
| Rate for Payer: Cofinity Commercial |
$16.77
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$22.44
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$23.48
|
| Rate for Payer: Healthscope Commercial |
$16.47
|
| Rate for Payer: Healthscope Commercial |
$19.07
|
| Rate for Payer: Healthscope Commercial |
$31.85
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: Healthscope Commercial |
$14.73
|
| Rate for Payer: Healthscope Commercial |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.58
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: PHP Commercial |
$15.56
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$30.08
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.77
|
| Rate for Payer: Priority Health SBD |
$11.53
|
| Rate for Payer: Priority Health SBD |
$10.31
|
| Rate for Payer: Priority Health SBD |
$13.35
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: Priority Health SBD |
$12.28
|
| Rate for Payer: Priority Health SBD |
$22.30
|
| Rate for Payer: Priority Health SBD |
$16.44
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$159.58
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
12587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.54 |
| Max. Negotiated Rate |
$143.62 |
| Rate for Payer: Aetna Commercial |
$135.64
|
| Rate for Payer: Aetna Commercial |
$167.81
|
| Rate for Payer: Aetna Commercial |
$158.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.32
|
| Rate for Payer: Cash Price |
$157.94
|
| Rate for Payer: Cash Price |
$127.66
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cofinity Commercial |
$137.24
|
| Rate for Payer: Cofinity Commercial |
$111.71
|
| Rate for Payer: Cofinity Commercial |
$169.78
|
| Rate for Payer: Cofinity Commercial |
$138.19
|
| Rate for Payer: Cofinity Commercial |
$130.37
|
| Rate for Payer: Cofinity Commercial |
$160.17
|
| Rate for Payer: Healthscope Commercial |
$167.62
|
| Rate for Payer: Healthscope Commercial |
$143.62
|
| Rate for Payer: Healthscope Commercial |
$177.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.81
|
| Rate for Payer: PHP Commercial |
$167.81
|
| Rate for Payer: PHP Commercial |
$158.30
|
| Rate for Payer: PHP Commercial |
$135.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.37
|
| Rate for Payer: Priority Health SBD |
$117.33
|
| Rate for Payer: Priority Health SBD |
$100.54
|
| Rate for Payer: Priority Health SBD |
$124.37
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.90
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Aetna Commercial |
$23.07
|
| Rate for Payer: Aetna Commercial |
$18.34
|
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.64
|
| Rate for Payer: Cash Price |
$21.71
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$17.26
|
| Rate for Payer: Cofinity Commercial |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$16.25
|
| Rate for Payer: Cofinity Commercial |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Cofinity Commercial |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.34
|
| Rate for Payer: Healthscope Commercial |
$17.01
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Healthscope Commercial |
$24.43
|
| Rate for Payer: Healthscope Commercial |
$19.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.07
|
| Rate for Payer: PHP Commercial |
$18.34
|
| Rate for Payer: PHP Commercial |
$23.07
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.00
|
| Rate for Payer: Priority Health SBD |
$16.82
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: Priority Health SBD |
$11.91
|
|
|
PIPERACILLIN-TAZOBACTAM (ZOSYN) 13.5 GRAM /560 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
IP
|
$99.68
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$89.71 |
| Rate for Payer: Aetna Commercial |
$84.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.79
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cofinity Commercial |
$69.78
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Healthscope Commercial |
$89.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.73
|
| Rate for Payer: PHP Commercial |
$84.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.78
|
| Rate for Payer: Priority Health SBD |
$62.80
|
|
|
PLACEMENT, ENTEROSTOMY OR CECOSTOMY, TUBE OPEN (EG, FOR FEEDING OR DECOMPRESSION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$3,138.00
|
|
|
Service Code
|
CPT 44300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$828.43 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: BCBS Trust/PPO |
$1,716.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$911.27
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$828.43
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 46020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.60 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,598.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,122.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,122.94
|
| Rate for Payer: BCBS Complete |
$1,435.05
|
| Rate for Payer: BCBS MAPPO |
$2,498.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,522.21
|
| Rate for Payer: BCN Medicare Advantage |
$2,498.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,498.35
|
| Rate for Payer: Mclaren Medicaid |
$1,366.60
|
| Rate for Payer: Mclaren Medicare |
$2,498.35
|
| Rate for Payer: Meridian Medicaid |
$1,435.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,623.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,873.10
|
| Rate for Payer: PACE Medicare |
$2,373.43
|
| Rate for Payer: PACE SWMI |
$2,498.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,498.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,366.60
|
| Rate for Payer: Priority Health Medicare |
$2,498.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,498.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.06
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,498.35
|
| Rate for Payer: UHC Exchange |
$114.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,573.30
|
| Rate for Payer: VA VA |
$2,498.35
|
|
|
PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; PRIMARY OR SIMPLE
|
Facility
|
OP
|
$15,835.74
|
|
|
Service Code
|
CPT 42500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$342.83 |
| Max. Negotiated Rate |
$15,835.74 |
| Rate for Payer: Aetna Medicare |
$5,419.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,513.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,513.48
|
| Rate for Payer: BCBS Complete |
$2,993.07
|
| Rate for Payer: BCBS MAPPO |
$5,210.78
|
| Rate for Payer: BCBS Trust/PPO |
$915.15
|
| Rate for Payer: BCN Medicare Advantage |
$5,210.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,210.78
|
| Rate for Payer: Mclaren Medicaid |
$2,850.30
|
| Rate for Payer: Mclaren Medicare |
$5,210.78
|
| Rate for Payer: Meridian Medicaid |
$2,993.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,471.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,992.40
|
| Rate for Payer: PACE Medicare |
$4,950.24
|
| Rate for Payer: PACE SWMI |
$5,210.78
|
| Rate for Payer: PHP Medicare Advantage |
$5,210.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,850.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,835.74
|
| Rate for Payer: Priority Health Medicare |
$5,210.78
|
| Rate for Payer: Priority Health Narrow Network |
$12,668.59
|
| Rate for Payer: Railroad Medicare Medicare |
$5,210.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.11
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,210.78
|
| Rate for Payer: UHC Exchange |
$342.83
|
| Rate for Payer: UHC Medicare Advantage |
$5,367.10
|
| Rate for Payer: VA VA |
$5,210.78
|
|
