|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$79,931.78
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,000.22 |
| Max. Negotiated Rate |
$71,938.60 |
| Rate for Payer: Aetna Commercial |
$67,942.01
|
| Rate for Payer: Aetna Medicare |
$3,977.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51,955.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,780.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,780.65
|
| Rate for Payer: BCBS Complete |
$2,100.43
|
| Rate for Payer: BCBS MAPPO |
$3,824.52
|
| Rate for Payer: BCBS Trust/PPO |
$9,455.39
|
| Rate for Payer: BCN Commercial |
$9,455.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,824.52
|
| Rate for Payer: Cash Price |
$63,945.42
|
| Rate for Payer: Cash Price |
$63,945.42
|
| Rate for Payer: Cofinity Advantage |
$55,952.25
|
| Rate for Payer: Cofinity Commercial |
$68,741.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63,945.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,824.52
|
| Rate for Payer: Healthscope Commercial |
$71,938.60
|
| Rate for Payer: Mclaren Medicaid |
$2,000.22
|
| Rate for Payer: Mclaren Medicare |
$3,824.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,015.75
|
| Rate for Payer: Meridian Medicaid |
$4,015.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,398.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,206.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67,942.01
|
| Rate for Payer: Nomi Health Commercial |
$11,473.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59,948.83
|
| Rate for Payer: PACE Medicare |
$3,633.29
|
| Rate for Payer: PACE SWMI |
$3,824.52
|
| Rate for Payer: PHP Commercial |
$67,942.01
|
| Rate for Payer: PHP Medicare Advantage |
$3,824.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,000.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,546.15
|
| Rate for Payer: Priority Health Medicare |
$3,824.52
|
| Rate for Payer: Priority Health SBD |
$50,357.02
|
| Rate for Payer: Priority Health Tiered Network |
$9,236.92
|
| Rate for Payer: Railroad Medicare Medicare |
$3,824.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,218.54
|
| Rate for Payer: UHC Core |
$6,218.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,824.52
|
| Rate for Payer: UHC Exchange |
$6,218.54
|
| Rate for Payer: UHC Medicaid |
$2,000.22
|
| Rate for Payer: UHCCP Medicaid |
$2,000.22
|
| Rate for Payer: VA VA |
$3,824.52
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC
|
Facility
|
IP
|
$35,608.25
|
|
|
Service Code
|
MSDRG 734
|
| Min. Negotiated Rate |
$16,188.12 |
| Max. Negotiated Rate |
$35,608.25 |
| Rate for Payer: Aetna Medicare |
$17,721.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,300.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,300.16
|
| Rate for Payer: BCBS MAPPO |
$17,040.13
|
| Rate for Payer: BCBS Trust/PPO |
$35,608.25
|
| Rate for Payer: BCN Commercial |
$35,608.25
|
| Rate for Payer: BCN Medicare Advantage |
$17,040.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,040.13
|
| Rate for Payer: Mclaren Medicare |
$17,040.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,892.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,596.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,744.14
|
| Rate for Payer: Nomi Health Commercial |
$27,477.00
|
| Rate for Payer: PACE Medicare |
$16,188.12
|
| Rate for Payer: PACE SWMI |
$17,040.13
|
| Rate for Payer: PHP Medicare Advantage |
$17,040.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,340.16
|
| Rate for Payer: Priority Health Medicare |
$17,040.13
|
| Rate for Payer: Priority Health Tiered Network |
$27,472.12
|
| Rate for Payer: Railroad Medicare Medicare |
$17,040.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,719.00
|
| Rate for Payer: UHC Core |
$29,046.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,040.13
|
| Rate for Payer: UHC Exchange |
$23,721.81
|
| Rate for Payer: VA VA |
$17,040.13
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$28,424.33
|
|
|
Service Code
|
MSDRG 735
|
| Min. Negotiated Rate |
$10,428.47 |
| Max. Negotiated Rate |
$28,424.33 |
| Rate for Payer: Aetna Medicare |
$11,416.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,721.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,721.67
|
| Rate for Payer: BCBS MAPPO |
$10,977.34
|
| Rate for Payer: BCBS Trust/PPO |
$28,424.33
|
| Rate for Payer: BCN Commercial |
$28,424.33
|
| Rate for Payer: BCN Medicare Advantage |
$10,977.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,977.34
|
| Rate for Payer: Mclaren Medicare |
$10,977.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,526.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,623.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,075.07
|
| Rate for Payer: Nomi Health Commercial |
$17,356.95
|
| Rate for Payer: PACE Medicare |
$10,428.47
|
| Rate for Payer: PACE SWMI |
$10,977.34
|
| Rate for Payer: PHP Medicare Advantage |
$10,977.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,692.34
|
| Rate for Payer: Priority Health Medicare |
$10,977.34
|
| Rate for Payer: Priority Health Tiered Network |
$17,353.87
|
| Rate for Payer: Railroad Medicare Medicare |
$10,977.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,931.65
|
| Rate for Payer: UHC Core |
$18,348.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,977.34
|
| Rate for Payer: UHC Exchange |
$14,984.83
|
| Rate for Payer: VA VA |
$10,977.34
|
|
|
PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.26
|
| Rate for Payer: BCN Commercial |
$2,076.26
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27,010.41
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.03 |
| Max. Negotiated Rate |
$24,309.37 |
| Rate for Payer: Aetna Commercial |
$22,958.85
|
| Rate for Payer: Aetna Medicare |
$63.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,556.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.56
|
| Rate for Payer: BCBS Complete |
$33.64
|
| Rate for Payer: BCBS MAPPO |
$61.25
|
| Rate for Payer: BCBS Trust/PPO |
$149.84
|
| Rate for Payer: BCN Commercial |
$149.84
|
| Rate for Payer: BCN Medicare Advantage |
$61.25
|
| Rate for Payer: Cash Price |
$21,608.33
|
| Rate for Payer: Cash Price |
$21,608.33
|
| Rate for Payer: Cofinity Advantage |
$18,907.29
|
| Rate for Payer: Cofinity Commercial |
$23,228.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,608.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.25
|
| Rate for Payer: Healthscope Commercial |
$24,309.37
|
| Rate for Payer: Mclaren Medicaid |
$32.03
|
| Rate for Payer: Mclaren Medicare |
$61.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.31
|
| Rate for Payer: Meridian Medicaid |
$64.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,958.85
|
| Rate for Payer: Nomi Health Commercial |
$183.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20,257.81
|
| Rate for Payer: PACE Medicare |
$58.19
|
| Rate for Payer: PACE SWMI |
$61.25
|
| Rate for Payer: PHP Commercial |
$22,958.85
|
| Rate for Payer: PHP Medicare Advantage |
$61.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.15
|
| Rate for Payer: Priority Health Medicare |
$61.25
|
| Rate for Payer: Priority Health SBD |
$17,016.56
|
| Rate for Payer: Priority Health Tiered Network |
$152.12
|
| Rate for Payer: Railroad Medicare Medicare |
$61.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.55
|
| Rate for Payer: UHC Core |
$98.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$61.25
|
| Rate for Payer: UHC Exchange |
$98.55
|
| Rate for Payer: UHC Medicaid |
$32.03
|
| Rate for Payer: UHCCP Medicaid |
$32.03
|
| Rate for Payer: VA VA |
$61.25
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27,010.41
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17,016.56 |
| Max. Negotiated Rate |
$24,309.37 |
| Rate for Payer: Aetna Commercial |
$22,958.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,556.77
|
| Rate for Payer: Cash Price |
$21,608.33
|
| Rate for Payer: Cofinity Advantage |
$18,907.29
|
| Rate for Payer: Cofinity Commercial |
$23,228.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,608.33
|
| Rate for Payer: Healthscope Commercial |
$24,309.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,958.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20,257.81
|
| Rate for Payer: PHP Commercial |
$22,958.85
|
| Rate for Payer: Priority Health SBD |
$17,016.56
|
|
|
PEMETREXED DISODIUM 1,000 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$705.05
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
200483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$634.54 |
| Rate for Payer: Aetna Commercial |
$599.29
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$9.01
|
| Rate for Payer: BCN Commercial |
$9.01
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: Cash Price |
$564.04
|
| Rate for Payer: Cash Price |
$564.04
|
| Rate for Payer: Cofinity Advantage |
$493.54
|
| Rate for Payer: Cofinity Commercial |
$606.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Healthscope Commercial |
$634.54
|
| Rate for Payer: Mclaren Medicaid |
$2.11
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.29
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.79
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PHP Commercial |
$599.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health SBD |
$444.18
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: VA VA |
$4.04
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$60.21
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.93 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna Commercial |
$51.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.14
|
| Rate for Payer: Cash Price |
$48.17
|
| Rate for Payer: Cofinity Advantage |
$42.15
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.17
|
| Rate for Payer: Healthscope Commercial |
$54.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.16
|
| Rate for Payer: PHP Commercial |
$51.18
|
| Rate for Payer: Priority Health SBD |
$37.93
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$60.21
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna Commercial |
$51.18
|
| Rate for Payer: Aetna Commercial |
$2,144.42
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,639.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$9.01
|
| Rate for Payer: BCBS Trust/PPO |
$9.01
|
| Rate for Payer: BCN Commercial |
$9.01
|
| Rate for Payer: BCN Commercial |
$9.01
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: Cash Price |
$2,018.28
|
| Rate for Payer: Cash Price |
$48.17
|
| Rate for Payer: Cash Price |
$48.17
|
| Rate for Payer: Cash Price |
$2,018.28
|
| Rate for Payer: Cofinity Advantage |
$1,765.99
|
| Rate for Payer: Cofinity Advantage |
$42.15
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$2,169.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,018.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Healthscope Commercial |
$54.19
|
| Rate for Payer: Healthscope Commercial |
$2,270.57
|
| Rate for Payer: Mclaren Medicaid |
$2.11
|
| Rate for Payer: Mclaren Medicaid |
$2.11
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,144.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.18
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,892.14
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PHP Commercial |
$51.18
|
| Rate for Payer: PHP Commercial |
$2,144.42
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health SBD |
$1,589.40
|
| Rate for Payer: Priority Health SBD |
$37.93
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
|
|
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 Advantage |
$12,389.49
|
| Rate for Payer: Cofinity Commercial |
$15,221.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,159.42
|
| Rate for Payer: Healthscope Commercial |
$15,929.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,044.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,274.45
|
| Rate for Payer: PHP Commercial |
$15,044.38
|
| 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 |
$2.11 |
| Max. Negotiated Rate |
$15,929.34 |
| Rate for Payer: Aetna Commercial |
$15,044.38
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,504.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$9.01
|
| Rate for Payer: BCN Commercial |
$9.01
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cofinity Advantage |
$12,389.49
|
| Rate for Payer: Cofinity Commercial |
$15,221.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,159.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Healthscope Commercial |
$15,929.34
|
| Rate for Payer: Mclaren Medicaid |
$2.11
|
| Rate for Payer: Mclaren Medicare |
$4.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,044.38
|
| Rate for Payer: Nomi Health Commercial |
$12.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,274.45
|
| Rate for Payer: PACE Medicare |
$3.84
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PHP Commercial |
$15,044.38
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health SBD |
$11,150.54
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Medicaid |
$2.11
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: VA VA |
$4.04
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,208.01
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$1,087.21 |
| Rate for Payer: Aetna Commercial |
$1,026.81
|
| Rate for Payer: Aetna Medicare |
$32.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.34
|
| Rate for Payer: BCBS Complete |
$17.28
|
| Rate for Payer: BCBS MAPPO |
$31.47
|
| Rate for Payer: BCBS Trust/PPO |
$83.35
|
| Rate for Payer: BCN Commercial |
$83.35
|
| Rate for Payer: BCN Medicare Advantage |
$31.47
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cofinity Advantage |
$845.61
|
| Rate for Payer: Cofinity Commercial |
$1,038.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$1,087.21
|
| Rate for Payer: Mclaren Medicaid |
$16.46
|
| Rate for Payer: Mclaren Medicare |
$31.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.04
|
| Rate for Payer: Meridian Medicaid |
$33.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.81
|
| Rate for Payer: Nomi Health Commercial |
$94.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.01
|
| Rate for Payer: PACE Medicare |
$29.90
|
| Rate for Payer: PACE SWMI |
$31.47
|
| Rate for Payer: PHP Commercial |
$1,026.81
|
| Rate for Payer: PHP Medicare Advantage |
$31.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$94.66
|
| Rate for Payer: Priority Health Medicare |
$31.47
|
| Rate for Payer: Priority Health SBD |
$761.05
|
| Rate for Payer: Priority Health Tiered Network |
$75.73
|
| Rate for Payer: Railroad Medicare Medicare |
$31.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.75
|
| Rate for Payer: UHC Core |
$52.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.47
|
| Rate for Payer: UHC Exchange |
$52.75
|
| Rate for Payer: UHC Medicaid |
$16.46
|
| Rate for Payer: UHCCP Medicaid |
$16.46
|
| Rate for Payer: VA VA |
$31.47
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,208.01
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$761.05 |
| Max. Negotiated Rate |
$1,087.21 |
| Rate for Payer: Aetna Commercial |
$1,026.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.21
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cofinity Advantage |
$845.61
|
| Rate for Payer: Cofinity Commercial |
$1,038.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.41
|
| Rate for Payer: Healthscope Commercial |
$1,087.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.01
|
| Rate for Payer: PHP Commercial |
$1,026.81
|
| Rate for Payer: Priority Health SBD |
$761.05
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE CUSTOM
|
Facility
|
OP
|
$1,208.01
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
301789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$1,087.21 |
| Rate for Payer: Aetna Commercial |
$1,026.81
|
| Rate for Payer: Aetna Medicare |
$32.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.34
|
| Rate for Payer: BCBS Complete |
$17.28
|
| Rate for Payer: BCBS MAPPO |
$31.47
|
| Rate for Payer: BCBS Trust/PPO |
$83.35
|
| Rate for Payer: BCN Commercial |
$83.35
|
| Rate for Payer: BCN Medicare Advantage |
$31.47
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cofinity Advantage |
$845.61
|
| Rate for Payer: Cofinity Commercial |
$1,038.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$1,087.21
|
| Rate for Payer: Mclaren Medicaid |
$16.46
|
| Rate for Payer: Mclaren Medicare |
$31.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.04
|
| Rate for Payer: Meridian Medicaid |
$33.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.81
|
| Rate for Payer: Nomi Health Commercial |
$94.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.01
|
| Rate for Payer: PACE Medicare |
$29.90
|
| Rate for Payer: PACE SWMI |
$31.47
|
| Rate for Payer: PHP Commercial |
$1,026.81
|
| Rate for Payer: PHP Medicare Advantage |
$31.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$94.66
|
| Rate for Payer: Priority Health Medicare |
$31.47
|
| Rate for Payer: Priority Health SBD |
$761.05
|
| Rate for Payer: Priority Health Tiered Network |
$75.73
|
| Rate for Payer: Railroad Medicare Medicare |
$31.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.75
|
| Rate for Payer: UHC Core |
$52.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.47
|
| Rate for Payer: UHC Exchange |
$52.75
|
| Rate for Payer: UHC Medicaid |
$16.46
|
| Rate for Payer: UHCCP Medicaid |
$16.46
|
| Rate for Payer: VA VA |
$31.47
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE CUSTOM
|
Facility
|
IP
|
$1,208.01
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
301789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$761.05 |
| Max. Negotiated Rate |
$1,087.21 |
| Rate for Payer: Aetna Commercial |
$1,026.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.21
|
| Rate for Payer: Cash Price |
$966.41
|
| Rate for Payer: Cofinity Advantage |
$845.61
|
| Rate for Payer: Cofinity Commercial |
$1,038.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.41
|
| Rate for Payer: Healthscope Commercial |
$1,087.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.01
|
| Rate for Payer: PHP Commercial |
$1,026.81
|
| Rate for Payer: Priority Health SBD |
$761.05
|
|
|
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 Advantage |
$113.75
|
| Rate for Payer: Cofinity Commercial |
$139.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.00
|
| Rate for Payer: Healthscope Commercial |
$146.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.88
|
| Rate for Payer: PHP Commercial |
$138.12
|
| Rate for Payer: Priority Health SBD |
$102.38
|
|
|
PENICILLIN G IV 16,000 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
OP
|
$162.50
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna Commercial |
$138.12
|
| Rate for Payer: Aetna Medicare |
$81.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.62
|
| Rate for Payer: BCBS Complete |
$65.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.95
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cofinity Advantage |
$113.75
|
| Rate for Payer: Cofinity Commercial |
$139.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.00
|
| Rate for Payer: Healthscope Commercial |
$146.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.88
|
| Rate for Payer: PHP Commercial |
$138.12
|
| Rate for Payer: Priority Health SBD |
$102.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
|
|
PENICILLIN G IV 1,600 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
OP
|
$18.75
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna Medicare |
$9.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.19
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.95
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cofinity Advantage |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.06
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
|
|
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 Advantage |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.06
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: Priority Health SBD |
$11.81
|
|
|
PENICILLIN G IV 160 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
OP
|
$6.25
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.95
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cofinity Advantage |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$5.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.69
|
| Rate for Payer: PHP Commercial |
$5.31
|
| Rate for Payer: Priority Health SBD |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
|
|
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 Advantage |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$5.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.69
|
| Rate for Payer: PHP Commercial |
$5.31
|
| Rate for Payer: Priority Health SBD |
$3.94
|
|
|
PENICILLIN G IV 3 MILLION UNITS IVPB 100 ML (IV PREMIX)
|
Facility
|
OP
|
$82.80
|
|
|
Service Code
|
NDC 09900000160
|
| Hospital Charge Code |
500537
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.54 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna Medicare |
$41.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.82
|
| Rate for Payer: BCBS Complete |
$33.12
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Advantage |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.10
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health SBD |
$52.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.82
|
| Rate for Payer: UHC Core |
$43.14
|
| Rate for Payer: UHC Exchange |
$32.54
|
|
|
PENICILLIN G IV 3 MILLION UNITS IVPB 100 ML (IV PREMIX)
|
Facility
|
IP
|
$82.80
|
|
|
Service Code
|
NDC 09900000160
|
| 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 Advantage |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.10
|
| Rate for Payer: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health SBD |
$52.16
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$109.70
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$98.73 |
| Rate for Payer: Aetna Commercial |
$93.25
|
| Rate for Payer: Aetna Commercial |
$178.81
|
| Rate for Payer: Aetna Commercial |
$83.03
|
| Rate for Payer: Aetna Medicare |
$54.85
|
| Rate for Payer: Aetna Medicare |
$105.18
|
| Rate for Payer: Aetna Medicare |
$48.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: BCBS Complete |
$39.07
|
| Rate for Payer: BCBS Complete |
$43.88
|
| Rate for Payer: BCBS Complete |
$84.14
|
| Rate for Payer: BCBS Trust/PPO |
$1.95
|
| Rate for Payer: BCBS Trust/PPO |
$1.95
|
| Rate for Payer: BCBS Trust/PPO |
$1.95
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$87.76
|
| Rate for Payer: Cash Price |
$87.76
|
| Rate for Payer: Cash Price |
$168.29
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$168.29
|
| Rate for Payer: Cofinity Advantage |
$147.25
|
| Rate for Payer: Cofinity Advantage |
$76.79
|
| Rate for Payer: Cofinity Advantage |
$68.38
|
| Rate for Payer: Cofinity Commercial |
$94.34
|
| Rate for Payer: Cofinity Commercial |
$180.91
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.76
|
| Rate for Payer: Healthscope Commercial |
$87.91
|
| Rate for Payer: Healthscope Commercial |
$189.32
|
| Rate for Payer: Healthscope Commercial |
$98.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.26
|
| Rate for Payer: PHP Commercial |
$93.25
|
| Rate for Payer: PHP Commercial |
$178.81
|
| Rate for Payer: PHP Commercial |
$83.03
|
| Rate for Payer: Priority Health SBD |
$69.11
|
| Rate for Payer: Priority Health SBD |
$61.54
|
| Rate for Payer: Priority Health SBD |
$132.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$210.36
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.53 |
| Max. Negotiated Rate |
$189.32 |
| Rate for Payer: Aetna Commercial |
$178.81
|
| Rate for Payer: Aetna Commercial |
$93.25
|
| Rate for Payer: Aetna Commercial |
$83.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.31
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$168.29
|
| Rate for Payer: Cash Price |
$87.76
|
| Rate for Payer: Cofinity Advantage |
$147.25
|
| Rate for Payer: Cofinity Advantage |
$76.79
|
| Rate for Payer: Cofinity Advantage |
$68.38
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$94.34
|
| Rate for Payer: Cofinity Commercial |
$180.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Healthscope Commercial |
$98.73
|
| Rate for Payer: Healthscope Commercial |
$189.32
|
| Rate for Payer: Healthscope Commercial |
$87.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.77
|
| Rate for Payer: PHP Commercial |
$93.25
|
| Rate for Payer: PHP Commercial |
$83.03
|
| Rate for Payer: PHP Commercial |
$178.81
|
| Rate for Payer: Priority Health SBD |
$61.54
|
| Rate for Payer: Priority Health SBD |
$69.11
|
| Rate for Payer: Priority Health SBD |
$132.53
|
|
