|
PILOCARPINE 2 % EYE DROPS
|
Facility
|
OP
|
$209.95
|
|
|
Service Code
|
NDC 69238174608
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.98 |
| Max. Negotiated Rate |
$188.96 |
| Rate for Payer: Aetna Commercial |
$178.46
|
| Rate for Payer: Aetna Medicare |
$104.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.47
|
| Rate for Payer: BCBS Complete |
$83.98
|
| Rate for Payer: Cash Price |
$167.96
|
| Rate for Payer: Cofinity Commercial |
$146.96
|
| Rate for Payer: Cofinity Commercial |
$180.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.96
|
| Rate for Payer: Healthscope Commercial |
$188.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.46
|
| Rate for Payer: PHP Commercial |
$178.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.47
|
| Rate for Payer: Priority Health SBD |
$132.27
|
|
|
PIMAVANSERIN 34 MG CAPSULE
|
Facility
|
IP
|
$18,481.50
|
|
|
Service Code
|
NDC 63090034030
|
| Hospital Charge Code |
187560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11,643.34 |
| Max. Negotiated Rate |
$16,633.35 |
| Rate for Payer: Aetna Commercial |
$15,709.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,012.98
|
| Rate for Payer: Cash Price |
$14,785.20
|
| Rate for Payer: Cofinity Commercial |
$12,937.05
|
| Rate for Payer: Cofinity Commercial |
$15,894.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,937.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,785.20
|
| Rate for Payer: Healthscope Commercial |
$16,633.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,709.28
|
| Rate for Payer: PHP Commercial |
$15,709.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,012.98
|
| Rate for Payer: Priority Health SBD |
$11,643.34
|
|
|
PIMAVANSERIN 34 MG CAPSULE
|
Facility
|
OP
|
$18,481.50
|
|
|
Service Code
|
NDC 63090034030
|
| Hospital Charge Code |
187560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,392.60 |
| Max. Negotiated Rate |
$16,633.35 |
| Rate for Payer: Aetna Commercial |
$15,709.28
|
| Rate for Payer: Aetna Medicare |
$9,240.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,012.98
|
| Rate for Payer: BCBS Complete |
$7,392.60
|
| Rate for Payer: Cash Price |
$14,785.20
|
| Rate for Payer: Cofinity Commercial |
$12,937.05
|
| Rate for Payer: Cofinity Commercial |
$15,894.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,937.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,785.20
|
| Rate for Payer: Healthscope Commercial |
$16,633.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,709.28
|
| Rate for Payer: PHP Commercial |
$15,709.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,012.98
|
| Rate for Payer: Priority Health SBD |
$11,643.34
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$490.56
|
|
|
Service Code
|
NDC 60687039101
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.22 |
| Max. Negotiated Rate |
$441.50 |
| Rate for Payer: Aetna Commercial |
$416.98
|
| Rate for Payer: Aetna Medicare |
$245.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.86
|
| Rate for Payer: BCBS Complete |
$196.22
|
| Rate for Payer: Cash Price |
$392.45
|
| Rate for Payer: Cofinity Commercial |
$343.39
|
| Rate for Payer: Cofinity Commercial |
$421.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.45
|
| Rate for Payer: Healthscope Commercial |
$441.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.98
|
| Rate for Payer: PHP Commercial |
$416.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.86
|
| Rate for Payer: Priority Health SBD |
$309.05
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$58.52
|
|
|
Service Code
|
NDC 16729002010
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$52.67 |
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: Aetna Medicare |
$29.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.04
|
| Rate for Payer: BCBS Complete |
$23.41
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Cofinity Commercial |
$40.96
|
| Rate for Payer: Cofinity Commercial |
$50.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.82
|
| Rate for Payer: Healthscope Commercial |
$52.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.74
|
| Rate for Payer: PHP Commercial |
$49.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.04
|
| Rate for Payer: Priority Health SBD |
$36.87
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$264.38
|
|
|
Service Code
|
NDC 16729002015
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$237.94 |
| Rate for Payer: Aetna Commercial |
$224.72
|
| Rate for Payer: Aetna Medicare |
$132.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.85
|
| Rate for Payer: BCBS Complete |
$105.75
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cofinity Commercial |
$185.07
|
| Rate for Payer: Cofinity Commercial |
$227.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.50
|
| Rate for Payer: Healthscope Commercial |
$237.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.72
|
| Rate for Payer: PHP Commercial |
$224.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.85
|
| Rate for Payer: Priority Health SBD |
$166.56
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$74.39
|
|
|
Service Code
|
NDC 00093727156
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Aetna Commercial |
$63.23
|
| Rate for Payer: Aetna Medicare |
$37.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.35
|
| Rate for Payer: BCBS Complete |
$29.76
|
| Rate for Payer: Cash Price |
$59.51
|
| Rate for Payer: Cofinity Commercial |
$52.07
|
| Rate for Payer: Cofinity Commercial |
$63.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.51
|
| Rate for Payer: Healthscope Commercial |
$66.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.23
|
| Rate for Payer: PHP Commercial |
$63.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.35
|
| Rate for Payer: Priority Health SBD |
$46.87
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$5.43
|
|
|
Service Code
|
NDC 51079051301
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$4.89 |
| Rate for Payer: Aetna Commercial |
$4.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.53
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.34
|
| Rate for Payer: Healthscope Commercial |
$4.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.62
|
| Rate for Payer: PHP Commercial |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.53
|
| Rate for Payer: Priority Health SBD |
$3.42
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$264.38
|
|
|
Service Code
|
NDC 16729002015
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.56 |
| Max. Negotiated Rate |
$237.94 |
| Rate for Payer: Aetna Commercial |
$224.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.85
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cofinity Commercial |
$185.07
|
| Rate for Payer: Cofinity Commercial |
$227.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.50
|
| Rate for Payer: Healthscope Commercial |
$237.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.72
|
| Rate for Payer: PHP Commercial |
$224.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.85
|
| Rate for Payer: Priority Health SBD |
$166.56
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$58.52
|
|
|
Service Code
|
NDC 16729002010
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.87 |
| Max. Negotiated Rate |
$52.67 |
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.04
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Cofinity Commercial |
$40.96
|
| Rate for Payer: Cofinity Commercial |
$50.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.82
|
| Rate for Payer: Healthscope Commercial |
$52.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.74
|
| Rate for Payer: PHP Commercial |
$49.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.04
|
| Rate for Payer: Priority Health SBD |
$36.87
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$490.56
|
|
|
Service Code
|
NDC 60687039101
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$309.05 |
| Max. Negotiated Rate |
$441.50 |
| Rate for Payer: Aetna Commercial |
$416.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.86
|
| Rate for Payer: Cash Price |
$392.45
|
| Rate for Payer: Cofinity Commercial |
$343.39
|
| Rate for Payer: Cofinity Commercial |
$421.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.45
|
| Rate for Payer: Healthscope Commercial |
$441.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.98
|
| Rate for Payer: PHP Commercial |
$416.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.86
|
| Rate for Payer: Priority Health SBD |
$309.05
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$74.39
|
|
|
Service Code
|
NDC 00093727156
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.87 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Aetna Commercial |
$63.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.35
|
| Rate for Payer: Cash Price |
$59.51
|
| Rate for Payer: Cofinity Commercial |
$52.07
|
| Rate for Payer: Cofinity Commercial |
$63.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.51
|
| Rate for Payer: Healthscope Commercial |
$66.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.23
|
| Rate for Payer: PHP Commercial |
$63.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.35
|
| Rate for Payer: Priority Health SBD |
$46.87
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$4.91
|
|
|
Service Code
|
NDC 60687039111
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.19
|
| Rate for Payer: BCBS Complete |
$1.96
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$4.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.17
|
| Rate for Payer: PHP Commercial |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.19
|
| Rate for Payer: Priority Health SBD |
$3.09
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$542.88
|
|
|
Service Code
|
NDC 51079051320
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$342.01 |
| Max. Negotiated Rate |
$488.59 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.87
|
| Rate for Payer: Cash Price |
$434.30
|
| Rate for Payer: Cofinity Commercial |
$380.02
|
| Rate for Payer: Cofinity Commercial |
$466.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$380.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.30
|
| Rate for Payer: Healthscope Commercial |
$488.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.45
|
| Rate for Payer: PHP Commercial |
$461.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.87
|
| Rate for Payer: Priority Health SBD |
$342.01
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$5.43
|
|
|
Service Code
|
NDC 51079051301
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$4.89 |
| Rate for Payer: Aetna Commercial |
$4.62
|
| Rate for Payer: Aetna Medicare |
$2.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.53
|
| Rate for Payer: BCBS Complete |
$2.17
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.34
|
| Rate for Payer: Healthscope Commercial |
$4.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.62
|
| Rate for Payer: PHP Commercial |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.53
|
| Rate for Payer: Priority Health SBD |
$3.42
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$1,337.11
|
|
|
Service Code
|
NDC 64764015104
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$842.38 |
| Max. Negotiated Rate |
$1,203.40 |
| Rate for Payer: Aetna Commercial |
$1,136.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.12
|
| Rate for Payer: Cash Price |
$1,069.69
|
| Rate for Payer: Cofinity Commercial |
$1,149.91
|
| Rate for Payer: Cofinity Commercial |
$935.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$935.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.69
|
| Rate for Payer: Healthscope Commercial |
$1,203.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.54
|
| Rate for Payer: PHP Commercial |
$1,136.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.12
|
| Rate for Payer: Priority Health SBD |
$842.38
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$1,337.11
|
|
|
Service Code
|
NDC 64764015104
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$534.84 |
| Max. Negotiated Rate |
$1,203.40 |
| Rate for Payer: Aetna Commercial |
$1,136.54
|
| Rate for Payer: Aetna Medicare |
$668.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.12
|
| Rate for Payer: BCBS Complete |
$534.84
|
| Rate for Payer: Cash Price |
$1,069.69
|
| Rate for Payer: Cofinity Commercial |
$1,149.91
|
| Rate for Payer: Cofinity Commercial |
$935.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$935.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.69
|
| Rate for Payer: Healthscope Commercial |
$1,203.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.54
|
| Rate for Payer: PHP Commercial |
$1,136.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.12
|
| Rate for Payer: Priority Health SBD |
$842.38
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$4.91
|
|
|
Service Code
|
NDC 60687039111
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.19
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$4.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.17
|
| Rate for Payer: PHP Commercial |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.19
|
| Rate for Payer: Priority Health SBD |
$3.09
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$542.88
|
|
|
Service Code
|
NDC 51079051320
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.15 |
| Max. Negotiated Rate |
$488.59 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Medicare |
$271.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.87
|
| Rate for Payer: BCBS Complete |
$217.15
|
| Rate for Payer: Cash Price |
$434.30
|
| Rate for Payer: Cofinity Commercial |
$380.02
|
| Rate for Payer: Cofinity Commercial |
$466.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$380.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.30
|
| Rate for Payer: Healthscope Commercial |
$488.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.45
|
| Rate for Payer: PHP Commercial |
$461.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.87
|
| Rate for Payer: Priority Health SBD |
$342.01
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$17.06
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$15.35 |
| Rate for Payer: Aetna Commercial |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.09
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.50
|
| Rate for Payer: PHP Commercial |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health SBD |
$10.75
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$17.06
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$15.35 |
| Rate for Payer: Aetna Commercial |
$14.50
|
| Rate for Payer: Aetna Medicare |
$8.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.09
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.50
|
| Rate for Payer: PHP Commercial |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health SBD |
$10.75
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.52
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$14.87 |
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna Commercial |
$14.50
|
| Rate for Payer: Aetna Commercial |
$16.17
|
| Rate for Payer: Aetna Commercial |
$18.85
|
| Rate for Payer: Aetna Commercial |
$23.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.09
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cash Price |
$15.22
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Cofinity Commercial |
$23.89
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Cofinity Commercial |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$16.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.22
|
| Rate for Payer: Healthscope Commercial |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$14.87
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.04
|
| Rate for Payer: PHP Commercial |
$18.85
|
| Rate for Payer: PHP Commercial |
$23.61
|
| Rate for Payer: PHP Commercial |
$16.17
|
| Rate for Payer: PHP Commercial |
$14.50
|
| Rate for Payer: PHP Commercial |
$14.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| Rate for Payer: Priority Health SBD |
$13.97
|
| Rate for Payer: Priority Health SBD |
$10.75
|
| Rate for Payer: Priority Health SBD |
$11.98
|
| Rate for Payer: Priority Health SBD |
$10.41
|
| Rate for Payer: Priority Health SBD |
$17.50
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.02
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$17.12 |
| Rate for Payer: Aetna Commercial |
$16.17
|
| Rate for Payer: Aetna Commercial |
$23.61
|
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna Commercial |
$18.85
|
| Rate for Payer: Aetna Commercial |
$14.50
|
| Rate for Payer: Aetna Medicare |
$11.09
|
| Rate for Payer: Aetna Medicare |
$9.51
|
| Rate for Payer: Aetna Medicare |
$8.26
|
| Rate for Payer: Aetna Medicare |
$8.53
|
| Rate for Payer: Aetna Medicare |
$13.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.36
|
| Rate for Payer: BCBS Complete |
$6.61
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS Complete |
$8.87
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: Cash Price |
$15.22
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$15.22
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cofinity Commercial |
$23.89
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Commercial |
$14.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.85
|
| Rate for Payer: PHP Commercial |
$23.61
|
| Rate for Payer: PHP Commercial |
$14.04
|
| Rate for Payer: PHP Commercial |
$16.17
|
| Rate for Payer: PHP Commercial |
$14.50
|
| Rate for Payer: PHP Commercial |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.74
|
| Rate for Payer: Priority Health SBD |
$10.75
|
| Rate for Payer: Priority Health SBD |
$11.98
|
| Rate for Payer: Priority Health SBD |
$10.41
|
| Rate for Payer: Priority Health SBD |
$17.50
|
| Rate for Payer: Priority Health SBD |
$13.97
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$17.58
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Aetna Commercial |
$14.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.43
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cofinity Commercial |
$12.31
|
| Rate for Payer: Cofinity Commercial |
$15.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.06
|
| Rate for Payer: Healthscope Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.94
|
| Rate for Payer: PHP Commercial |
$14.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.43
|
| Rate for Payer: Priority Health SBD |
$11.08
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$17.58
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Aetna Commercial |
$14.94
|
| Rate for Payer: Aetna Medicare |
$8.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.43
|
| Rate for Payer: BCBS Complete |
$7.03
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cofinity Commercial |
$12.31
|
| Rate for Payer: Cofinity Commercial |
$15.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.06
|
| Rate for Payer: Healthscope Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.94
|
| Rate for Payer: PHP Commercial |
$14.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.43
|
| Rate for Payer: Priority Health SBD |
$11.08
|
|
