|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna Commercial |
$16.83
|
| Rate for Payer: Aetna Medicare |
$9.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.87
|
| Rate for Payer: BCBS Complete |
$7.92
|
| Rate for Payer: BCBS Trust/PPO |
$1.95
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cofinity Advantage |
$13.86
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.84
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.85
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: Priority Health SBD |
$12.47
|
| 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 POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna Commercial |
$16.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.87
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cofinity Advantage |
$13.86
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.84
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.85
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: Priority Health SBD |
$12.47
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$253.80
|
|
|
Service Code
|
NDC 00093412774
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.74 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna Medicare |
$126.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.97
|
| Rate for Payer: BCBS Complete |
$101.52
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Advantage |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.35
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health SBD |
$159.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.97
|
| Rate for Payer: UHC Core |
$132.23
|
| Rate for Payer: UHC Exchange |
$99.74
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$145.70
|
|
|
Service Code
|
NDC 00093412773
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.26 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna Medicare |
$72.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: BCBS Complete |
$58.28
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Advantage |
$101.99
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.28
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health SBD |
$91.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.70
|
| Rate for Payer: UHC Core |
$75.91
|
| Rate for Payer: UHC Exchange |
$57.26
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 00093412774
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.89 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.97
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Advantage |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.35
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health SBD |
$159.89
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$145.70
|
|
|
Service Code
|
NDC 00093412773
|
| Hospital Charge Code |
6091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.79 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Advantage |
$101.99
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.28
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health SBD |
$91.79
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
OP
|
$176.25
|
|
|
Service Code
|
NDC 57237004001
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.27 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna Medicare |
$88.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: BCBS Complete |
$70.50
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Advantage |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health SBD |
$111.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.56
|
| Rate for Payer: UHC Core |
$91.83
|
| Rate for Payer: UHC Exchange |
$69.27
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
IP
|
$211.50
|
|
|
Service Code
|
NDC 65862017501
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.47
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Advantage |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.62
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health SBD |
$133.25
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
OP
|
$211.50
|
|
|
Service Code
|
NDC 65862017501
|
| Hospital Charge Code |
6092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.12 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna Medicare |
$105.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.47
|
| Rate for Payer: BCBS Complete |
$84.60
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Advantage |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.62
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health SBD |
$133.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.47
|
| Rate for Payer: UHC Core |
$110.19
|
| Rate for Payer: UHC Exchange |
$83.12
|
|
|
PENICILLIN V POTASSIUM 250 MG TABLET
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 57237004001
|
| 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 Advantage |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health SBD |
$111.04
|
|
|
PENIS PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$37,931.73
|
|
|
Service Code
|
MSDRG 709
|
| Min. Negotiated Rate |
$17,635.20 |
| Max. Negotiated Rate |
$37,931.73 |
| Rate for Payer: Aetna Medicare |
$19,305.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,204.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,204.21
|
| Rate for Payer: BCBS MAPPO |
$18,563.37
|
| Rate for Payer: BCBS Trust/PPO |
$36,408.80
|
| Rate for Payer: BCN Commercial |
$36,408.80
|
| Rate for Payer: BCN Medicare Advantage |
$18,563.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,563.37
|
| Rate for Payer: Mclaren Medicare |
$18,563.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,491.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,347.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,419.71
|
| Rate for Payer: Nomi Health Commercial |
$30,019.59
|
| Rate for Payer: PACE Medicare |
$17,635.20
|
| Rate for Payer: PACE SWMI |
$18,563.37
|
| Rate for Payer: PHP Medicare Advantage |
$18,563.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,517.83
|
| Rate for Payer: Priority Health Medicare |
$18,563.37
|
| Rate for Payer: Priority Health Tiered Network |
$30,014.26
|
| Rate for Payer: Railroad Medicare Medicare |
$18,563.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,931.73
|
| Rate for Payer: UHC Core |
$31,734.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,563.37
|
| Rate for Payer: UHC Exchange |
$25,916.91
|
| Rate for Payer: VA VA |
$18,563.37
|
|
|
PENIS PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,839.56
|
|
|
Service Code
|
MSDRG 710
|
| Min. Negotiated Rate |
$10,837.41 |
| Max. Negotiated Rate |
$22,839.56 |
| Rate for Payer: Aetna Medicare |
$11,864.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,259.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,259.75
|
| Rate for Payer: BCBS MAPPO |
$11,407.80
|
| Rate for Payer: BCBS Trust/PPO |
$12,017.67
|
| Rate for Payer: BCN Commercial |
$12,017.67
|
| Rate for Payer: BCN Medicare Advantage |
$11,407.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,407.80
|
| Rate for Payer: Mclaren Medicare |
$11,407.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,978.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,118.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,548.58
|
| Rate for Payer: Nomi Health Commercial |
$18,075.48
|
| Rate for Payer: PACE Medicare |
$10,837.41
|
| Rate for Payer: PACE SWMI |
$11,407.80
|
| Rate for Payer: PHP Medicare Advantage |
$11,407.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,590.34
|
| Rate for Payer: Priority Health Medicare |
$11,407.80
|
| Rate for Payer: Priority Health Tiered Network |
$18,072.27
|
| Rate for Payer: Railroad Medicare Medicare |
$11,407.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,839.56
|
| Rate for Payer: UHC Core |
$19,108.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,407.80
|
| Rate for Payer: UHC Exchange |
$15,605.16
|
| Rate for Payer: VA VA |
$11,407.80
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$6,358.47
|
|
|
Service Code
|
APR-DRG 4831
|
| Min. Negotiated Rate |
$6,055.69 |
| Max. Negotiated Rate |
$6,358.47 |
| Rate for Payer: BCBS Complete |
$6,358.47
|
| Rate for Payer: Mclaren Medicaid |
$6,055.69
|
| Rate for Payer: Meridian Medicaid |
$6,358.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,055.69
|
| Rate for Payer: UHC Medicaid |
$6,055.69
|
| Rate for Payer: UHCCP Medicaid |
$6,055.69
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$24,453.54
|
|
|
Service Code
|
APR-DRG 4834
|
| Min. Negotiated Rate |
$23,289.08 |
| Max. Negotiated Rate |
$24,453.54 |
| Rate for Payer: BCBS Complete |
$24,453.54
|
| Rate for Payer: Mclaren Medicaid |
$23,289.08
|
| Rate for Payer: Meridian Medicaid |
$24,453.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,289.08
|
| Rate for Payer: UHC Medicaid |
$23,289.08
|
| Rate for Payer: UHCCP Medicaid |
$23,289.08
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$13,223.16
|
|
|
Service Code
|
APR-DRG 4833
|
| Min. Negotiated Rate |
$12,593.49 |
| Max. Negotiated Rate |
$13,223.16 |
| Rate for Payer: BCBS Complete |
$13,223.16
|
| Rate for Payer: Mclaren Medicaid |
$12,593.49
|
| Rate for Payer: Meridian Medicaid |
$13,223.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,593.49
|
| Rate for Payer: UHC Medicaid |
$12,593.49
|
| Rate for Payer: UHCCP Medicaid |
$12,593.49
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$9,126.36
|
|
|
Service Code
|
APR-DRG 4832
|
| Min. Negotiated Rate |
$8,691.77 |
| Max. Negotiated Rate |
$9,126.36 |
| Rate for Payer: BCBS Complete |
$9,126.36
|
| Rate for Payer: Mclaren Medicaid |
$8,691.77
|
| Rate for Payer: Meridian Medicaid |
$9,126.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,691.77
|
| Rate for Payer: UHC Medicaid |
$8,691.77
|
| Rate for Payer: UHCCP Medicaid |
$8,691.77
|
|
|
PENTAMIDINE 300 MG IM INJECTION
|
Facility
|
OP
|
$168.58
|
|
|
Service Code
|
NDC 63323011310
|
| Hospital Charge Code |
299999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna Medicare |
$84.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: BCBS Complete |
$67.43
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Advantage |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.44
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.58
|
| Rate for Payer: UHC Core |
$87.83
|
| Rate for Payer: UHC Exchange |
$66.25
|
|
|
PENTAMIDINE 300 MG IM INJECTION
|
Facility
|
IP
|
$168.58
|
|
|
Service Code
|
NDC 63323011310
|
| 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 Advantage |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.44
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health SBD |
$106.21
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$224.41
|
|
|
Service Code
|
HCPCS J2545
|
| Hospital Charge Code |
28235
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.38 |
| Max. Negotiated Rate |
$201.97 |
| Rate for Payer: Aetna Commercial |
$190.75
|
| Rate for Payer: Aetna Commercial |
$283.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.87
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Cash Price |
$179.53
|
| Rate for Payer: Cofinity Advantage |
$233.34
|
| Rate for Payer: Cofinity Advantage |
$157.09
|
| Rate for Payer: Cofinity Commercial |
$192.99
|
| Rate for Payer: Cofinity Commercial |
$286.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.53
|
| Rate for Payer: Healthscope Commercial |
$300.01
|
| Rate for Payer: Healthscope Commercial |
$201.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.00
|
| Rate for Payer: PHP Commercial |
$283.34
|
| Rate for Payer: PHP Commercial |
$190.75
|
| Rate for Payer: Priority Health SBD |
$141.38
|
| Rate for Payer: Priority Health SBD |
$210.00
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INHALATION
|
Facility
|
OP
|
$333.34
|
|
|
Service Code
|
HCPCS J2545
|
| Hospital Charge Code |
28235
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.78 |
| Max. Negotiated Rate |
$300.01 |
| Rate for Payer: Aetna Commercial |
$283.34
|
| Rate for Payer: Aetna Commercial |
$190.75
|
| Rate for Payer: Aetna Medicare |
$166.67
|
| Rate for Payer: Aetna Medicare |
$112.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.67
|
| Rate for Payer: BCBS Complete |
$133.34
|
| Rate for Payer: BCBS Complete |
$89.76
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Cash Price |
$179.53
|
| Rate for Payer: Cash Price |
$179.53
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Cofinity Advantage |
$157.09
|
| Rate for Payer: Cofinity Advantage |
$233.34
|
| Rate for Payer: Cofinity Commercial |
$192.99
|
| Rate for Payer: Cofinity Commercial |
$286.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.53
|
| Rate for Payer: Healthscope Commercial |
$201.97
|
| Rate for Payer: Healthscope Commercial |
$300.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.00
|
| Rate for Payer: PHP Commercial |
$190.75
|
| Rate for Payer: PHP Commercial |
$283.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$69.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$69.73
|
| Rate for Payer: Priority Health SBD |
$141.38
|
| Rate for Payer: Priority Health SBD |
$210.00
|
| Rate for Payer: Priority Health Tiered Network |
$55.78
|
| Rate for Payer: Priority Health Tiered Network |
$55.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.29
|
| Rate for Payer: UHC Core |
$271.29
|
| Rate for Payer: UHC Core |
$271.29
|
| Rate for Payer: UHC Exchange |
$271.29
|
| Rate for Payer: UHC Exchange |
$271.29
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$168.58
|
|
|
Service Code
|
HCPCS J2516
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
636
|
| 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 Advantage |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.44
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health SBD |
$106.21
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$168.58
|
|
|
Service Code
|
HCPCS J2516
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna Medicare |
$84.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: BCBS Complete |
$67.43
|
| Rate for Payer: BCBS Trust/PPO |
$0.59
|
| Rate for Payer: BCN Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Advantage |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.86
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.44
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health SBD |
$106.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.40
|
| Rate for Payer: UHC Core |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.40
|
|
|
PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$4,120.69
|
|
|
Service Code
|
NDC 50458009801
|
| Hospital Charge Code |
12912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,596.03 |
| Max. Negotiated Rate |
$3,708.62 |
| Rate for Payer: Aetna Commercial |
$3,502.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,678.45
|
| Rate for Payer: Cash Price |
$3,296.55
|
| Rate for Payer: Cofinity Advantage |
$2,884.48
|
| Rate for Payer: Cofinity Commercial |
$3,543.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,296.55
|
| Rate for Payer: Healthscope Commercial |
$3,708.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,502.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,090.52
|
| Rate for Payer: PHP Commercial |
$3,502.59
|
| Rate for Payer: Priority Health SBD |
$2,596.03
|
|
|
PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$4,120.69
|
|
|
Service Code
|
NDC 50458009801
|
| Hospital Charge Code |
12912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,619.43 |
| Max. Negotiated Rate |
$3,708.62 |
| Rate for Payer: Aetna Commercial |
$3,502.59
|
| Rate for Payer: Aetna Medicare |
$2,060.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,678.45
|
| Rate for Payer: BCBS Complete |
$1,648.28
|
| Rate for Payer: Cash Price |
$3,296.55
|
| Rate for Payer: Cofinity Advantage |
$2,884.48
|
| Rate for Payer: Cofinity Commercial |
$3,543.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,296.55
|
| Rate for Payer: Healthscope Commercial |
$3,708.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,296.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,502.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,090.52
|
| Rate for Payer: PHP Commercial |
$3,502.59
|
| Rate for Payer: Priority Health SBD |
$2,596.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,678.45
|
| Rate for Payer: UHC Core |
$2,146.88
|
| Rate for Payer: UHC Exchange |
$1,619.43
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$218.50
|
|
|
Service Code
|
NDC 00904544861
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.87 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna Commercial |
$185.72
|
| Rate for Payer: Aetna Medicare |
$109.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.03
|
| Rate for Payer: BCBS Complete |
$87.40
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Cofinity Advantage |
$152.95
|
| Rate for Payer: Cofinity Commercial |
$187.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$196.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.88
|
| Rate for Payer: PHP Commercial |
$185.72
|
| Rate for Payer: Priority Health SBD |
$137.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.03
|
| Rate for Payer: UHC Core |
$113.84
|
| Rate for Payer: UHC Exchange |
$85.87
|
|
