|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,304.00
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
189200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.99 |
| Max. Negotiated Rate |
$4,773.60 |
| Rate for Payer: Aetna Commercial |
$4,508.40
|
| Rate for Payer: Aetna Medicare |
$110.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,447.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.91
|
| Rate for Payer: BCBS Complete |
$59.84
|
| Rate for Payer: BCBS MAPPO |
$106.33
|
| Rate for Payer: BCN Medicare Advantage |
$106.33
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Cofinity Commercial |
$3,712.80
|
| Rate for Payer: Cofinity Commercial |
$4,561.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,712.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,243.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.33
|
| Rate for Payer: Healthscope Commercial |
$4,773.60
|
| Rate for Payer: Mclaren Medicaid |
$56.99
|
| Rate for Payer: Mclaren Medicare |
$106.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.65
|
| Rate for Payer: Meridian Medicaid |
$59.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,508.40
|
| Rate for Payer: PACE Medicare |
$101.01
|
| Rate for Payer: PACE SWMI |
$106.33
|
| Rate for Payer: PHP Commercial |
$4,508.40
|
| Rate for Payer: PHP Medicare Advantage |
$106.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,447.60
|
| Rate for Payer: Priority Health Medicare |
$106.33
|
| Rate for Payer: Priority Health SBD |
$3,341.52
|
| Rate for Payer: Railroad Medicare Medicare |
$106.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.33
|
| Rate for Payer: UHC Medicare Advantage |
$106.33
|
| Rate for Payer: UHCCP Medicaid |
$59.86
|
| Rate for Payer: VA VA |
$106.33
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,616.00
|
|
|
Service Code
|
HCPCS Q5108
|
| Hospital Charge Code |
187520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,538.08 |
| Max. Negotiated Rate |
$5,054.40 |
| Rate for Payer: Aetna Commercial |
$4,773.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,650.40
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cofinity Commercial |
$3,931.20
|
| Rate for Payer: Cofinity Commercial |
$4,829.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,931.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,492.80
|
| Rate for Payer: Healthscope Commercial |
$5,054.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,773.60
|
| Rate for Payer: PHP Commercial |
$4,773.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,650.40
|
| Rate for Payer: Priority Health SBD |
$3,538.08
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,616.00
|
|
|
Service Code
|
HCPCS Q5108
|
| Hospital Charge Code |
187520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.13 |
| Max. Negotiated Rate |
$5,054.40 |
| Rate for Payer: Aetna Commercial |
$4,773.60
|
| Rate for Payer: Aetna Commercial |
$4,442.12
|
| Rate for Payer: Aetna Medicare |
$103.10
|
| Rate for Payer: Aetna Medicare |
$103.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,396.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,650.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.91
|
| Rate for Payer: BCBS Complete |
$55.79
|
| Rate for Payer: BCBS Complete |
$55.79
|
| Rate for Payer: BCBS MAPPO |
$99.13
|
| Rate for Payer: BCBS MAPPO |
$99.13
|
| Rate for Payer: BCN Medicare Advantage |
$99.13
|
| Rate for Payer: BCN Medicare Advantage |
$99.13
|
| Rate for Payer: Cash Price |
$4,180.82
|
| Rate for Payer: Cash Price |
$4,180.82
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cofinity Commercial |
$3,931.20
|
| Rate for Payer: Cofinity Commercial |
$3,658.21
|
| Rate for Payer: Cofinity Commercial |
$4,494.38
|
| Rate for Payer: Cofinity Commercial |
$4,829.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,658.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,931.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,180.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,492.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.13
|
| Rate for Payer: Healthscope Commercial |
$4,703.42
|
| Rate for Payer: Healthscope Commercial |
$5,054.40
|
| Rate for Payer: Mclaren Medicaid |
$53.13
|
| Rate for Payer: Mclaren Medicaid |
$53.13
|
| Rate for Payer: Mclaren Medicare |
$99.13
|
| Rate for Payer: Mclaren Medicare |
$99.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.09
|
| Rate for Payer: Meridian Medicaid |
$55.79
|
| Rate for Payer: Meridian Medicaid |
$55.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,773.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,442.12
|
| Rate for Payer: PACE Medicare |
$94.17
|
| Rate for Payer: PACE Medicare |
$94.17
|
| Rate for Payer: PACE SWMI |
$99.13
|
| Rate for Payer: PACE SWMI |
$99.13
|
| Rate for Payer: PHP Commercial |
$4,442.12
|
| Rate for Payer: PHP Commercial |
$4,773.60
|
| Rate for Payer: PHP Medicare Advantage |
$99.13
|
| Rate for Payer: PHP Medicare Advantage |
$99.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,396.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,650.40
|
| Rate for Payer: Priority Health Medicare |
$99.13
|
| Rate for Payer: Priority Health Medicare |
$99.13
|
| Rate for Payer: Priority Health SBD |
$3,292.39
|
| Rate for Payer: Priority Health SBD |
$3,538.08
|
| Rate for Payer: Railroad Medicare Medicare |
$99.13
|
| Rate for Payer: Railroad Medicare Medicare |
$99.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.13
|
| Rate for Payer: UHC Medicare Advantage |
$99.13
|
| Rate for Payer: UHC Medicare Advantage |
$99.13
|
| Rate for Payer: UHCCP Medicaid |
$55.81
|
| Rate for Payer: UHCCP Medicaid |
$55.81
|
| Rate for Payer: VA VA |
$99.13
|
| Rate for Payer: VA VA |
$99.13
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$76,228.88
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48,024.19 |
| Max. Negotiated Rate |
$68,605.99 |
| Rate for Payer: Aetna Commercial |
$64,794.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49,548.77
|
| Rate for Payer: Cash Price |
$60,983.10
|
| Rate for Payer: Cofinity Commercial |
$53,360.22
|
| Rate for Payer: Cofinity Commercial |
$65,556.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$53,360.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60,983.10
|
| Rate for Payer: Healthscope Commercial |
$68,605.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64,794.55
|
| Rate for Payer: PHP Commercial |
$64,794.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49,548.77
|
| Rate for Payer: Priority Health SBD |
$48,024.19
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$76,228.88
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,962.20 |
| Max. Negotiated Rate |
$68,605.99 |
| Rate for Payer: Aetna Commercial |
$64,794.55
|
| Rate for Payer: Aetna Medicare |
$3,807.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49,548.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,576.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,576.04
|
| Rate for Payer: BCBS Complete |
$2,060.32
|
| Rate for Payer: BCBS MAPPO |
$3,660.83
|
| Rate for Payer: BCN Medicare Advantage |
$3,660.83
|
| Rate for Payer: Cash Price |
$60,983.10
|
| Rate for Payer: Cash Price |
$60,983.10
|
| Rate for Payer: Cofinity Commercial |
$53,360.22
|
| Rate for Payer: Cofinity Commercial |
$65,556.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$53,360.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60,983.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,660.83
|
| Rate for Payer: Healthscope Commercial |
$68,605.99
|
| Rate for Payer: Mclaren Medicaid |
$1,962.20
|
| Rate for Payer: Mclaren Medicare |
$3,660.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,843.87
|
| Rate for Payer: Meridian Medicaid |
$2,060.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,209.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64,794.55
|
| Rate for Payer: PACE Medicare |
$3,477.79
|
| Rate for Payer: PACE SWMI |
$3,660.83
|
| Rate for Payer: PHP Commercial |
$64,794.55
|
| Rate for Payer: PHP Medicare Advantage |
$3,660.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,962.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49,548.77
|
| Rate for Payer: Priority Health Medicare |
$3,660.83
|
| Rate for Payer: Priority Health SBD |
$48,024.19
|
| Rate for Payer: Railroad Medicare Medicare |
$3,660.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,304.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,660.83
|
| Rate for Payer: UHC Medicare Advantage |
$3,660.83
|
| Rate for Payer: UHCCP Medicaid |
$2,061.05
|
| Rate for Payer: VA VA |
$3,660.83
|
|
|
PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 57410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,745.82
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25,961.54
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$23,365.39 |
| Rate for Payer: Aetna Commercial |
$22,067.31
|
| Rate for Payer: Aetna Medicare |
$62.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,875.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.36
|
| Rate for Payer: BCBS Complete |
$33.93
|
| Rate for Payer: BCBS MAPPO |
$60.29
|
| Rate for Payer: BCN Medicare Advantage |
$60.29
|
| Rate for Payer: Cash Price |
$20,769.23
|
| Rate for Payer: Cash Price |
$20,769.23
|
| Rate for Payer: Cofinity Commercial |
$18,173.08
|
| Rate for Payer: Cofinity Commercial |
$22,326.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,173.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,769.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.29
|
| Rate for Payer: Healthscope Commercial |
$23,365.39
|
| Rate for Payer: Mclaren Medicaid |
$32.32
|
| Rate for Payer: Mclaren Medicare |
$60.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.30
|
| Rate for Payer: Meridian Medicaid |
$33.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,067.31
|
| Rate for Payer: PACE Medicare |
$57.28
|
| Rate for Payer: PACE SWMI |
$60.29
|
| Rate for Payer: PHP Commercial |
$22,067.31
|
| Rate for Payer: PHP Medicare Advantage |
$60.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,875.00
|
| Rate for Payer: Priority Health Medicare |
$60.29
|
| Rate for Payer: Priority Health SBD |
$16,355.77
|
| Rate for Payer: Railroad Medicare Medicare |
$60.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.29
|
| Rate for Payer: UHC Medicare Advantage |
$60.29
|
| Rate for Payer: UHCCP Medicaid |
$33.94
|
| Rate for Payer: VA VA |
$60.29
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25,961.54
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
173778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16,355.77 |
| Max. Negotiated Rate |
$23,365.39 |
| Rate for Payer: Aetna Commercial |
$22,067.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,875.00
|
| Rate for Payer: Cash Price |
$20,769.23
|
| Rate for Payer: Cofinity Commercial |
$18,173.08
|
| Rate for Payer: Cofinity Commercial |
$22,326.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,173.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,769.23
|
| Rate for Payer: Healthscope Commercial |
$23,365.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,067.31
|
| Rate for Payer: PHP Commercial |
$22,067.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,875.00
|
| Rate for Payer: Priority Health SBD |
$16,355.77
|
|
|
PEMETREXED DISODIUM 1,000 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$711.05
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
200483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$639.95 |
| Rate for Payer: Aetna Commercial |
$604.39
|
| Rate for Payer: Aetna Medicare |
$4.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.45
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.36
|
| Rate for Payer: BCN Medicare Advantage |
$4.36
|
| Rate for Payer: Cash Price |
$568.84
|
| Rate for Payer: Cash Price |
$568.84
|
| Rate for Payer: Cofinity Commercial |
$611.50
|
| Rate for Payer: Cofinity Commercial |
$497.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$497.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.36
|
| Rate for Payer: Healthscope Commercial |
$639.95
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Mclaren Medicare |
$4.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.58
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.39
|
| Rate for Payer: PACE Medicare |
$4.14
|
| Rate for Payer: PACE SWMI |
$4.36
|
| Rate for Payer: PHP Commercial |
$604.39
|
| Rate for Payer: PHP Medicare Advantage |
$4.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.18
|
| Rate for Payer: Priority Health Medicare |
$4.36
|
| Rate for Payer: Priority Health SBD |
$447.96
|
| Rate for Payer: Railroad Medicare Medicare |
$4.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.36
|
| Rate for Payer: UHC Medicare Advantage |
$4.36
|
| Rate for Payer: UHCCP Medicaid |
$2.45
|
| Rate for Payer: VA VA |
$4.36
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$2,522.85
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
89350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$2,270.57 |
| Rate for Payer: Aetna Commercial |
$2,144.42
|
| Rate for Payer: Aetna Medicare |
$4.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,639.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.45
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.36
|
| Rate for Payer: BCN Medicare Advantage |
$4.36
|
| Rate for Payer: Cash Price |
$2,018.28
|
| Rate for Payer: Cash Price |
$2,018.28
|
| Rate for Payer: Cofinity Commercial |
$1,765.99
|
| Rate for Payer: Cofinity Commercial |
$2,169.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,765.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,018.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.36
|
| Rate for Payer: Healthscope Commercial |
$2,270.57
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Mclaren Medicare |
$4.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.58
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,144.42
|
| Rate for Payer: PACE Medicare |
$4.14
|
| Rate for Payer: PACE SWMI |
$4.36
|
| Rate for Payer: PHP Commercial |
$2,144.42
|
| Rate for Payer: PHP Medicare Advantage |
$4.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,639.85
|
| Rate for Payer: Priority Health Medicare |
$4.36
|
| Rate for Payer: Priority Health SBD |
$1,589.40
|
| Rate for Payer: Railroad Medicare Medicare |
$4.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.36
|
| Rate for Payer: UHC Medicare Advantage |
$4.36
|
| Rate for Payer: UHCCP Medicaid |
$2.45
|
| Rate for Payer: VA VA |
$4.36
|
|
|
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 |
$2.34 |
| Max. Negotiated Rate |
$15,929.34 |
| Rate for Payer: Aetna Commercial |
$15,044.38
|
| Rate for Payer: Aetna Medicare |
$4.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,504.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.45
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.36
|
| Rate for Payer: BCN Medicare Advantage |
$4.36
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cofinity Commercial |
$15,221.37
|
| Rate for Payer: Cofinity Commercial |
$12,389.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,389.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,159.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.36
|
| Rate for Payer: Healthscope Commercial |
$15,929.34
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Mclaren Medicare |
$4.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.58
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,044.38
|
| Rate for Payer: PACE Medicare |
$4.14
|
| Rate for Payer: PACE SWMI |
$4.36
|
| Rate for Payer: PHP Commercial |
$15,044.38
|
| Rate for Payer: PHP Medicare Advantage |
$4.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,504.53
|
| Rate for Payer: Priority Health Medicare |
$4.36
|
| Rate for Payer: Priority Health SBD |
$11,150.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.36
|
| Rate for Payer: UHC Medicare Advantage |
$4.36
|
| Rate for Payer: UHCCP Medicaid |
$2.45
|
| Rate for Payer: VA VA |
$4.36
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$17,699.27
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
37894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,150.54 |
| Max. Negotiated Rate |
$15,929.34 |
| Rate for Payer: Aetna Commercial |
$15,044.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,504.53
|
| Rate for Payer: Cash Price |
$14,159.42
|
| Rate for Payer: Cofinity Commercial |
$12,389.49
|
| Rate for Payer: Cofinity Commercial |
$15,221.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,389.49
|
| 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: PHP Commercial |
$15,044.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,504.53
|
| Rate for Payer: Priority Health SBD |
$11,150.54
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$998.34
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$898.51 |
| Rate for Payer: Aetna Commercial |
$848.59
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.51
|
| Rate for Payer: BCBS Complete |
$16.89
|
| Rate for Payer: BCBS MAPPO |
$30.01
|
| Rate for Payer: BCN Medicare Advantage |
$30.01
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cofinity Commercial |
$698.84
|
| Rate for Payer: Cofinity Commercial |
$858.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$698.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$798.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.01
|
| Rate for Payer: Healthscope Commercial |
$898.51
|
| Rate for Payer: Mclaren Medicaid |
$16.09
|
| Rate for Payer: Mclaren Medicare |
$30.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.51
|
| Rate for Payer: Meridian Medicaid |
$16.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.59
|
| Rate for Payer: PACE Medicare |
$28.51
|
| Rate for Payer: PACE SWMI |
$30.01
|
| Rate for Payer: PHP Commercial |
$848.59
|
| Rate for Payer: PHP Medicare Advantage |
$30.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.92
|
| Rate for Payer: Priority Health Medicare |
$30.01
|
| Rate for Payer: Priority Health SBD |
$628.95
|
| Rate for Payer: Railroad Medicare Medicare |
$30.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.01
|
| Rate for Payer: UHC Medicare Advantage |
$30.01
|
| Rate for Payer: UHCCP Medicaid |
$16.90
|
| Rate for Payer: VA VA |
$30.01
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$998.34
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
112201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$628.95 |
| Max. Negotiated Rate |
$898.51 |
| Rate for Payer: Aetna Commercial |
$848.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.92
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cofinity Commercial |
$698.84
|
| Rate for Payer: Cofinity Commercial |
$858.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$698.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$798.67
|
| Rate for Payer: Healthscope Commercial |
$898.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.59
|
| Rate for Payer: PHP Commercial |
$848.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.92
|
| Rate for Payer: Priority Health SBD |
$628.95
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE CUSTOM
|
Facility
|
IP
|
$998.34
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
301789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$628.95 |
| Max. Negotiated Rate |
$898.51 |
| Rate for Payer: Aetna Commercial |
$848.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.92
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cofinity Commercial |
$698.84
|
| Rate for Payer: Cofinity Commercial |
$858.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$698.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$798.67
|
| Rate for Payer: Healthscope Commercial |
$898.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.59
|
| Rate for Payer: PHP Commercial |
$848.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.92
|
| Rate for Payer: Priority Health SBD |
$628.95
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE CUSTOM
|
Facility
|
OP
|
$998.34
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
301789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$898.51 |
| Rate for Payer: Aetna Commercial |
$848.59
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.51
|
| Rate for Payer: BCBS Complete |
$16.89
|
| Rate for Payer: BCBS MAPPO |
$30.01
|
| Rate for Payer: BCN Medicare Advantage |
$30.01
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cash Price |
$798.67
|
| Rate for Payer: Cofinity Commercial |
$698.84
|
| Rate for Payer: Cofinity Commercial |
$858.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$698.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$798.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.01
|
| Rate for Payer: Healthscope Commercial |
$898.51
|
| Rate for Payer: Mclaren Medicaid |
$16.09
|
| Rate for Payer: Mclaren Medicare |
$30.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.51
|
| Rate for Payer: Meridian Medicaid |
$16.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.59
|
| Rate for Payer: PACE Medicare |
$28.51
|
| Rate for Payer: PACE SWMI |
$30.01
|
| Rate for Payer: PHP Commercial |
$848.59
|
| Rate for Payer: PHP Medicare Advantage |
$30.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.92
|
| Rate for Payer: Priority Health Medicare |
$30.01
|
| Rate for Payer: Priority Health SBD |
$628.95
|
| Rate for Payer: Railroad Medicare Medicare |
$30.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.01
|
| Rate for Payer: UHC Medicare Advantage |
$30.01
|
| Rate for Payer: UHCCP Medicaid |
$16.90
|
| Rate for Payer: VA VA |
$30.01
|
|
|
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 |
$65.00 |
| 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: Cash Price |
$130.00
|
| Rate for Payer: Cofinity Commercial |
$113.75
|
| Rate for Payer: Cofinity Commercial |
$139.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.75
|
| 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: PHP Commercial |
$138.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.62
|
| Rate for Payer: Priority Health SBD |
$102.38
|
|
|
PENICILLIN G IV 16,000 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$162.50
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna Commercial |
$138.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.62
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cofinity Commercial |
$113.75
|
| Rate for Payer: Cofinity Commercial |
$139.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.75
|
| 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: PHP Commercial |
$138.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.62
|
| Rate for Payer: Priority Health SBD |
$102.38
|
|
|
PENICILLIN G IV 1,600 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$18.75
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.19
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.12
|
| 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: PHP Commercial |
$15.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.19
|
| Rate for Payer: Priority Health SBD |
$11.81
|
|
|
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 |
$7.50 |
| 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: Cash Price |
$15.00
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.12
|
| 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: PHP Commercial |
$15.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.19
|
| 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 |
$2.50 |
| 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: Cash Price |
$5.00
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$5.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.38
|
| 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: PHP Commercial |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health SBD |
$3.94
|
|
|
PENICILLIN G IV 160 UNITS/ML INFUSION FOR DESENSITIZATION
|
Facility
|
IP
|
$6.25
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
300136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$5.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.38
|
| 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: PHP Commercial |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| 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 |
$33.12 |
| 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 Commercial |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.96
|
| 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: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.82
|
| Rate for Payer: Priority Health SBD |
$52.16
|
|
|
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 Commercial |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$71.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.96
|
| 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: PHP Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.82
|
| Rate for Payer: Priority Health SBD |
$52.16
|
|
|
PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$210.58
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
6085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.23 |
| Max. Negotiated Rate |
$189.52 |
| Rate for Payer: Aetna Commercial |
$178.99
|
| Rate for Payer: Aetna Commercial |
$178.81
|
| Rate for Payer: Aetna Medicare |
$105.18
|
| Rate for Payer: Aetna Medicare |
$105.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.88
|
| Rate for Payer: BCBS Complete |
$84.23
|
| Rate for Payer: BCBS Complete |
$84.14
|
| Rate for Payer: Cash Price |
$168.29
|
| Rate for Payer: Cash Price |
$168.46
|
| Rate for Payer: Cofinity Commercial |
$147.25
|
| Rate for Payer: Cofinity Commercial |
$147.41
|
| Rate for Payer: Cofinity Commercial |
$181.10
|
| Rate for Payer: Cofinity Commercial |
$180.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.46
|
| Rate for Payer: Healthscope Commercial |
$189.32
|
| Rate for Payer: Healthscope Commercial |
$189.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.99
|
| Rate for Payer: PHP Commercial |
$178.99
|
| Rate for Payer: PHP Commercial |
$178.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.88
|
| Rate for Payer: Priority Health SBD |
$132.67
|
| Rate for Payer: Priority Health SBD |
$132.53
|
|
