|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28.52
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$25.67 |
| Rate for Payer: Aetna Commercial |
$24.24
|
| Rate for Payer: Aetna Commercial |
$18.85
|
| Rate for Payer: Aetna Commercial |
$16.38
|
| Rate for Payer: Aetna Commercial |
$22.07
|
| Rate for Payer: Aetna Commercial |
$13.28
|
| Rate for Payer: Aetna Medicare |
$7.81
|
| Rate for Payer: Aetna Medicare |
$9.63
|
| Rate for Payer: Aetna Medicare |
$11.09
|
| Rate for Payer: Aetna Medicare |
$14.26
|
| Rate for Payer: Aetna Medicare |
$12.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: BCBS Complete |
$11.41
|
| Rate for Payer: BCBS Complete |
$7.71
|
| Rate for Payer: BCBS Complete |
$8.87
|
| Rate for Payer: BCBS Complete |
$6.25
|
| Rate for Payer: BCBS Complete |
$10.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cofinity Advantage |
$19.96
|
| Rate for Payer: Cofinity Advantage |
$18.18
|
| Rate for Payer: Cofinity Advantage |
$13.49
|
| Rate for Payer: Cofinity Advantage |
$10.93
|
| Rate for Payer: Cofinity Advantage |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$22.33
|
| Rate for Payer: Cofinity Commercial |
$24.53
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Healthscope Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$25.67
|
| Rate for Payer: Healthscope Commercial |
$23.37
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Commercial |
$14.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.48
|
| Rate for Payer: PHP Commercial |
$18.85
|
| Rate for Payer: PHP Commercial |
$16.38
|
| Rate for Payer: PHP Commercial |
$13.28
|
| Rate for Payer: PHP Commercial |
$24.24
|
| Rate for Payer: PHP Commercial |
$22.07
|
| Rate for Payer: Priority Health SBD |
$13.97
|
| Rate for Payer: Priority Health SBD |
$16.36
|
| Rate for Payer: Priority Health SBD |
$17.97
|
| Rate for Payer: Priority Health SBD |
$12.14
|
| Rate for Payer: Priority Health SBD |
$9.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.52
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$25.67 |
| Rate for Payer: Aetna Commercial |
$24.24
|
| Rate for Payer: Aetna Commercial |
$16.38
|
| Rate for Payer: Aetna Commercial |
$13.28
|
| Rate for Payer: Aetna Commercial |
$18.85
|
| Rate for Payer: Aetna Commercial |
$22.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.54
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cofinity Advantage |
$18.18
|
| Rate for Payer: Cofinity Advantage |
$15.53
|
| Rate for Payer: Cofinity Advantage |
$19.96
|
| Rate for Payer: Cofinity Advantage |
$10.93
|
| Rate for Payer: Cofinity Advantage |
$13.49
|
| Rate for Payer: Cofinity Commercial |
$24.53
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Cofinity Commercial |
$22.33
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.82
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Commercial |
$25.67
|
| Rate for Payer: Healthscope Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$14.06
|
| Rate for Payer: Healthscope Commercial |
$23.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.39
|
| Rate for Payer: PHP Commercial |
$13.28
|
| Rate for Payer: PHP Commercial |
$22.07
|
| Rate for Payer: PHP Commercial |
$24.24
|
| Rate for Payer: PHP Commercial |
$16.38
|
| Rate for Payer: PHP Commercial |
$18.85
|
| Rate for Payer: Priority Health SBD |
$16.36
|
| Rate for Payer: Priority Health SBD |
$13.97
|
| Rate for Payer: Priority Health SBD |
$12.14
|
| Rate for Payer: Priority Health SBD |
$9.84
|
| Rate for Payer: Priority Health SBD |
$17.97
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$19.77
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$17.79 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.85
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Advantage |
$13.84
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.83
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: Priority Health SBD |
$12.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$19.77
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$17.79 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.85
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Advantage |
$13.84
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.83
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: Priority Health SBD |
$12.46
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.77
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$17.79 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$19.76
|
| Rate for Payer: Aetna Commercial |
$30.08
|
| Rate for Payer: Aetna Commercial |
$23.20
|
| Rate for Payer: Aetna Commercial |
$18.09
|
| Rate for Payer: Aetna Commercial |
$12.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.11
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$17.02
|
| Rate for Payer: Cash Price |
$28.31
|
| Rate for Payer: Cash Price |
$12.03
|
| Rate for Payer: Cofinity Advantage |
$16.27
|
| Rate for Payer: Cofinity Advantage |
$10.53
|
| Rate for Payer: Cofinity Advantage |
$24.77
|
| Rate for Payer: Cofinity Advantage |
$13.84
|
| Rate for Payer: Cofinity Advantage |
$19.11
|
| Rate for Payer: Cofinity Advantage |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Cofinity Commercial |
$12.93
|
| Rate for Payer: Cofinity Commercial |
$18.30
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$23.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.31
|
| Rate for Payer: Healthscope Commercial |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$24.57
|
| Rate for Payer: Healthscope Commercial |
$17.79
|
| Rate for Payer: Healthscope Commercial |
$20.93
|
| Rate for Payer: Healthscope Commercial |
$19.15
|
| Rate for Payer: Healthscope Commercial |
$31.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.44
|
| Rate for Payer: PHP Commercial |
$19.76
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$23.20
|
| Rate for Payer: PHP Commercial |
$18.09
|
| Rate for Payer: PHP Commercial |
$12.78
|
| Rate for Payer: PHP Commercial |
$30.08
|
| Rate for Payer: Priority Health SBD |
$13.41
|
| Rate for Payer: Priority Health SBD |
$14.65
|
| Rate for Payer: Priority Health SBD |
$17.20
|
| Rate for Payer: Priority Health SBD |
$9.48
|
| Rate for Payer: Priority Health SBD |
$12.46
|
| Rate for Payer: Priority Health SBD |
$22.30
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.77
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$17.79 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$18.09
|
| Rate for Payer: Aetna Commercial |
$30.08
|
| Rate for Payer: Aetna Commercial |
$12.78
|
| Rate for Payer: Aetna Commercial |
$19.76
|
| Rate for Payer: Aetna Commercial |
$23.20
|
| Rate for Payer: Aetna Medicare |
$7.52
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna Medicare |
$10.64
|
| Rate for Payer: Aetna Medicare |
$13.65
|
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: Aetna Medicare |
$11.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.83
|
| Rate for Payer: BCBS Complete |
$8.51
|
| Rate for Payer: BCBS Complete |
$14.16
|
| Rate for Payer: BCBS Complete |
$10.92
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$17.02
|
| Rate for Payer: Cash Price |
$12.03
|
| Rate for Payer: Cash Price |
$12.03
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cash Price |
$17.02
|
| Rate for Payer: Cash Price |
$28.31
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cash Price |
$28.31
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Advantage |
$10.53
|
| Rate for Payer: Cofinity Advantage |
$19.11
|
| Rate for Payer: Cofinity Advantage |
$16.27
|
| Rate for Payer: Cofinity Advantage |
$24.77
|
| Rate for Payer: Cofinity Advantage |
$14.90
|
| Rate for Payer: Cofinity Advantage |
$13.84
|
| Rate for Payer: Cofinity Commercial |
$18.30
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Cofinity Commercial |
$12.93
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$23.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.84
|
| Rate for Payer: Healthscope Commercial |
$31.85
|
| Rate for Payer: Healthscope Commercial |
$24.57
|
| Rate for Payer: Healthscope Commercial |
$20.93
|
| Rate for Payer: Healthscope Commercial |
$19.15
|
| Rate for Payer: Healthscope Commercial |
$17.79
|
| Rate for Payer: Healthscope Commercial |
$13.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.54
|
| Rate for Payer: PHP Commercial |
$19.76
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$18.09
|
| Rate for Payer: PHP Commercial |
$12.78
|
| Rate for Payer: PHP Commercial |
$30.08
|
| Rate for Payer: PHP Commercial |
$23.20
|
| Rate for Payer: Priority Health SBD |
$17.20
|
| Rate for Payer: Priority Health SBD |
$12.46
|
| Rate for Payer: Priority Health SBD |
$22.30
|
| Rate for Payer: Priority Health SBD |
$14.65
|
| Rate for Payer: Priority Health SBD |
$13.41
|
| Rate for Payer: Priority Health SBD |
$9.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$177.74
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
12587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$159.97 |
| Rate for Payer: Aetna Commercial |
$151.08
|
| Rate for Payer: Aetna Commercial |
$190.83
|
| Rate for Payer: Aetna Commercial |
$175.02
|
| Rate for Payer: Aetna Commercial |
$139.73
|
| Rate for Payer: Aetna Medicare |
$88.87
|
| Rate for Payer: Aetna Medicare |
$112.25
|
| Rate for Payer: Aetna Medicare |
$102.95
|
| Rate for Payer: Aetna Medicare |
$82.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.53
|
| Rate for Payer: BCBS Complete |
$89.80
|
| Rate for Payer: BCBS Complete |
$71.10
|
| Rate for Payer: BCBS Complete |
$65.76
|
| Rate for Payer: BCBS Complete |
$82.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$142.19
|
| Rate for Payer: Cash Price |
$164.73
|
| Rate for Payer: Cash Price |
$179.61
|
| Rate for Payer: Cash Price |
$164.73
|
| Rate for Payer: Cash Price |
$131.51
|
| Rate for Payer: Cash Price |
$131.51
|
| Rate for Payer: Cash Price |
$179.61
|
| Rate for Payer: Cash Price |
$142.19
|
| Rate for Payer: Cofinity Advantage |
$157.16
|
| Rate for Payer: Cofinity Advantage |
$115.07
|
| Rate for Payer: Cofinity Advantage |
$144.14
|
| Rate for Payer: Cofinity Advantage |
$124.42
|
| Rate for Payer: Cofinity Commercial |
$141.38
|
| Rate for Payer: Cofinity Commercial |
$193.08
|
| Rate for Payer: Cofinity Commercial |
$152.86
|
| Rate for Payer: Cofinity Commercial |
$177.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.19
|
| Rate for Payer: Healthscope Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$147.95
|
| Rate for Payer: Healthscope Commercial |
$202.06
|
| Rate for Payer: Healthscope Commercial |
$159.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.38
|
| Rate for Payer: PHP Commercial |
$175.02
|
| Rate for Payer: PHP Commercial |
$151.08
|
| Rate for Payer: PHP Commercial |
$190.83
|
| Rate for Payer: PHP Commercial |
$139.73
|
| Rate for Payer: Priority Health SBD |
$103.57
|
| Rate for Payer: Priority Health SBD |
$129.72
|
| Rate for Payer: Priority Health SBD |
$141.44
|
| Rate for Payer: Priority Health SBD |
$111.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$205.91
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
12587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$185.32 |
| Rate for Payer: Aetna Commercial |
$175.02
|
| Rate for Payer: Aetna Commercial |
$190.83
|
| Rate for Payer: Aetna Commercial |
$139.73
|
| Rate for Payer: Aetna Commercial |
$151.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: Cash Price |
$164.73
|
| Rate for Payer: Cash Price |
$179.61
|
| Rate for Payer: Cash Price |
$142.19
|
| Rate for Payer: Cash Price |
$131.51
|
| Rate for Payer: Cofinity Advantage |
$144.14
|
| Rate for Payer: Cofinity Advantage |
$115.07
|
| Rate for Payer: Cofinity Advantage |
$157.16
|
| Rate for Payer: Cofinity Advantage |
$124.42
|
| Rate for Payer: Cofinity Commercial |
$193.08
|
| Rate for Payer: Cofinity Commercial |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$152.86
|
| Rate for Payer: Cofinity Commercial |
$141.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.73
|
| Rate for Payer: Healthscope Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$202.06
|
| Rate for Payer: Healthscope Commercial |
$147.95
|
| Rate for Payer: Healthscope Commercial |
$159.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.31
|
| Rate for Payer: PHP Commercial |
$175.02
|
| Rate for Payer: PHP Commercial |
$151.08
|
| Rate for Payer: PHP Commercial |
$139.73
|
| Rate for Payer: PHP Commercial |
$190.83
|
| Rate for Payer: Priority Health SBD |
$111.98
|
| Rate for Payer: Priority Health SBD |
$141.44
|
| Rate for Payer: Priority Health SBD |
$129.72
|
| Rate for Payer: Priority Health SBD |
$103.57
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.63
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna Commercial |
$34.82
|
| Rate for Payer: Aetna Commercial |
$17.01
|
| Rate for Payer: Aetna Commercial |
$14.55
|
| Rate for Payer: Aetna Medicare |
$9.31
|
| Rate for Payer: Aetna Medicare |
$20.48
|
| Rate for Payer: Aetna Medicare |
$10.01
|
| Rate for Payer: Aetna Medicare |
$8.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.11
|
| Rate for Payer: BCBS Complete |
$16.38
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS Complete |
$6.85
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$16.01
|
| Rate for Payer: Cash Price |
$32.77
|
| Rate for Payer: Cash Price |
$16.01
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cash Price |
$32.77
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Advantage |
$28.67
|
| Rate for Payer: Cofinity Advantage |
$11.98
|
| Rate for Payer: Cofinity Advantage |
$14.01
|
| Rate for Payer: Cofinity Advantage |
$13.04
|
| Rate for Payer: Cofinity Commercial |
$14.72
|
| Rate for Payer: Cofinity Commercial |
$35.23
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$17.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$18.01
|
| Rate for Payer: Healthscope Commercial |
$15.41
|
| Rate for Payer: Healthscope Commercial |
$36.86
|
| Rate for Payer: Healthscope Commercial |
$16.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.72
|
| Rate for Payer: PHP Commercial |
$17.01
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: PHP Commercial |
$34.82
|
| Rate for Payer: PHP Commercial |
$14.55
|
| Rate for Payer: Priority Health SBD |
$10.79
|
| Rate for Payer: Priority Health SBD |
$12.61
|
| Rate for Payer: Priority Health SBD |
$25.80
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.96
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$36.86 |
| Rate for Payer: Aetna Commercial |
$34.82
|
| Rate for Payer: Aetna Commercial |
$17.01
|
| Rate for Payer: Aetna Commercial |
$14.55
|
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.62
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$16.01
|
| Rate for Payer: Cash Price |
$32.77
|
| Rate for Payer: Cofinity Advantage |
$13.04
|
| Rate for Payer: Cofinity Advantage |
$14.01
|
| Rate for Payer: Cofinity Advantage |
$28.67
|
| Rate for Payer: Cofinity Advantage |
$11.98
|
| Rate for Payer: Cofinity Commercial |
$17.21
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$35.23
|
| Rate for Payer: Cofinity Commercial |
$14.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.77
|
| Rate for Payer: Healthscope Commercial |
$15.41
|
| Rate for Payer: Healthscope Commercial |
$18.01
|
| Rate for Payer: Healthscope Commercial |
$16.77
|
| Rate for Payer: Healthscope Commercial |
$36.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.72
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: PHP Commercial |
$14.55
|
| Rate for Payer: PHP Commercial |
$34.82
|
| Rate for Payer: PHP Commercial |
$17.01
|
| Rate for Payer: Priority Health SBD |
$12.61
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: Priority Health SBD |
$25.80
|
| Rate for Payer: Priority Health SBD |
$10.79
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$20.01
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$18.01 |
| Rate for Payer: Aetna Commercial |
$17.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.01
|
| Rate for Payer: Cash Price |
$16.01
|
| Rate for Payer: Cofinity Advantage |
$14.01
|
| Rate for Payer: Cofinity Commercial |
$17.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.01
|
| Rate for Payer: Healthscope Commercial |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.01
|
| Rate for Payer: PHP Commercial |
$17.01
|
| Rate for Payer: Priority Health SBD |
$12.61
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$20.01
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$18.01 |
| Rate for Payer: Aetna Commercial |
$17.01
|
| Rate for Payer: Aetna Medicare |
$10.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.01
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$16.01
|
| Rate for Payer: Cash Price |
$16.01
|
| Rate for Payer: Cofinity Advantage |
$14.01
|
| Rate for Payer: Cofinity Commercial |
$17.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.01
|
| Rate for Payer: Healthscope Commercial |
$18.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.01
|
| Rate for Payer: PHP Commercial |
$17.01
|
| Rate for Payer: Priority Health SBD |
$12.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
PIPERACILLIN-TAZOBACTAM (ZOSYN) 13.5 GRAM /560 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
OP
|
$99.68
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$89.71 |
| Rate for Payer: Aetna Commercial |
$84.73
|
| Rate for Payer: Aetna Medicare |
$49.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.79
|
| Rate for Payer: BCBS Complete |
$39.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cofinity Advantage |
$69.78
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.74
|
| Rate for Payer: Healthscope Commercial |
$89.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.76
|
| Rate for Payer: PHP Commercial |
$84.73
|
| Rate for Payer: Priority Health SBD |
$62.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
PIPERACILLIN-TAZOBACTAM (ZOSYN) 13.5 GRAM /560 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
IP
|
$99.68
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$89.71 |
| Rate for Payer: Aetna Commercial |
$84.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.79
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cofinity Advantage |
$69.78
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.74
|
| Rate for Payer: Healthscope Commercial |
$89.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.76
|
| Rate for Payer: PHP Commercial |
$84.73
|
| Rate for Payer: Priority Health SBD |
$62.80
|
|
|
PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEEDLE, RADIOACTIVE SEEDS), PERCUTANEOUS; FIRST LESION, INCLUDING MAMMOGRAPHIC GUIDANCE
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 19281
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$225.33 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$528.64
|
| Rate for Payer: BCCCP Commercial |
$225.33
|
| Rate for Payer: BCN Commercial |
$528.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
PLACEMENT OF NEPHROURETERAL CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, NEW ACCESS
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 50433
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,096.19 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.19
|
| Rate for Payer: BCN Commercial |
$1,096.19
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$1,836.94
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,007.77
|
| Rate for Payer: BCN Commercial |
$2,007.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$1,446.45
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
PLASTIC OPERATION ON PENIS TO CORRECT ANGULATION
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 54360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,520.55
|
| Rate for Payer: BCN Commercial |
$2,520.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$1,836.94
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
PLEURAL EFFUSION WITH CC
|
Facility
|
IP
|
$16,617.34
|
|
|
Service Code
|
MSDRG 187
|
| Min. Negotiated Rate |
$7,811.84 |
| Max. Negotiated Rate |
$16,617.34 |
| Rate for Payer: Aetna Medicare |
$8,551.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,278.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,278.74
|
| Rate for Payer: BCBS MAPPO |
$8,222.99
|
| Rate for Payer: BCBS Trust/PPO |
$16,617.34
|
| Rate for Payer: BCN Commercial |
$16,617.34
|
| Rate for Payer: BCN Medicare Advantage |
$8,222.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,222.99
|
| Rate for Payer: Mclaren Medicare |
$8,222.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,634.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,456.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,045.29
|
| Rate for Payer: Nomi Health Commercial |
$12,759.39
|
| Rate for Payer: PACE Medicare |
$7,811.84
|
| Rate for Payer: PACE SWMI |
$8,222.99
|
| Rate for Payer: PHP Medicare Advantage |
$8,222.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,946.41
|
| Rate for Payer: Priority Health Medicare |
$8,222.99
|
| Rate for Payer: Priority Health Tiered Network |
$12,757.12
|
| Rate for Payer: Railroad Medicare Medicare |
$8,222.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,122.33
|
| Rate for Payer: UHC Core |
$13,488.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,222.99
|
| Rate for Payer: UHC Exchange |
$11,015.61
|
| Rate for Payer: VA VA |
$8,222.99
|
|
|
PLEURAL EFFUSION WITH MCC
|
Facility
|
IP
|
$25,403.55
|
|
|
Service Code
|
MSDRG 186
|
| Min. Negotiated Rate |
$11,992.28 |
| Max. Negotiated Rate |
$25,403.55 |
| Rate for Payer: Aetna Medicare |
$13,128.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,779.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,779.31
|
| Rate for Payer: BCBS MAPPO |
$12,623.45
|
| Rate for Payer: BCBS Trust/PPO |
$24,852.27
|
| Rate for Payer: BCN Commercial |
$24,852.27
|
| Rate for Payer: BCN Medicare Advantage |
$12,623.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,623.45
|
| Rate for Payer: Mclaren Medicare |
$12,623.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,254.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,516.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,885.80
|
| Rate for Payer: Nomi Health Commercial |
$20,104.65
|
| Rate for Payer: PACE Medicare |
$11,992.28
|
| Rate for Payer: PACE SWMI |
$12,623.45
|
| Rate for Payer: PHP Medicare Advantage |
$12,623.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,126.36
|
| Rate for Payer: Priority Health Medicare |
$12,623.45
|
| Rate for Payer: Priority Health Tiered Network |
$20,101.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12,623.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,403.55
|
| Rate for Payer: UHC Core |
$21,253.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,623.45
|
| Rate for Payer: UHC Exchange |
$17,357.01
|
| Rate for Payer: VA VA |
$12,623.45
|
|
|
PLEURAL EFFUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$12,450.72
|
|
|
Service Code
|
MSDRG 188
|
| Min. Negotiated Rate |
$5,815.60 |
| Max. Negotiated Rate |
$12,450.72 |
| Rate for Payer: Aetna Medicare |
$6,366.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,652.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,652.10
|
| Rate for Payer: BCBS MAPPO |
$6,121.68
|
| Rate for Payer: BCBS Trust/PPO |
$12,450.72
|
| Rate for Payer: BCN Commercial |
$12,450.72
|
| Rate for Payer: BCN Medicare Advantage |
$6,121.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,121.68
|
| Rate for Payer: Mclaren Medicare |
$6,121.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,427.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,039.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,733.85
|
| Rate for Payer: Nomi Health Commercial |
$9,251.88
|
| Rate for Payer: PACE Medicare |
$5,815.60
|
| Rate for Payer: PACE SWMI |
$6,121.68
|
| Rate for Payer: PHP Medicare Advantage |
$6,121.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,562.80
|
| Rate for Payer: Priority Health Medicare |
$6,121.68
|
| Rate for Payer: Priority Health Tiered Network |
$9,250.24
|
| Rate for Payer: Railroad Medicare Medicare |
$6,121.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,690.36
|
| Rate for Payer: UHC Core |
$9,780.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,121.68
|
| Rate for Payer: UHC Exchange |
$7,987.46
|
| Rate for Payer: VA VA |
$6,121.68
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
OP
|
$775.68
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$250.32 |
| Max. Negotiated Rate |
$736.87 |
| Rate for Payer: Aetna Commercial |
$659.33
|
| Rate for Payer: Aetna Medicare |
$387.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.19
|
| Rate for Payer: BCBS Complete |
$310.27
|
| Rate for Payer: BCBS Trust/PPO |
$736.87
|
| Rate for Payer: BCN Commercial |
$736.87
|
| Rate for Payer: Cash Price |
$620.54
|
| Rate for Payer: Cash Price |
$620.54
|
| Rate for Payer: Cofinity Advantage |
$542.98
|
| Rate for Payer: Cofinity Commercial |
$667.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.54
|
| Rate for Payer: Healthscope Commercial |
$698.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$620.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$581.76
|
| Rate for Payer: PHP Commercial |
$659.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$312.90
|
| Rate for Payer: Priority Health SBD |
$488.68
|
| Rate for Payer: Priority Health Tiered Network |
$250.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.29
|
| Rate for Payer: UHC Core |
$516.29
|
| Rate for Payer: UHC Exchange |
$516.29
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$775.68
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$488.68 |
| Max. Negotiated Rate |
$698.11 |
| Rate for Payer: Aetna Commercial |
$659.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.19
|
| Rate for Payer: Cash Price |
$620.54
|
| Rate for Payer: Cofinity Advantage |
$542.98
|
| Rate for Payer: Cofinity Commercial |
$667.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.54
|
| Rate for Payer: Healthscope Commercial |
$698.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$581.76
|
| Rate for Payer: PHP Commercial |
$659.33
|
| Rate for Payer: Priority Health SBD |
$488.68
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$347.89
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
111964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.78 |
| Max. Negotiated Rate |
$313.10 |
| Rate for Payer: Aetna Commercial |
$295.71
|
| Rate for Payer: Aetna Medicare |
$173.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.13
|
| Rate for Payer: BCBS Complete |
$139.16
|
| Rate for Payer: BCBS Trust/PPO |
$288.30
|
| Rate for Payer: BCN Commercial |
$288.30
|
| Rate for Payer: Cash Price |
$278.31
|
| Rate for Payer: Cash Price |
$278.31
|
| Rate for Payer: Cofinity Advantage |
$243.52
|
| Rate for Payer: Cofinity Commercial |
$299.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.31
|
| Rate for Payer: Healthscope Commercial |
$313.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.92
|
| Rate for Payer: PHP Commercial |
$295.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$133.47
|
| Rate for Payer: Priority Health SBD |
$219.17
|
| Rate for Payer: Priority Health Tiered Network |
$106.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.23
|
| Rate for Payer: UHC Core |
$220.23
|
| Rate for Payer: UHC Exchange |
$220.23
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$347.89
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
111964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.17 |
| Max. Negotiated Rate |
$313.10 |
| Rate for Payer: Aetna Commercial |
$295.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.13
|
| Rate for Payer: Cash Price |
$278.31
|
| Rate for Payer: Cofinity Advantage |
$243.52
|
| Rate for Payer: Cofinity Commercial |
$299.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.31
|
| Rate for Payer: Healthscope Commercial |
$313.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.92
|
| Rate for Payer: PHP Commercial |
$295.71
|
| Rate for Payer: Priority Health SBD |
$219.17
|
|
